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PROOF OF INSURANCE (2018) CLOSED DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE I 8/10/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER pan ACT Bolton 3475 E. Foothill ill B vd., Suite 100 PHONE.Fxt); ), [AIG, v (626),799-7000 Pasadena, CA 91.107 E MAI 1 ic,N� (626)583-2117 ADDRESS: INSURERS)AFFORDING COVERAGE „NAIC#, www.boltonco.com 0008309 wsURERA: Hartford Fire Insurance Company 19682 INSURED INSURERB: Travelers Property Casualty Siaiic Contractors Corporation INSURER c: Hartford Accident and Indemnity insurance Co 36161 dba: Shawnan Company 22357 12240 Woodruff Avenue INSURER D: DowneyCA 90241 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 37196027 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS II . NSR TYPE OF INSURANCE AODL SUER' POLICY EFF POLICY EXP LTR u NSD wVO POLICY NUMBER IMMIDDIYYYY) IMM.IDD/YXYYI Y LIMITS A ,f" COMMERCIAL GENERAL LIABILITY ✓ �/ 72UEAHA5196 6/1/2017 6/1/2018 EACH OCCURRENCE $ 1,000,000 TO REN FC CLAIMS-MADE ,/ OCCUR PHiEMISE ,S(Ea occurrence)„ $ 300,000 MED EXP(Any one person) $ 5,000 PERSONAL BADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY P_✓ II j Loc PRODUCTS Dt c'r's•COMP/CP AGG $ 2,000,000 OTHER $ 0 A AUTOMOBILE LIABILITY72UEAHA5198 6/1/2017 6/1/2018 COMBINED SINGLE LIMIT $ ✓ ✓ (Fa accident) 1,000,000 ,✓ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY , AUTOS ONLY (Per accident) $ B ✓ UMBRELLA LIAB ✓ OCCUR ZUP15S9047617NF 6/1/2017 6/1/2018 EACH OCCURRENCE $ 9,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $ 9,000,000 ..... DED ..✓ ( RETENTION$.0..„, ., $ C WORKERS COMPENSATION � ✓ 72WEAZI8410 6/1/2017 6/1/2018 �/ P R UTE ER AND EMPLOYERS'LIABILITYYIN ER ANYPROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N NIA EE.., .,,,...., 1,000,000 if describe under ESC DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT (Mandatory m E L DISEASE-EA EMPLOY $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The Certificate of Insurance is subject to policy terms,conditions.limitations„and exclusions, GL Additional Insured and Primary Wording applies per HS24800713 attached,onlyy if required by written contract/agreement. Auto Additional Insured and Primary Wording applies per HA99160312 pg1-2 attactted,GL,Auto and WC Waivers of Subrogation apply per HG00010605 pg 15,HA99160312 pg 4-5 and WCD40306 attached.GL,Auto and WC Cancellation Clauses per H824501214 pg 1&6, IH03130611 and WC990548 attached.Re:Shawnan Job#288,Project#'PW 16-10,Irripedal Highway Overlay Project. _Cont... CERTIFICATE HOLDER CANCELLATION Shawnan Job#288 Clt Ot EI Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 35 main Street ACCORDANCE WITH THE POLICY PROVISIONS. EI Segundo, CA 90245 AUTHORIZED REPRESENTATIVE Cassandra Rosales ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 37196037 1 SIALCON-01 1 17-18 Jobs-Public Agencies - All Lines I Shannon Smith 1 8/10/2017 11:49:41 AM (PDT) I Page 1 of 14 AGENCY CUSTOMER ID: SIALCON-01 LOC#: .............. A�I'�" ADDITIONAL REMARKS SCHEDULE Page . .....mm.of AGENCY NAMEDINSURED Bolton&Company Sialic Shawnanors Corporation POLICY NUMBER 12240 Woodruff Avenue G Downey CA 90241 CARRIER NAIC CODE EFFECTIVE DATE: ............................... ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE:Certificate of Liability(03/16) HOLDER:City of EI Segundo _............ ADDRESS:350 Main Street EI Segundo,CA 90245 Additional Insured(s) : City of E1 Segundo its officials and employees. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ADDENDUM 37196027 1 SIALCON-01 117-18 Jobe-Public Agencies - All Linea I Shannon Smith 8/10/2017 11:49:41 AM (PDT) I Page 2 of 14 POLICY NUMBER:72UEAHA5196 r . THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - OPTION I This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Designated Project(s)Or Location(s) Or Organization(s): Of Covered Operations: When Required by Written Contract, Written Agreement or Permit Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. With respect to those person(s) or organization(s) (3)In connection with "your work" for shown in the Schedule above when you have the additional insured at the project(s) or agreed in a written contract or written agreement location(s) designated in the Schedule to provide insurance such as is afforded under and included within the "products- this policy to them, Subparagraph f., Any Other completed operations hazard", but only if: Party, under the Additional Insureds When (a) The written contract or written Required By Written Contract, Written agreement requires you to provide Agreement Or Permit Paragraph of Section II - such coverage to such additional Who Is An Insured is replaced with the following: insured at the project(s) or location(s) f. Any Other Party designated in the Schedule; and Any other person or organization who is not an (b) This Coverage Part provides insured under Paragraphs a.through e. above, coverage