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PROOF OF INSURANCE (2018) CLOSED JLEEENG-01 YLIENG CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) _...._. _...... 8/17/2017 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(les)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 qq ( „ PRODUCER .NFk Gig!Y .m.............ww. .....w ,.,.. IDA Insurance Services#0 67768n err rights to the certificate holder in lieu of such PHONE FAX, " FAx Pleasanton,CA 94588 Els xt 25 663514 5000 (vc No):(925) 16-7869 SBtalt 24 and Road f l�aI(I,Yttett Icwausa. 8 g 5 4 ......,,,,, IN-SURER(S),. - NAIC a .. _ f4FFORDI� Ct�vERACE A!Travelers INsuRRProfserty Casualty Company of America 25674 INSURED 8 Argonaut Insur _�� � „ ---_ INSURER.. 2�cv c1rr1 ro 1,9801.....,,,,,,, JLee Engineering,Inc. INSURER„C,,: 430 S.Garfield Avenue,#301 Alhambra,CA 91801 INSURER P.?... _ „INSURER,k;; ............ INSURER F; ............ COVERACa ,,, C RTIFICATE NUMBER,:,,,,,,, REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED W 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, EYCLUSIONS AND CONDITIONS O OF OLI IES LIMITS SHOWN MAY HAVE BEEN REINSR DUCED PAID CLAIMS ADDtMPOLICY EXPPEOFINSURANCEPOLICY NUMBER IYYY )� MJma - --' LIMITS TR A X COMMERCIALGENERAL EACH OCCURRENCE 2,000,000 00 CLAIMS-MADE I X occuR 6802H013864 09/0112017 09/01/2018 DAMAGETO RENTED 1,000 000REMIS ......... MED EXP LADY one per„son), $ ,000 P. $ 2,000,000 ERsaNA�a ADV!N,.ILaRY......... ......... Y'"ECvI"I.AGGREGATE LIMY APPLIES PER: GENERAL AGGREGATE d..OMPdOP AC.a $ 4,000,000 POLICY I X PES 0 LOC PRCdDU4,000,000 ..... J OTFIE R, $ A AUTOMOBILE LIABILITY .,IO IOL�k'4CAk�D ��LII INGLEIMI R $ 2,000,000 ANY Aura 6802HO13864 09/01/2017 09/01/2018 Q,Q,DILYINJUR_V_(Per persoW s OWNED SCHEDULED AUTOS ONLY AUTOS O $ .X,. AUTOS ONLY AI„P"%"(;i d';dNC.Y DILY INJURY(Per accident), HIRED �( NON F.f �f�rlrPi��deiik��AMAGAr $ UMBRELLA LIAB OCCUR EEAPRHOCCURRENCF - - „ „EXCESS LIAB a CLAIMS-MADE AGGGATE $ . ,.,..,.„ ...... . DED f �RETENTION$ ...$ AND EMPLOYERS'LIABILITYYiN UB3J84391A 09/01/2017 09/01/2018 XL�MR Il -_ a EPH A WORKERS COMPENSATION PEA FI EMPLOYERS' E L EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE 1,000,000 DISE SE �" � MBER EXCLUDED? � � N/A 1,000,000 E L DISEASE-POLICY LIMIT $ 1,000,000 - mida ary'In NH) Pf es,descrtbe under D 'SCRIPTiDN O a.I,r�ERA1IONS t.,dow B Profess lonal[Fii;- -IT IAE1262605 09%-6112017 09/01/2018 Per Claim __.. 1,000,000 B Professional Liab. IAE1252606 09/01/2017 09/01/2018 Aggregate 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101red) ,Additional Remarks Schedule,may be attached if more space is required) All Operations of the Named Insured. General Liability only:City of EI Segundo,its officers,of'fic'ials,employees,and authorized volunteers is named as Additional Insured but only as respects tiability arising out of the Named Insured"s operations In Professional Services Agreement;such coverage is Primary and Non-Contributory as respects any insurance carried by the Additional Insured with respect to work performed by the Named Insurer/, Also,note that the aforementioned General Liability Includes coverage for Hired 8 Non-Owned Auto Liabi'lit'y, Above policies include Waiver of Subrogation III favor of the aformentioned Additional Insured. ....,...... _. .CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE City of EI Segundo 350 Main Street IEI Seaundo.C"9245 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 680-8855x594• COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE NAME OF PERSON(S)OR ORGANIZATION(S): ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT PROJECT/LOCATION OF COVERED OPERATIONS: PROVISIONS A. The following is added to WHO IS AN INSURED The insurance provided to such additional insured (Section II): is limited as follows: The person or organization shown in the Sched- d. This insurance does not apply to the render- ule above is an additional insured on this Cover- ing of or failure to render any "professional age Part, but only with respect to liability for"bod- services". ily injury"', "property damage" or "personal injury" e, The limits of insurance afforded to the addi- caused, in whole or in part, by your acts or orris- tional insured shall be the limits which you sions or the acts or omissions of those acting on agreed in