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PROOF OF INSURANCE (2018 - 2018) CLOSED DATE(MM/DD/YYYY) AR'O' CERTIFICATE OF LIABILITY INSURANCE 6/2/2017 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 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 CONTACTNAh1E: Diana Moore Leavitt Insurance Services of Los Angeles, Inc. P HONE Ixf) (818)593-7001 SAA/ No):(866)886-7468 License #0769447 DDR)ESS,LISLA-certrequest@leavitt.com 21820 Burbank Blvd, Suite 300 INSURER(S)AFFORDING COVERAGE NAIC# Woodland Hills CA 91367 INSURERA:Travelers Propertv Casualty 36161 INSURED INSURERB:Cvpress Insurance Company 10855 Network Integration Company INSURERC:Capitol Speciality Insurance 10328 11981 Jack BennyDrive #103 _ 10328 � INSURER Specialty InsuranceCo.,, Partners, Inc. INSURER E: Rancho Cucamonga CA 91739 INSURER F: COVERAGES CERTIFICATE NUMBER:17/18 Master Liability REVISION NIUMBER: 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 POLI:IES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR„ ..., ,TYPE OF INSURANCE.... .....Ab'b'L SUSn ... ...... -OL-- -- POLICY EFF M1DDf EXP LIMITS � ��' POLICY NUMBER tMArldODPY'YY'Y'd IMMVOOdV'V'Y'Y1 X I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A .. .,,V CLAIMS-MADE I—XI OCCURPREPMNES(L'IaoNu',sRiaLiftt+suz:�.r) $.,., 300,.000 X ZLP71M79244 6/4/2017 6/4/2018 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY FI IBRO. LOC PRODUCTS COMP/OP AGG uECT D $ 2,000,000 OTHER. Employee Benefits $ 1,000,000 AUTOMOBILE LIABILITY COMBINED $ 1,000,000 (Ea acredenl)SINGLE I_I�1��...... A X ANY AUTOBODILY IN (Per person) $ ALL OWNED SCHEDULED (Per accident) $ AUTOS AUTOS X HIRED AUTOS X 6E532700 6/4/2017 6/4/2018 NON-OWNED POP TY DAMAGE $ (Per aqqioqn�) Medical payments $ 5,000 X UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 5,000,000 A c EXCESS LIAR CLAIMS-MADE AGGREGATE $ 5,000,000 DED ( ( RETENTION$ ZUP15T86171 6/4/2017 6/4/2018 �$ WORKERS COMPENSATION X ( PER 1OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ 1,000,000 OFFICERB (Mandatory/MEMBER in NH EXCLUDED N/A NEWC804443 1/1/2017 1/1/2018 E,L,DISEASE-EA EMPLOYEE: $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 1,000,000 C Professional Liability SGCO1100-08 5/12/2017 5/12/2018 OcGAgg $2mm/3mrit D Inst Floater w/EQ-FL 6020337998 6/4/2017 6/4/2018 Limit $250,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of E1 Segundo is included as Additional Insured as it pertains to the named insured's operations for, General Liability per written agreement and per form #CGD2460805 with Primary and Non-contributory basis per form #CGD4250708, and WC Waiver of Subrogation per form #WC99041013, subject to policy terms & conditions per attached Endorsements. CER'TIFI'CATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of E1 Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Clerk's Office ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE Rml I ©1988-2014 ACORD CORPORATION. All rights reserved, ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD NS025 t9rrlemi WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 04106 (Ed.9-14) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT.CALIFORNIA BLANKET BASIS 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.) The additional premium for this endorsement shall be 2% of the total manual premium otherwise due on such remuneration. The minimum premium for this endorsement is $350. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule, SCHEDULE BLANKET WAIVER Person/Organization Blanket Waiver—Any person or organization for whom the Named Insured has agreed by written contract tc furnish this waiver. Job Description Waiver Premium All CA Operations This endorsement changes the policy to which It Is attached and is effective on the date Issued unless otherwise stated. (The information below Is required only when this endorsement Is Issued subsequent to preparation of the policy.) Endorsement Effective 01/01/2017 PollcyNo. NEWC804443 Endorsement No. Insured Premium$ Insurance Company Cypress Insurance Company Countersigned by WC 99 04108 (Ed.9-14) POLICY NUMBER: ZLP71 M79244 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL L ISUFE (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED — (Section II) is amended c) The insurance provided to the additional in- to include any person or organization that you sured does not apply to "bodily injury" or agree in a "written contract requiring insurance" "property damage" caused by "your work" to include as an additional insured on this Cover- and included in the "products-completed op- age Part, but: erations hazard" unless the "written contract a) Only with respect to liability for"bodily injury", requiring insurance" specifically requires you "property damage"or"personal injury"; and to provide such coverage for that additional insured, and then the insurance provided to b) If, and only to the extent that, the injury or the additional insured applies only to such damage is caused by acts or omissions of "bodily injury" or "property damage" that oc- you or your subcontractor in the performance curs before the end of the period of time for of "your work" to which the "written contract which the "written contract requiring insur- requiring insurance" applies. The person or ance" requires you to provide such coverage organization does not qualify as an additional or the end of the policy period, whichever is insured with respect to the independent acts earlier. or omissions of such person or organization. 