for "bodily injury" or but only with respect to liability for "bodily "property damage" included within the injury", "property damage" or "personal and "products-completed operations advertising injury" caused, in whole or in part, hazard". by your acts or omissions or the acts or The insurance afforded to the additional omissions of those acting on your behalf: insured shown in the Schedule applies: (1) In the performance of your ongoing (1) Only if the "bodily injury" or "property operations for such additional insured at damage" occurs, or the "personal and the project(s) or location(s) designated advertising injury" offense is committed: in the Schedule; (a) During the policy period; and (2) In connection with your premises owned (b) Subsequent to the execution of such by or rented to you and shown in the Schedule; or written contract or written agreement; and Form HS 24 80 07 13 Page 1 of 2 ©2013, The Hartford (Includes copyrighted material of Insurance Services Office, Inc.,with its permission.) 37196027 SIALCON-01 1 17-18 Jobs-Public Agencies - All Lines I Shannon Smith 1 8/10/2017 11:49:41 AM (PDT) I Page 3 of 14 (c) Prior to the expiration of the period of When You Add Others As An Additional time that the written contract or written Insured To This Insurance agreement requires such insurance be (a) Primary Insurance When Required By provided to the additional insured. Contract (2)Only to the extent permitted by law; and This insurance is primary if you have agreed in (3)Will not be broader than that which you a written contract or written agreement that are required by the written contract or this insurance be primary. If other insurance is written agreement to provide for such also primary, we will share with all that other additional insured. insurance by the method described in With respect to the insurance afforded to the Paragraph (c) below. This insurance does not person(s) or organization(s) that are apply to other insurance to which the additional insureds under this endorsement, additional insured in the Schedule has been the following additional exclusion applies: added as an additional insured. This insurance does not apply to "bodily (b) Primary And Non-Contributory To Other injury", "property damage" or "personal and Insurance When Required By Contract advertising injury" arising out of the rendering This insurance is primary to and will not of, or the failure to render, any professional seek contribution from any other architectural, engineering or surveying insurance available to an additional services, including: insured under your policy provided that: (1)The preparing, approving, or failing to (I) The additional insured in the Schedule prepare or approve maps, shop is a Named Insured under such other drawings, opinions, reports, surveys, insurance; and field orders, change orders, designs or (ii) You have agreed in a written contract or specifications; or written agreement that this insurance (2)Supervisory, inspection, architectural or would be primary and would not seek engineering activities. contribution from any other insurance The limits of insurance that apply to the additional available to the additional insured in the insured shown in the Schedule are described in Schedule. the Limits Of Insurance section. (c) 'Method Of Sharing How this insurance applies when other insurance If all of the other insurance permits is available to the additional insured is described contribution by equal shares, we will follow in the Other Insurance Condition in Section IV - this method also. Under this approach, each Commercial General Liability Conditions, except insurer contributes equal amounts until it has as otherwise amended below. paid its applicable limit of insurance or none of B. With respect to insurance provided to the the loss remains, whichever comes first. person(s) or organization(s) that are additional If any of the other insurance does not permit insureds under this endorsement, the When You contribution by equal shares, we will Add Others As An Additional Insured To This contribute by limits. Under this method, each Insurance subparagraph, under the Other insurers share is based on the ratio of its Insurance Condition of Section IV— Commercial applicable limit of insurance to the total General Liability Conditions is replaced with the applicable limits of insurance of all insurers. following: All other terms and conditions in the policy remain unchanged. Page 2 of 2 Form HS 24 80 07 13 37196077 1 SIALCON-01 1 17-18 Jobs-Public Agencies - All Lines 1 Shannon Smith 1 8/10/2017 11:49:41 AM (PDT) 1 Page 4 of 14 72UEAHA5198 COMMERCIAL AUTOMOBILE HA 99 16 03 12 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL, AUTOMOBILE, BROAD FOS ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM To the extent that the provisions of this endorsement provide broader benefits to the "insured" than other provisions of the Coverage Form, the provisions of this endorsement apply. 