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PROOF OF INSURANCE (2018) CLOSED N DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 802017 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 IOA Insurance Services NAME: Beth Tran 130 Vantis, Suite 250 PHONE JI AI Viejo, CA 92656 E ss°xr), be9�r tsran�6ra,sa.cDrx? c Nip. 949..297-5960 INSURER(S)AFFORDING COVERAGE NAIC# www.ioausa.com CA License#OE67768 INSURERA: RLI Insurance Company 13056 INSURED Omnis Consulting, Inc. Navigators Insurance Company 42307 PO Box 955 INsuRERc: Chino Hills CA 91709 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 37086937 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. INSR rADl L S06rt POLICY NUMB TYPE OF INSURANCE POLICY Err t'Or.VCY EXP LIMITS LTR � ER IMMPODPYYYYt dM'MIrODPYYYYr A ,e r' COMMERCIAL GENERAL LIABILITY / �/ PSB0002339 7/22/2017 7/22/2018 EACH OCCURRENCE $ 2,000,000 #PPB3130212Scheduled At Endt PREM SES l la occur e'er _ CLAIMS-MADE y ✓ OCCUR n 1,000,000 ✓ Professional Services 10,000 Prim/NonCon MED EXP(Any one person) $ ✓ Wvr Of Subr performed by the Insured PERSONAL&ADV INJURY $ 2,000,000 I POLIJECT ✓II LOC PRODUCTS $ 4,000,0001 GEN'L AGGREGATE LIMIT APPLIES PER are Excluded GENERAL AGGREGATE PoucY( ✓ � N COMP/OP $ 4,000,000 OTHER lNED Sit ANY AUTO ✓ ✓ Designated Insured Endt BODILY INJURY F(Per person) 1000000 A AUTOMOBILE LIABILITY PSA0001537 7/22/2017 7/22/201$ ,BODILY INJURY(Per accident) $ OWNED SCHEDULED #CA20481013;Prim/NonCon AUTOS ONLY 'AUTOS and Blkt Wvr of Subr cident} $ ✓ AUTOS ONLY ✓I AUTOS ONLY included on pg 2 of Form PROPERTY v l7nnpPGE $ I ci rt accident) ✓' PrnVNortConI ✓I Wvr of Subr #PPA3000313 $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB LA AGGREGATE S DED a RETENTION$ ', i M -MADE $ A WORKERS COMPENSATION ✓ PSW0002073 7/22/2017 7/22/2018 V I PER ETH AND EMPLOYERS'LIABILITY YIN II Waiver of Subrogation ' (MandatoOFFICEMMBER ry in NH)EXCLUDED?ANYPROPRIETORIPARTNER/EX Y�I N 1 A Endt#WC0403060484 E,L EACH ACCIDENT s 1,000,000 DISEASE-EA EMPLOYEE S 1,000,000 yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ 1,000,000 B Professional L(abidit y DN16DPLO278231V 7/22/2017 7/22/2018 $1,000,000 Each Claim Claims-Made $1,000,000 Aggregate DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder I$an Additional Insured with respect to General Liability(GL)and Automobile Liability but only when required byy written contract with the Insured prior to ail occurrence as per E'ndorserrlents noted above.GL Includes Separation of Insureds and Contractual Ldab'ilily per°limital'ions in the BusinessOwners'Coverage'form.A Workers"Compensation Walver of Subrogation as noted above is Included for the person or organization named in the Schedule that are parties to a Contract requiring this Endorsement.,provided that contract is executed before the loss. Coverage is subject to all policy terms,conditions,limitations and exclusions.30 Day Notice of Cancellation/10 Days for Non-Payment in accordance with policy provisions. CERTIFICATE HOLDER CANCELLATION tN Engineering and Design Support Services for Various Sewer Improvements City of EI Se Undo, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE IIS y of El 0 (ICIdo and employees THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 350 Iain s'tree't EI Segundo CA 90245 AUTHORIZED REPRESENTATIVE (AVC)Alicia K. Igram ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 37086937 1 7/17-18 GL, AUTO, WC & PL I (AVC) Betty Tran 1 8/2/2017 10:23:09 AM (PDT) I Page 1 of 5 Policy Number: PSB0002339 RLI Insurance Company Named Insured:omnis Consulting,Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. RLIPack° FOR PROFESSIONALS SCHEDULED ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM—SECTION II— LIABILITY Schedule Name of Person(s)or Organization(s): City of EI Se�undo, its officers, officials and employees 1. SECTION II C. Who Is An Insured is amended to primary basis, or a primary and non-contributory include as an additional insured the person or basis, this insurance is primary to other insurance organization shown in the schedule above, but only that is available to such additional insured which with respect to liability for "bodily injury", "property covers such additional insured as a named insured, damage" or "personal and advertising injury" and we will not share with that other insurance, caused in whole or in part by you or those acting on provided that: your behalf: a. The "bodily injury" or "property damage" for a. In the performance of your ongoing operations; which coverage is sought occurs after you have b. In connection with premises owned by or rented entered into that contract or agreement; or to you; or b. The "personal and advertising injury" for which c. In connection with "your work" and included coverage is sought arises out of an offense within the "product-completed operations committed after you have entered into that hazard". contract or agreement. 2. The insurance provided to the additional insured by 4. The following is added to SECTION III K.2 Transfer this endorsement is limited as follows: of Rights of Recovery Against Others to Us — COMMON POLICY CONDITIONS (BUT a. This insurance does not apply to the rendering APPLICABLE TO SECTION I — PROPERTY AND of or failure to render any "professional SECTION II—LIABILITY) services". We waive any rights of recovery we may have b. This endorsement does not increase any of the against any person or organization because of limits of insurance stated in D. Liability And payments we make for "bodily injury", "property Medical Expenses Limits of Insurance. damage" or "personal and advertising injury" arising 3. The following is added to SECTION III H.2. Other out of "your work" performed by you, or on your Insurance — COMMON POLICY CONDITIONS behalf, under a contract or agreement with that (BUT APPLICABLE ONLY TO SECTION II — person or organization. We waive these rights only LIABILITY) where you have agreed to do so as part of a contract or agreement with such person or However, if you specifically agree in a contract or organization entered into by you before the "bodily agreement that the insurance provided to an injury" or"property damage" occurs, or the"personal additional insured under this policy must apply on a and advertising injury" offense is committed. ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. LII:'B 1313 02 '12 Page 1 of 1 nxr, v/ ( 'i,1'r in ,,i,, A r( w ii r,i, ( tn.vr) i,,!rhp 'r..,.. ( 8/:%/''01 r' I(I ak.ir' rm IPUT) p rr.,,1r uE s POLICY NUMBER: PSA0001537 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: omnis consulting, Inc. Endorsement Effective Date: 7/22/2017 SCHEDULE Name Of Person(s)Or Organization(s): City of EI Segundo, its officers, o4icWs and employees Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 1013 O Insurance Services Office, Inc., 2011 Page 1 of 1 37065?37 17(17-1P GL, AUTO, WC L PL I (AVC) Petty Ti— 1 8/2(2017 10:23:09 AM (PDT) I Paye 3 of 5 This endorsement modifies insurance provided under the following; BUSINESS AUTO COVERAGE FORM A. Broad Form Named Insured "loss", provided that the "accident" or "loss" arises The following is added to the SECTION II — out of the operations contemplated by such contract. COVERED AUTOS LIABILITY COVERAGE, Para- The waiver applies only to the person or graph A.1.Who Is An Insured Provision: organization designated in such contract. Any business entity newly acquired or formed by you E. Employee Hired Autos during the policy period, provided you own fifty 1. The following is added to the SECTION II — percent(50%) or more of the business entity and the COVERED AUTOS LIABILITY COVERAGE, business entity is not separately insured for Bus- Paragraph A.I.Who Is An Insured Provision: iness Auto Coverage. Coverage is extended up to a maximum of one hundred eighty (180) days An "employee" of yours is an "insured" while following the acquisition or formation of the business operating an "auto" hired or rented under a entity. contract or agreement in that "employee's" name, with your permission, while performing This provision does not apply to any person or duties related to the conduct of your business. organization for which coverage is excluded by 2. Changes In General Conditions: endorsement. B. Employees As Insureds Paragraph 5.b. of the Other Insurance Con- dition in the BUSINESS AUTO CONDITIONS is The following is added to the SECTION II — deleted and replaced with the following: COVERED AUTOS LIABILITY COVERAGE, Para- graph A.1.Who'Is An Insured Provision: b. For Hired Auto Physical Damage Coverage, the following are deemed to be covered Any "employee" of yours is an "insured" while using "autos" you own: a covered "auto" you don't own, hire or borrow in (1) Any covered "auto" you lease, hire, rent your business or your personal affairs. or borrow; and C. Blanket Additional Insured (2) Any covered "auto" hired or rented by The following is added to the SECTION II — your"employee" under a contract in that COVERED AUTOS LIABILITY COVERAGE, Para- individual "employee's" name, with your graph A.I.Who Is An Insured Provision: permission, while performing duties Any person or organization that you are required to related to the conduct of your business. include as an additional insured on this coverage However, any "auto" that is leased, form in a contract or agreement that is executed by hired, rented or borrowed with a driver is you before the "bodily injury" or "property dams e" not a covered "auto". Y Y 9 occurs is an "insured" for liability coverage, but only F. Fellow Employee Coverage for damages to which this insurance applies and SECTION II — COVERED AUTOS LIABILITY only to the extent that person or organization COVERAGE, Exclusion B.5. does nota I if you qualifies as an "insured" under the Who Is An apply Insured provision contained in SECTION II — have workers compensation insurance in-force covering all of your employees. COVERED AUTOS LIABILITY COVERAGE. The insurance provided to the additional insured will G. Auto Loan Lease Gap Coverage be on a primary and non-contributory basis to the SECTION III — PHYSICAL DAMAGE COVERAGE, additional insured's own business auto coverage if C. Limit Of Insurance, is amended by the addition you are required to do so in a contract or agreement of the following: that is executed by you before the "bodily injury" or "property damage"occurs. In the event of a total "loss" to a covered "auto" shown in the Schedule of Declarations, we will pay D. Blanket Waiver Of Subrogation any unpaid amount due on the lease or loan for a covered "auto", less: The following is added to the SECTION IV — BUSI- 1. The amount paid under the PHYSICAL NESS AUTO CONDITIONS, A. Loss Conditions, DAMAGE COVERAGE section of the policy; 5. Transfer Of Rights Of Recovery Against Others To Us: and We waive any right of recovery we may have against 2. Any: any person or organization to the extent required of a. Overdue lease/loan payments at the time of you by a contract executed prior to any "accident" or the"loss"; PPA 300 03 13 Page 2 of 5 4i, NJ1i (i,I J. ,.,, , WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed.4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA 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 2 % of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description City of EI Segundo, Jobs performed for any person or organization that you its officers, officials and employees have agreed with in a written contract to provide this agreement. 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 7/22/2017 Policy No.PSW0002073 Endorsement No.. Insured Insurance Company Omnis Consulting,Inc. RLI Insurance Company Countersigned By ©1998 by the Workers'Compensation Insurance Rating Bureau of California.All rights reserved. „ i I I i' ir, 0, "JIT'', v, ri, I r`.0 .11 ti.,. I n, I� [ , a\1' �frvvi I i ,