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PROOF OF INSURANCE (2018) CLOSED DATE(MM/2017 Y) CERTIFICATE OF LIABILITY INSURANCE D6/Db/2D17 J 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 w certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Aon Risk Services Central, Inc. Pittsburgh PA Office (JVC..No. Ext); (866) 283-7122 I FAX (800) 363-0165 to Dominion Tower, 10th Floor E-MAIL 625 Liberty Avenue ADDRESS: _ Pittsburgh PA 15222-3110 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: XL Insurance America Inc 24554 Michael Baker international, Inc INSURER B: Liberty Mutual Fire Ins CO 23035 5 Hutton Centre Drive Suite 500 INSURER c Liberty Insurance Corporation 42404 Santa Ana CA 92707 USA INSURER D: Lloyd's Syndicate No. 2623 AA1128623 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570068249994 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. Limits shown are as requested INSN ADDL SUHR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE IN,SD WVO POLICY NUMBER (MMI IYYI'Y (MMIDD/YVYY LIMITS _.� X I COMMERCIAL GENERAL LIABILITY TB2681004145717 UB/ D6/3U/2018 EACH OCCURRENCE $2,000,000 CLAIMS-MADE IIX (OCCUR General Liability DAMAGLIORENtED $300,000 1,,,,_•..11 PREMISES(Ea occurrence) MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $2,000,000 rn OT ��-GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $4,000,000 POLICY [flJECT LOC PRODUCTS-COMP/OP AGO $4,000,000 00 OTHER' B AUTOMOBILE LIABILITY �- AS2-681-004145-727 08/30/2017 08/30/2018 COMBINED SINGLE LIMIT $2,000,000 Commercial Auto - AOS „1,Ea,psngmQ X ANY AUTO BODILY INJURY(Per person) Z OWNED SCHEDULED BODILY INJURY(Per accident) y ...._.." AUTOS ONLY .........................................................."."..w.."."."..,._.,•,•,•,,,__ � HIRED AUTOS •........... PROPERTY DAMAGE NON-OWNED ............,ONLY ., AUTOS ONLY (Per accident) 14 A X mmRELLALIABmlx] $10,0(l0OCCUR mmmumbOre1gaAGGREGATE $10,000,000 52LI17A 08/30/2017 08/30/2018 EACH OCCURRENCE $10,000,000 U EXCESS ,. � IR AB NTION CLAIMS-MADE .' ry C OR SYC1 ORKERS OMP'EN'SATIONAN�D � D0077"L08/30/101/08/30/2618 X PER OTH EMPE LIABILITY N IFR ANY PROPRIETOR/PARTNER I EXECUTIVE IWorkers Comp AOS 'EL EACHACCIDENT $1,000,000 D6P'Nr„;IF RAtJ.'EIM&VEA�'EXCLUDED? NIA 014n4wory In NHIi EL DISEASE-EA EMPLOYEE $1,000,000 On a,describe w1dor 0t��RIP71'IN OF OPERl4'NONS belowEL DISEASE-POLICY LIMIT $1,000,000 i D E&O-PL-Primary PSDEF1700460 08/31/2017''08/31/2018 Per Claim $5,000,006 Professional Liab. and CP Aggregate $5,000,000 SIR applies per policy terns & condi ',i ons DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) ,gyp For Named Insured only: Attn: Kim Hartsfield. RE: Project: All Operations, City of El Segundo, its officials and employees are included as Additional Insured in accordance with the policy .provisions of the General Liability policy. ,General Liability policy evidenced herein is Primary and Non-Contributory to other insurance available to Additional Insured,. but only in accordance with the policy's provisions. A waiver of Subrogation is granted in favor of Certificate Holder in , accordance with the policy provisions of the workers' Compensation policy. r-` 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. City of El Segundo AUTHORIZED REPRESENTATIVE 350 Main Street = E1 Segundo CA 90245 USA ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD POLICYNUMBER: TB2-681-004145-717 COMMERCIAL GENERAL LIABILITY CG 2010 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL AL II 'SURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to 1. All work, including materials, parts or include as an additional insured the person(s) or equipment furnished in connection with such organization(s) shown in the Schedule, but only with work, on the project (other than service, respect to liability for "bodily ijury', "property maintenance or repairs) to be performed by or damage" or "personal and advertising injury' on behalf of the additional insured(s) at the caused,in whole or in part,by location of the covered operations has been 1. Your acts or omissions;or completed;or 2. The acts or omissions of those acting on your 2. That portion of "your work" out of which the behalf. injury or damage arises has been put to its in the performance of your ongoing operations for intended use by any person or organization the additional insured(s) at the location(s) other than another contractor or subcontractor designated above. engaged in performing operations for a principal as a part of the same project. However. C. With respect to the insurance afforded to these 1. The insurance afforded to such additional additional insureds, the following is added to insured only applies to the extent permitted by Section III—Limits Of Insurance: law;and If coverage provided to the additional insured is 2. If coverage provided to the additional insured is required by a contract or agreement, the most we required by a contract or agreement, the will pay on behalf of the additional insured is the insurance afforded to such additional insured will amount of insurance: not be broader than that which you are required 1. Required by the contract or agreement;or by the contract or agreement to provide for such additional insured. 