1. BROAD FORM INSURED d. Any "employee" of yours while using a A. Subsidiaries and Newly Acquired or covered "auto" you don't own, hire or Formed Organizations borrow in your business or your The Named Insured shown in the personal affairs. Declarations is amended to include: C. Lessors as Insureds (1) Any legal business entity other than a Paragraph A.1. -WHO IS AN INSURED -of partnership or joint venture, formed as a Section II - Liability Coverage is amended to subsidiary in which you have an add: ownership interest of more than 50% on e. The lessor of a covered "auto" while the the effective date of the Coverage Form. "auto" is leased to you under a written However, the Named Insured does not agreement if: include any subsidiary that is an (1) The agreement requires you to "insured" under any other automobile policy or would be an "insured" under provide direct primary insurance for the lessor and such a policy but for its termination or the exhaustion of its Limit of Insurance. (2) The"auto" is leased without a driver. (2) Any organization that is acquired or Such a leased "auto" will be considered a formed by you and over which you covered "auto" you own and not a covered maintain majority ownership. However, .,auto"you hire. the Named Insured does not include any D. Additional Insured if Required by Contract newly formed or acquired organization: (1) Paragraph A.1. -WHO IS AN INSURED (a) That is a partnership or joint - of Section II - Liability Coverage is venture, amended to add: (b) That is an "insured" under any other f. When you have agreed, in a written policy, contract or written agreement, that a (c) That has exhausted its Limit of person or organization be added as Insurance under any other policy, or an additional insured on your (d) 180 days or more after its business auto policy, such person or acquisition or formation by you, organization is an "insured", but only unless you have given us notice of to the extent such person or the acquisition or formation. organization is liable for "bodily Coverage does not apply to "bodily injury" or "property damage" caused injury" or "property damage" that results by the conduct of an "insured" under from an "accident" that occurred before paragraphs a. or b. of Who Is An you formed or acquired the organization. Insured with regard to the B. Employees as Insureds ownership, maintenance or use of a covered"auto." Paragraph A.1. -WHO IS AN INSURED - of SECTION II - LIABILITY COVERAGE is amended to add: ©2011, The Hartford (Includes copyrighted material Form HA 99 16 03 12 of ISO Properties, Inc., with its permission.) Page 1 of 5 37196017 SIALCON-01 1 17-18 Jobs-Public Agencies - All Lines I Shannon Smith 1 8/10/2017 11:49:41 AM (PDT) I Page 5 of 14 The insurance afforded to any such E. Primary and Non-Contributory if additional insured applies only if the Required by Contract "bodily injury" or "property damage" Only with respect to insurance provided to occurs: an additional insured in 1.D. - Additional (1) During the policy period, and Insured If Required by Contract, the (2) Subsequent to the execution of such following provisions apply: written contract, and (3) Primary Insurance When Required By (3) Prior to the expiration of the period Contract of time that the written contract This insurance is primary if you have requires such insurance be provided agreed in a written contract or written to the additional insured. agreement that this insurance be (2) How Limits Apply primary. If other insurance is also If you have agreed in a written contract primary, we will share with all that other or written agreement that another insurance by the method described in person or organization be added as an Other Insurance 5.d. additional insured on your policy, the (4) Primary And Non-Contributory To Other most we will pay on behalf of such Insurance When Required By Contract additional insured is the lesser of: If you have agreed in a written contract (a) The limits of insurance specified in or written agreement that this insurance the written contract or written is primary and non-contributory with the agreement; or additional insured's own insurance, this (b) The Limits of Insurance shown in insurance is primary and we will not seek contribution from that other the Declarations. insurance. Such amount shall be a part of and not Paragraphs (3) and (4) do not apply to other in addition to Limits of Insurance shown insurance to which the additional insured in the Declarations and described in this has been added as an additional insured. Section. When this insurance is excess, we will have no (3) Additional Insureds Other Insurance duty to defend the insured against any "suit" if If we cover a claim or "suit" under this any other insurer has a duty to defend the Coverage Part that may also be covered insured against that "suit". If no other insurer by other insurance available to an defends, we will