that"contract or agreement requir- your behalf: Ing insurance" to provide for that additional a. In the performance of your ongoing opera- insured, or the limits shown in the Declara- tions; tions for this Coverage Part, whichever are b. In connection with premises owned by or less_This endorsement does not increase the rented to you;or limits of insurance stated in the LIMITS OF INSURANCE (Section III) for this Coverage c. In connection with "your work" and included Part. within the "products-completed operations hazard". B. The following is added to Paragraph a. of 4. Other Insurance in COMMERCIAL GENERAL, Such person or organization does not qualify as LIABILITY CONDITIONS(Section IV): an additional insured for"bodily injury", "property damage" or "personal injury" for which that per- However,if you specifically agree in a"contract or son or organization has assumed liability in a con- agreement requiring insurance"that,for the addi- tract or agreement. tional insured shown in the Schedule, the insur- ance provided to that additional insured under this CG D3 82 09 07 ©2007 The Travelers Companies,Inc. Page 1 of 2 Includes the copyrighted material of Insurance Services Office,Inc.,with its permission COMMERCIAL GENERAL LIABILITY Coverage Part must apply on a primary basis, or Injury"arising out of"your worm"on or for the pro- a primary and non-contributory basis, this insur- ject, or at the location, shown in the Schedule ance Is primary to other insurance that is avail- above, performed by you, or on your behalf, un- able to such additional insured which covers such der a "contract or agreement requiring insurance" additional insured as a named insured, and we with that additional insured. We waive these will not share with the other insurance, provided rights only where you have agreed to do so as that: part of the"contract or agreement requiring insur- (1) The "bodily injury" or "property damage" for anoe" with that additional insured entered Into by which coverage is sought occurs:and you before, and in effect when, the"bodily injury" (2) The "personal injury" for which coverage is or"property damage" occurs, or the "personal in- sought arises out of an offense committed; jury"offense is committed. after you have entered into that "contrail or D. The following definition is added to DEFINITIONS (Section V): agreement requiring insurance" for such addi- tional Insured. But this Insurance still is excess "Contract or agreement requiring insurance" over valid and collectible other insurance, means that part of any contract or agreement un- whether primary, excess, contingent or on any der which you are required to include the person other basis, that is available to the additional in- or organization shown in the Schedule as an ad- sured when the additional insured is also an addi- ditional insured on this Coverage Part, provided tional insured under any other insurance. that the"bodily injury" and "property damage" oc- curs, and the"personal injury"is caused by an of- C. The following is added to Paragraph 8. Transfer fense committed: Of Rights Of Recovery Against Others To Us in COMMERCIAL GENERAL LIABILITY CON- a_ After you have entered into that contract or DITIONS(Section IV): agreement; We waive any rights of recovery we may have b. While that part of the contract or agreement is against the additional insured shown in the in effect;and Schedule above because of payments we make c. Before the end of the policy period. for"bodily injury", "property damage"or"personal Page 2 of 2 ©2007 The Travelers Companies,Inc. CG D3 82 09 07 Includes the copyrighted matenal of Insurance Services Office,Inc.,with its permission WORKERS COMPENSATION TRAVELERSJAND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 99 03 76 ( A) POLICY NUMBER: UB-3J84391A WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT -- CALIFORNIA (BLANKET WAIVER) 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 Schedufc, The additional premium for this endorsement shall be 3.00 % of the California workers' compensation pre- mium. Schedule Person or Organization Job Description ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. 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 Policy No. Endorsement No. Insured Premium Insurance Company Countersigned by DATE OF ISSUE: 08-14-17 ST ASSIGN: Page 1 of 1