2. Available under the applicable Limits of B. With respect to the insurance afforded to these Insurance shown in the Declarations; additional insureds, the following additional whichever is less. exclusions apply. This endorsement shall not increase the This insurance does not apply to "bodily injury' or applicable Limits of Insurance shown in the "property damage"occurring after. Declarations. SCHEDULE Name Of Additional Insured Person(s) Location(s)Of Covered Operations Or Organization(s): All persons or organizations with whom you have All locations as required by a written contract or entered into a written contract or agreement,prior to an agreement entered into prior to an"occurrence"or "occurrence"or offense,to provide additional insured offense. status. Information required to complete this Schedule,if not shown above,will be shown in the Declarations. CG 2010 0413 C Insurance Services Office,Inc.,2012 Page 1 of 1 POLICYNUMBER: T132-681-004145-717 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS S - COMPLETED D OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to B. With respect to the issuance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III—Limits Of Insurance: with respect to liability for "bodily iNury' or If coverage provided to the additional insured is "property damage" caused, in whole or in part, by required by a contract or agreement, the most we "your work" at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement performed for that additional insured and included amount of issuance: in the"products-completed operations hazard". 1. Required bythe contract or agreement;or However. 2. Available under the applicable Limits of 1. The insurance afforded to such additional Insurance shown in the Declarations; insured only applies to the e)dent permitted by whichever is less. law;and This endorsement shall not increase the applicable 2. If coverage provided to the additional insured is Limits of Insurance shown in the Declarations. required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations All persons or organizations with whom you have All locations as required by a written contractor entered into a written contract or agreement,prior to an agreement entered into prior to an"occurrence"or "occurrence"or offense,to provide additional insured offense. status. Information required to complete this Schedule,if not shown above,will be shown in the Declarations. CG 20 37 0413 C Insurance Services Office,Inc.,2012 Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG 20 01 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY ASIC I' ONCONTI I UTOR,Y - OTHER IISISUFSAISICE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the This insurance is primary to and will not seek additional insured. contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and Policy Number TB2-681-004145-717 Issued by Liberty Mutual Fire Insurance Company CG 20 01 0413 © Insurance Services Office, Inc., 2012 Page 1 of"I WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Where required by contract or written agreement prior to loss and allowed by law. Schedule Issued by: Liberty Insurance Corporation For attachment to Policy No WA7-68D-004145-777 Effective Date 8/30/2017 Premium Issued to: Michael Baker International,LLC WC 00 0313 0 1983 National-Council on Compensation Insurance, Inc-. -Page-1 o 1 Ed.4/1/1984 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 Additional premium is a percent of the California Manual Workers Compensation premium. Subject to a minimum premium charge of$250 Person or Croanization Job Description Where required by contract or written agreement prior to loss and allowed by law. Issued by Co 7-Liberty Insurance Corporation For attachment to Policy No. WA7-68D-004145-777 Effective Date 8/30/2017 Premium $ Issued to Michael Baker International, Inc. WC 04 03 06 Page °'n of 2 Ed. 04/1984