undertake to do so, but we will additional insured, such additional be entitled to the insured's rights against all insured must submit such claim or"suit" those other insurers. to the other insurer for defense and When this insurance is excess over other indemnity. insurance, we will pay only our share of the However, this provision does not apply amount of the loss, if any, that exceeds the sum to the extent that you have agreed in a of: written contract or written agreement (1) The total amount that all such other that this insurance is primary and non- insurance would pay for the loss in the contributory with the additional insured's absence of this insurance; and own insurance. (2) The total of all deductible and self-insured (4) Duties in The Event Of Accident, Claim, amounts under all that other insurance. Suit or Loss If you have agreed in a written contract We will share the remaining loss, if any, by the or written agreement that another method described in Other Insurance 5.d. person or organization be added as an 2. AUTOS RENTED BY EMPLOYEES additional insured on your policy, the Any "auto" hired or rented by your "employee" additional insured shall be required to on your behalf and at your direction will be comply with the provisions in LOSS considered an"auto"you hire. CONDITIONS 2. - DUTIES IN THE The OTHER INSURANCE Condition is amended EVENT OF ACCIDENT, CLAIM , SUIT by adding the following: OR LOSS — OF SECTION IV — BUSINESS AUTO CONDITIONS, in the same manner as the Named Insured. ©2011, The Hartford (Includes copyrighted material Form HA 99 16 03 12 of ISO Properties, Inc., with its permission.) Page 2 of 5 37196027 SIALCON-01 1 17-18 Jobs-Public Agencies - All Lines I Shannon Smith 1 8/10/2017 11:49:41 AM (PDT) I Page 6 of 14 72UEAHA5196 If any of the other insurance does not permit insured will bring "suit" or transfer those rights to us contribution by equal shares, we will contribute by and help us enforce them. limits. Under this method, each insurer's share is b. Waiver Of Rights Of Recovery (Waiver Of based on the ratio of its applicable limit of Subrogation) insurance to the total applicable limits of insurance of all insurers. If the insured has waived any rights of recovery against any person or organization for all or part of 5. Premium Audit any payment, including Supplementary Payments, a. We will compute all premiums for this Coverage we have made under this Coverage Part, we also Part in accordance with our rules and rates. waive that right, provided the insured waived their b. Premium shown in this Coverage Part as advance rights of recovery against such person or premium is a deposit premium only. At the close of organization in a contract, agreement or permit that each audit period we will compute the earned was executed prior to the injury or damage. premium for that period and send notice to the first 9. When We Do Not Renew Named Insured. The due date for audit and If we decide not to renew this Coverage Part, we will retrospective premiums is the date shown as the mail or deliver to the first Named Insured shown in the due date on the bill. If the sum of the advance and Declarations written notice of the nonrenewal not less audit premiums paid for the policy period is greater than 30 days before the expiration date. than the earned premium, we will return the excess to the first Named Insured. If notice is mailed, proof of mailing will be sufficient proof of notice. c. The first Named Insured must keep records of the SECTION V—DEFINITIONS information we need for premium computation, and send us copies at such times as we may request. 1. "Advertisement" means the widespread public 6. Representations dissemination of information or images that has the a. When You Accept This Policy purpose of inducing the sale of goods, products or services through: By accepting this policy, you agree: a. (1) Radio; (1) The statements in the Declarations are accurate (2) Television; and complete; (3) Billboard; (2) Those statements are based upon representations you made to us; and (4) Magazine; (3) We have issued this policy in reliance upon your (5) Newspaper; or representations. b. Any other publication that is given widespread b. Unintentional Failure To Disclose Hazards public distribution. If unintentionally you should fail to disclose all However, "advertisement"does not include: hazards relating to the conduct of your business a. The design, printed material, information or images that exist at the inception date of this Coverage contained in, on or upon the packaging or labeling Part, we shall not deny coverage under this of any goods or products; or Coverage Part because of such failure. b. An interactive conversation between or among 7. Separation Of Insureds persons through a computer network. Except with respect to the Limits of Insurance, and any 2. "Advertising idea" means any idea for an rights or duties specifically assigned in this Coverage "advertisement". Part to the first Named Insured, this insurance applies: 3. "Asbestos hazard" means an exposure or threat of a. As if each Named Insured were the only Named exposure to the actual or alleged properties of Insured; and asbestos and includes the mere presence of asbestos b. Separately to each insured against whom claim is in any form. made or"suit" is brought. 