3. The insurance provided to the additional insured 2. The insurance provided to the additional insured by this endorsement is excess over any valid and by this endorsement is limited as follows: collectible "other insurance", whether primary, a) In the event that the Limits of Insurance of excess, contingent or on any other basis, that is this Coverage Part shown in the Declarations available to the additional insured for a loss we exceed the limits of liability required by the cover under this endorsement. However, if the "written contract requiring insurance", the in- "written contract requiring insurance" specifically surance provided to the additional insured requires that this insurance apply on a primary shall be limited to the limits of liability re- basis or a primary and non-contributory basis, quired by that "written contract requiring in- this insurance is primary to "other insurance" surance". This endorsement shall not in- available to the additional insured which covers crease the limits of insurance described in that person or organization as a named insured Section III—Limits Of Insurance. for such loss, and we will not share with that "other insurance". But the insurance provided to b) The insurance provided to the additional in- the additional insured by this endorsement still is sured does not apply to "bodily injury", "prop- the over any valid and collectible "other in- of t damage or personal injury" arising out surance", whether primary, excess, contingent or of the rendering of, or failure to render, any on any other basis, that is available to the addi- professional architectural, engineering or sur- tional insured when that person or organization is veying services, including: an additional insured under such "other insur- i. The preparing, approving, or failing to ance". prepare or approve, maps, shop draw- 4. As a condition of coverage provided to the ings, opinions, reports, surveys, field or- additional insured by this endorsement: ders or change orders, or the preparing, approving, or failing to prepare or ap- a) The additional insured must give us written prove, drawings and specifications; and notice as soon as practicable of an "occur- ii. Supervisory, inspection, architectural or rence" or an offense which may result in a engineering activities. claim. To the extent possible, such notice should include: CG D2 46 08 05 ®2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 COMMERCIAL GENERAL LIABILITY I. How, when and where the 'occurrence" any provider of 'other insurance"which would or offense took place; cover the additional insured for a loss we ii. The names and addresses of any injured cover under this endorsement. However, this persons and witnesses; and condition does not affect whether the insur- ance provided to the additional insured by iii. The nature and location of any injury or this endorsement is primary to 'other insur- damage arising out of the 'occurrence"or ance" available to the additional insured offense. which covers that person or organization as a b) If a claim is made or "suit" is brought against named insured as described in paragraph 3. the additional insured, the additional insured above. must: 5. The following definition is added to SECTION V. i. Immediately record the specifics of the —DEFINITIONS: claim or"suit'and the date received; and "Written contract requiring insurance" means ii. Notify us as soon as practicable. that part of any written contract or agreement The additional insured must see to it that we under which you are required to include a receive written notice of the claim or"suit' as person or organization as an additional in- sured on this Coverage Part, provided that soon as practicable. the "bodily injury" and "property damage" oc- c) The additional insured must immediately curs and the "personal injury" is caused by an send us copies of all legal papers received in offense committed: connection with the claim or "suit', cooperate a. After the signing and execution of the with us in the investigation or settlement of contract or agreement by you; the claim or defense against the "suit', and otherwise comply with all policy conditions. b. While that part of the contract or d) The additional insured must tender the de- agreement is in effect; and fense and indemnity of any claim or "suit' to c. Before the end of the policy period. Page 2 of 2 0 2005 The St. Paul Travelers Companies, Inc. CG D2 46 08 05 POLICY NUMBER: H-630-5F254188TIL-16 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE - ADDITIONAL INSUREDS - PRIMARY AND NON-CONTRIBUTORY WITH RESPECT TO CERTAIN OTHER INSURANCE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following is added to Paragraph 4. a., Primary (1) The"bodily injury" or"property damage"for which Insurance, of SECTION IV — COMMERCIAL GEN- coverage is sought is caused by an 'occurrence" ERAL LIABILITY CONDITIONS: that takes place; and However, if you specifically agree in a written contract (2) The "personal injury" or "advertising injury" for or agreement that the insurance afforded to an addi- which coverage is sought arises out of an offense tional insured under this Coverage Part must apply on that is committed; a primary basis, or a primary and non-contributory basis,this insurance is primary to other insurance that subsequent to the signing and execution of that con- is available to such additional insured which covers tract or agreement by you. such additional insured as a named insured, and we will not share with that other insurance, provided that: CG D4 25 07 08 ©2008 The Travelers Companies,Inc. 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