4. "Auto" means a land motor vehicle, trailer or semitrailer 8. Transfer Of Rights Of Recovery Against Others To designed for travel on public roads, including any Us attached machinery or equipment. But "auto" does not a. Transfer of Rights Of Recovery include "mobile equipment". If the insured has rights to recover all or part of any 5. "Bodily injury" means physical: payment, including Supplementary Payments, we a. Injury; have made under this Coverage Part, those rights b. Sickness; or are transferred to us. The insured must do nothing c. Disease after loss to impair them. At our request, the sustained by a person and, if arising out of the above, mental anguish or death at any time. HG 00 01 06 05 Page 15 of 18 37196027 1 SIALCON-01 1 17-18 Jobs-Public Agencies - All Lines 1 Shannon Smith 8/10/2017 11;49;41 AM (PDT) 1 Page 7 of 14 72UEAHA5198 (4) Necessary for the normal If another Hartford Financial Services Group, operation of the covered "auto"or Inc. company policy or coverage form that is not the monitoring of the covered an automobile policy or coverage form applies to "auto's"operating system. the same"accident", the following applies: b.Section III — Version CA 00 01 03 10 of the (1) If the deductible under this Business Auto Business Auto Coverage Form, Physical Coverage Form is the smaller (or smallest) Damage Coverage, Limit of Insurance, deductible, it will be waived; Paragraph C.2 and Version CA 00 01 10 01 of (2) If the deductible under this Business Auto the Business Auto Coverage Form, Physical Coverage Form is not the smaller (or Damage Coverage, Limit of Insurance, smallest) deductible, it will be reduced by Paragraph C are each amended to add the the amount of the smaller (or smallest) following: deductible. $1,500 is the most we will pay for"loss" in 12. AMENDED DUTIES IN THE EVENT OF any one "accident" to all electronic ACCIDENT,CLAIM, SUIT OR LOSS equipment(other than equipment designed solely for the reproduction of sound, and The requirement in LOSS CONDITIONS 2.a. - accessories used with such equipment) DUTIES IN THE EVENT OF ACCIDENT,CLAIM, that reproduces, receives or transmits SUIT OR LOSS - of SECTION IV - BUSINESS audio, visual or data signals which, at the AUTO CONDITIONS that you must notify us of time of"loss", is: an "accident" applies only when the"accident" is known to: (1) Permanently installed in or upon the covered "auto" in a housing, (1) You, if you are an individual; opening or other location that is not (2) A partner, if you are a partnership; normally used by the "auto" (3) A member, if you are a limited liability manufacturer for the installation of company; or such equipment; (4) An executive officer or insurance manager, if (2) Removable from a permanently you are a corporation. installed housing unit as described 13. UNINTENTIONAL FAILURE TO DISCLOSE in Paragraph 2.a. above or is an HAZARDS integral part of that equipment; or (3)An integral part of such equipment. If you unintentionally fail to disclose any hazards existing at the inception date of your policy, we c.For each covered "auto", should loss be limited will not deny coverage under this Coverage to electronic equipment only, our obligation to Form because of such failure. pay for, repair, return or replace damaged or 14. HIRED AUTO -COVERAGE TERRITORY stolen electronic equipment will be reduced by the applicable deductible shown in the Paragraph e. of GENERAL CONDITIONS 7. - Declarations, or $250, whichever deductible is POLICY PERIOD, COVERAGE TERRITORY - less. of SECTION IV - BUSINESS AUTO 9. EXTRA EXPENSE - BROADENED CONDITIONS is replaced by the following: COVERAGE e. For short-term hired "autos", the coverage Under Paragraph A. -COVERAGE -of SECTION territory with respect to Liability Coverage is III - PHYSICAL DAMAGE COVERAGE, we will anywhere in the world provided that if the pay for the expense of returning a stolen covered "insured's" responsibility to pay damages for "auto"to you. "bodily injury" or "property damage" is determined in a suit,"the"suit" is brought in 10. GLASS REPAIR-WAIVER OF DEDUCTIBLE the United States of America, the territories Under Paragraph D.-DEDUCTIBLE-of SECTION and possessions of the United States of III - PHYSICAL DAMAGE COVERAGE, the America, Puerto Rico or Canada or in a following is added: settlement we agree to. No deductible applies to glass damage if the 15. WAIVER OF SUBROGATION glass is repaired rather than replaced. TRANSFER OF RIGHTS OF RECOVERY 11. TWO OR MORE DEDUCTIBLES AGAINST OTHERS TO US - of SECTION IV - Under Paragraph D.-DEDUCTIBLE-of SECTION BUSINESS AUTO CONDITIONS is amended by III - PHYSICAL DAMAGE COVERAGE, the adding the following: following is added: ©2011, The Hartford (Includes copyrighted material Form HA 99 16 03 12 of ISO Properties, Inc., with its permission.) Page 4 of 5 37196077 SIALCON-01 1 17-18 Jobs-Public Agencies - All Linea I Shannon Smith 1 8/10/2017 11:49:41 AM (PDT) I Page 8 of 14 We waive any right of recovery we may have c.Regardless of the number of autos deemed a against any person or organization with whom total loss, the most we will pay under this you have a written contract that requires such Hybrid, Electric, or Natural Gas Vehicle waiver because of payments we make for Payment Coverage provision for any one damages under this Coverage Form. "loss" is$10,000. 16. RESULTANT MENTAL ANGUISH COVERAGE For the purposes of the coverage provision, The definition of "bodily injury" in SECTION V- a.A "non-hybrid" auto is defined as an auto that DEFINITIONS is replaced by the following: uses only an internal combustion engine to "Bodily injury" means bodily injury, sickness or move the auto but does not include autos disease sustained by any person, including powered solely by electricity or natural gas. mental anguish or death resulting from any of b.A "hybrid" auto is defined as an auto with an these. internal combustion engine and one or more 17. EXTENDED CANCELLATION CONDITION electric motors; and that uses the internal combustion engine and one or more electric Paragraph 2. of the COMMON POLICY motors to move the auto, or the internal CONDITIONS - CANCELLATION - applies combustion engine to charge one or more except as follows: electric motors,which move the auto. If we cancel for any reason other than 19. VEHICLE WRAP COVERAGE nonpayment of premium, we will mail or deliver to the first Named Insured written notice of In the event of a total loss to an "auto" for which cancellation at least 60 days before the effective Comprehensive, Specified Causes of Loss, or date of cancellation. Collision coverages are provided under this 18. HYBRID, ELECTRIC, OR NATURAL GAS Coverage Form, then such Physical Damage VEHICLE PAYMENT COVERAGE Coverages are amended to add the following: In addition to the actual cash value of the "auto", In the event of a total loss to a "non-hybrid" auto we will pay up to $1,000 for vinyl vehicle wraps for which Comprehensive, Specified Causes of which are displayed on the covered "auto" at the Loss, or Collision coverages are provided under time of total loss. Regardless of the number of this Coverage Form, then such Physical autos deemed a total loss, the most we will pay Damage Coverages are amended as follows: under this Vehicle Wrap Coverage provision for a.lf the auto is replaced with a "hybrid" auto or any one "loss" is $5,000. For purposes of this an auto powered solely by electricity or natural coverage provision, signs or other graphics gas, we will pay an additional 10%, to a painted or magnetically affixed to the vehicle are maximum of$2,500, of the "non-hybrid" auto's not considered vehicle wraps. actual cash value or replacement cost, whichever is less, b.The auto must be replaced and a copy of a bill of sale or new lease agreement received by us within 60 calendar days of the date of"loss," ©2011, The Hartford (Includes copyrighted material Form HA 99 16 03 12 of ISO Properties, Inc., with its permission.) Page 5 of 5 37196027 SIALCON-01 1 17-19 Jobs-Public Agencies - All Lines I Shannon Smith 1 8/10/2017 11;49:41 AM (PDT) I Page 9 of 14 72UEAHA5196 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS BROAD FORM ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART INDEX 1. Alienated Premises Coverage.........................................................................................................................1 2. Damage To Your Work...................................................................................................................................1 3 Contractors Limited Professional Liability........... ................................................................. ...................... ..1 4. Per Project and Per Location General Aggregate Limits Of Insurance........................................................ ..2 5. Motor Vehicle Laws.........................................................................................................................................3 6. Medical Payments Coverage—Including Products-Completed Operations .................................................3 7. Insured Contract—Construction Operations And Municipal Work..................................................................3 8. Injury To Employee's Reputation With Respect To Incidental Medical Malpractice .......................................3 9. Bodily Injury Employee Suits...........................................................................................................................4 10. Consolidated Insurance (Wrap-Up) Programs................................................................................................4 11. Access Or Disclosure Of Confidential Or Personal Information And Data-Related Liability ..........................4 12. Contractual Liability Coverage For Personal And Advertising Injury...............................................................5 13. Supplementary Payments...............................................................................................................................6 14. Two Or More Coverage Parts Or Policies Issued By Us.................................................................................6 15. Notice of Cancellation to Certificate Holders.................................................................... 6 1. ALIENATED PREMISES COVERAGE This exclusion does not apply if the damaged work Exclusion j. Damage To Property of Section I — or the work out of which the damage arises was Coverage A is amended as follows: performed on your behalf by a subcontractor. a. The following exception to the exclusion is This provision does not apply if exclusion I. deleted: Damage To Your Work has been otherwise modified by endorsement. Paragraph this exclusion does not apply 3CONTRACTORS LIMITED PROFESSIONAL if the premises ess are your work .and were LIABILITY never occupied, rented or held for rental by you. The following exclusion is added to Paragraph 2., b. This exception is replaced by the following: Exclusions of Section I - Coverage A - Bodily Paragraph (2) of this exclusion does not apply Injury And Property Damage Liability, and to Paragraph 2., Exclusions of Section I - if the premises are"your work". Coverage B - Personal And Advertising Injury 2. DAMAGE TO YOUR WORK Liability: Exclusion I. Damage To Your Work of Section I - This insurance does not apply to "bodily injury", Coverage A is replaced by the following: "property damage" or "personal and advertising I. Damage to Your Work injury" arising out of the rendering of or failure to "Property damage" to that particular part of render any professional services by you with respect to your providing engineering, architectural "your work" out of which damage arises and or surveying services in your capacity as an included in the products-completed engineer, architect or surveyor. operations hazard". Form HS 24 50 12 14 Page 1 of 6 ©2014, The Hartford 37196077 1 SIALCON•01 1 17-18 Jobe-Public Agencies - All Lines I Shannon Smith 1 8/10/3017 11;49:11 AM (PDT) I Page 10 of 14 B. Subparagraph f. of the definition of 13. SUPPLEMENTARY PAYMENTS "insured contract" (Section V — In the Supplementary Payments—Coverages A Definitions) is replaced by the following: and B provision: f. That part of any other contract or The limit for the cost of bail bonds in increased to agreement pertaining to your business $2,500. (including an indemnification of a 14. TWO OR MORE COVERAGE PARTS OR municipality in connection with work performed for a municipality) under POLICIES ISSUED BY US which you assume the tort liability of If this policy and any other policy issued to an another party to pay for"bodily injury", insured by us or any affiliated company provides "property damage", or "personal and coverage that applies to the same claim or advertising injury" to a third person or damages, the maximum applicable limit(s) of organization. Tort liability means a liability or limit of insurance under all the policies liability that would be imposed by law will not exceed the highest applicable limit of in the absence of any contract or liability or limit of insurance under any one policy. agreement. Paragraph f. includes that This condition does not apply to any policy issued part of any contract or agreement that by us or an affiliated company specifically written indemnifies a railroad for "bodily to apply as excess insurance over this policy. injury", "property damage", or 15. NOTICE OF CANCELLATION TO CERTIFICATE personal and advertising injuryHOLDER(S) arising out of construction or demolition operations, within 50 feet This policy is subject to the following additional of any railroad property and affecting Conditions: any railroad bridge or trestle, tracks, A. If this policy is cancelled by the Company, road-beds, tunnel, underpass or other than for nonpayment of premium, notice crossing. of such cancellation will be provided at least However, Paragraph f. does not thirty (30) days in advance of the cancellation include that part of any contract or effective date to the certificate holder(s) with agreement: mailing addresses on file with the agent of (1) That indemnifies an architect, record or the Company. engineer or surveyor for injury or B. If this policy is cancelled by the Company for damage arising out of: nonpayment of premium, or by the insured, notice of such cancellation will be provided (a) Preparing, approving, or within (10) days of the cancellation effective failing to prepare or approve, date to the certificate holder(s) with mailing maps, shop drawings, addresses on file with the agent of record or opinions, reports, surveys, the Company. field orders, change orders or drawings and specifications; If notice is mailed, proof of mailing to the last or known mailing address of the certificate holder(s) on file with the agent of record or the Company will (b) Giving directions or be sufficient proof of notice. instructions, or failing to give them, if that is the primary Any notification rights provided by this cause of the injury or endorsement apply only to active certificate damage; or holder(s) who were issued a certificate of insurance applicable to this policy's term. (2) Under which the insured, if an Failure to provide such notice to the certificate architect, engineer or surveyor, holder(s) will not amend or extend the date the assumes liability for an injury or cancellation becomes effective, nor will it negate damage arising out of the cancellation of the policy. Failure to send notice insured's rendering or failure to shall impose no liability of any kind upon the render professional services, Company or its agents or representatives. including those listed in (1) above and supervisory, inspection, architectural or engineering activities. Page 6 of 6 Form HS 24 50 12 14 37196027 I SIALCON-01 1 17-18 Jobs-Public Agencies - All Linea 1 Shannon Smith 1 8/10/3017 11:49:41 AM (PDT) 1 Page 11 of 14 72 U EAHA5198 lk THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO CERTIFICATE HOLDER(S) This policy is subject to the following additional If notice is mailed, proof of mailing to the last known Conditions: mailing address of the certificate holder(s) on file with A. If this policy is cancelled by the Company, other the agent of record or the Company will be sufficient than for nonpayment of premium, notice of such proof of notice. cancellation will be provided at least thirty (30) Any notification rights provided by this endorsement days in advance of the cancellation effective date apply only to active certificate holder(s) who were to the certificate holder(s) with mailing addresses issued a certificate of insurance applicable to this on file with the agent of record or the Company. policy's term. B. If this policy is cancelled by the Company for Failure to provide such notice to the certificate nonpayment of premium, or by the insured, notice holder(s) will not amend or extend the date the of such cancellation will be provided within (10) cancellation becomes effective, nor will it negate days of the cancellation effective date to the cancellation of the policy. Failure to send notice shall certificate holder(s) with mailing addresses on file impose no liability of any kind upon the Company or its with the agent of record or the Company. agents or representatives. Form 103 13 06 11 Page 1 of 1 O 2011, The Hartford 31195037 1 SIALCION-01 1 17-18 Joba-Public Agencies - All Linea 1 Shannon Smith 10/10/1017 11;49;41 AM (PDT) I Page 12 of 14 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CANCELLATION BY US Policy Number:72WEAZI8410 Endorsement Number: Effective Date: 6/1/2017 Effective hour is the same as stated on the Information Page of the policy, Named Insured and Address:Sialic Contractors Corporation dba: Shawnan 12240 Woodruff Avenue Downey CA 90241 Paragraph 2. Of Part Six-Conditions, D. Cancellation in the Workers' Compensation and Employers' Liability Insurance Policy Provisions is replaced by the following: 2.We may cancel this policy by mailing or delivering to the Named Insured written notice of cancellation at least: a. 30 days before the effective date of cancellation or as required by statute whichever is longer if we cancel for nonpayment of premium; or b. 10 days before the effective date of cancellation or as required by statute, whichever is longer, if we cancel for any other reason. Nothing herein contained shall be held to vary, waive, alter, or extend any of the terms, conditions, agreements or declarations of the policy, other than as herein stated. Form WC 99 05 48 Printed in USA Process Date: Policy Expiration ate:6/1/2018 37196037 1 81ALCON-01 1 17-18 Jobs-Public agencies - A11 Linea I Shannon smith 1 0/10/2017 11:®9:41 AN (PDT) I Page 13 of 14 it THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number:72 WEA Z18410 Effective Date:06/01/2017 Named Insured and Address:SIALIC CONTRACTORS CORPORATION 12240 WOODRUFF AVENUE DOWNEY,CA 90241 We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description CITY OF EL SEGUNDO, ITS OFFICIALS, SHAWNAN JOB#288, PROJECT#PW 16-10 EMPLOYEES,AGENTS AND VOLUNTEERS IMPERIAL HIGHWAY OVERLAY PROJECT CITY OF EL SEGUNDO 350 MAIN STREET EL SEGUNDO, CA 90245 Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date: Policy Expiration Date:06/01/2018 77196077 1 SIAL -01 1 17-18 Jobs-Public Agencies - A11 Linea I Shannon Smith 0/10/1017 1.1:19a41 AM (ear) I page 14 of 14