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PROOF OF INSURANCE (2018 - 2018) CLOSED WHO CONST h1lAIELN, DATE iMMIDDYYi �,. CERTIFICATE OF LIABILITY INSURANCE _ i 11xIYY 1712017 THIS CERTIFICATE IS ISSUED AS A MATTEROFINFORMATION 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 pollcy(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). PROOucER License#0252636Uni _IaIAACT 301 E.C gencle's' (Al ,No,End-(626)535-8300,._..............'....... .y........� Arcs.. ...........,,..... 301 E.Colorado Blvd.,#200 & I�......r.�.ef;(626)577w1346 Pasadena,CA 91101 _ INKS„NRERiS,I:A,FFQR[�11,f .CQYEIRA#QE NA,iC..k..L. •••. INSI,f RA:Associated Industries InsuranceCornny,Inc. 23140 INSUREDm_. ._._.�............_.......m,..�....._..._... ,lR .l��..__,......,.w.........._,................a,_..,,..._,........._..._.._.. NoHo Constructors Attn:Bryce Greenstein !N.S48. .V..?..... ,...._.m. 4554 Wlllowcrst Ave !tSURER D: .......... North Hollywood,CA 91602 NSURER,E: INSURER P COVERAGES CERTIFICATE NUMBER: 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 POLIC ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, TS SHOWN MAY HAVE BEEN REDUCED BY'AID CLAIMS. EXCLUSIOMMER P GENERRA�L LU1eanY CH 'OLICIES LiMI _ _.. .__...._ __. ._. w_ .,.POU NS F S E OF .R X CO .., .. ADOL SUBR� POLICY'EFF POLICY EXP I.TR JNW.Aw POLICY NUMBER — mIlVl llll�J L Q6i l- LIMITS 000,000 CLAIMS-MADE q..X.�OCCUR AES104805800 07124/2017 07/24/2018 ° p! T ENTED S / ,100,0 SE'tal g 1000000 GEN'LAw4,aGRE(P.ASE LIMIT CIEER,ARE,G IT APPLIES PER: .._ _ ,L„mA A•�RC,.....,.S. �000,000 i , 00 -.....,. PCUCY�._...�JECT LOC PRQCII TS�;COMP!OPAL.S.., .._._............._.__.._... ........_........ s p 'il._........_ µ. .LIMIT .. . Al!'OMOBILE LIABILITYaV f tap LAWyNY AUTO BM YINJURY(Perpm n)SCHED S .._ A.O. OES ONLY .,,_. AUTOSULED _BODILY_IMJU,RY ,,,,•,,,a,,,,caderl_m. �p ��yy gyg� OPER.'P e'roPAAP . . ,.,.,....._._., AUTOS ONLY .�FAmP aF�XarpYi _..�._.,....... HIR N 'W• '4k B IOCCUR EACH O&�.URRENCE_, EXCESS LIAB P CLAIMS-MAOE UMBRELLA UA S WORKERS PER E I TFI µ ••• V DED-F-111. ED �RETENTIONS ..-•••__.m..m_,_.._ »-_ m �.�. COMPENSATION ND EMPLOYERS'LIABILITY YIN -- -STATUTE [ . PRIETORPARTNEWEXECUTNE NIA ...5, ....�..........,,...__...�.�. Ifes.desoft under �a'sC'RIPTIOf10F4FE,,RATsgbelaw DESCRIPTION OF OPERA'TION'S!LOCATIONS I VEWCLES (ACORD 101 Adllflwial Rsanerks'Sc�hedu le rnsy be aftnoR�sd M more space Is required) Project:George E.Gordon Clubhouse Playground Res'u661ng Project_Project No.PW 14.10 City of EI Segundo CA,its officers and employees,and Los Angeles Region Park and Open Space District are listed as additional insured for General Liability in regards to services performed by the Insured during the referenced project,on a primary and non-contributory basis via CG 2010&CG 2037,when required by written contract.A Waiver of Subrogation applies in favor of the additional insureds on the General Liability policy,when required by written contract. _C ,tEICATE HOLDERCANC L:L TION..,., ... SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE NOTI City of EI Segundo ACCORDANCE WITH THE POLICY P OTION DATE VISIONSCE WILL BE DELIVERED IN City Clerk 350 Main Street El Segundo,g 5 AUTHORFtED AtPRE'SENTAVV e ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER:AES 1048058 00 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE ,Name of Additional Insured Person(s)or Location and Description of Completed Orqartl ation(s): Operations ,City of EI Segundo,CA George E.Gordon Clubhouse Playground Its officers and employees Resurfacing Project-Project No.PW 14-10 a 350 Main Street I iorrna0on r autirred to comp ele thisynot It Schedule, not � . e,if shown above will be shown in the C�aaplaralions. Section II -- Who Is An Insured is amended to include as an additional Insured the person(s) or organization(s)shown in the Schedule, but only with respect to liability for"bodily injury"'or"property dam- age" caused, in whole or in part, by "your work" at the location designated and described in the sched- ule of this endorsement,performed for that additional insured and included in the "'products-completed operations hazard". CG 20 37 07 04 ©ISO Properties,Inc.,2004 Page 1 of 1 O POLICY NUMBER:AES1048058 00 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: City of EI Segundo,CA Its officers and employees 350 Main Street EI Segundo,CA 90245 LInformstion required to complete this Schedule,If not shown above,will be shown in the Declarations, The following is added to Paragraph 8.Transfer Of Rights Of Recovery Against Others To Us of Section IV—Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for Injury or damage arising out of your ongoing operations or "your work"done under a contract with that person or organization and Included in the"'products- completed operations hazard".This waiver applies only to the person or organization shown in the Schedule above, CG 24 04 06 09 0 Insurance Services Office,Inc.,2008 Page 1 of 1 0 COMMERCIAL GENERAL LIABILITY CG 20 33 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS -- AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured any person or or- additional insureds, the following additional exclu- ganization for whom you are performing operations sions apply: when you and such person: or organization have This insurance does not apply to: agreed in writing in a contract or agreement that such person or organization be added as an addi- 1. "Bodily injury" "property damage" or"personal tlonal insured on your policy. Such person or or- and advertising injury arising out of the render- gan'ization is an additional insured only with re- ing of,,or the failure to render,any professional spect to liability for "bodily injury", "property architectural, engineering or surveying servic- damage" or "personal and advertising Injury" es, including: caused, in whole or in part, by: a. The preparing, approving„ or failing to pre- 1. Your acts or omissions;or pare or approve, snaps, shop drawings, opi- nions, 2. The acts or omissions of those actin on your reports, surveys, field orders,change g orders or drawings and specifications;or behalf; in the performance of our ongoing operations for b. Supervisory, inspection, architectural or p Y 9 g P engineering activities. the additional insured. 2. "Bodily injury' or "property damage" occurring A person's or organization's status as an additional after insured under this endorsement ends when your operations for that additional insured are com- a. All work, including materials, parts or plated. equipment furnished in connection with such work, on the project (other than ser- vice, maintenance or repairs) to be per- formed by or on behalf of the additional in- sureds) at the location of the covered operations has been completed;or b. That portion of"your work"out of which the Injury or damage arises has been put to its Intended use by any person or organization other than another contractor or subcontrac- tor engaged in performing operations for a principal as a part of the same project. CG 20 33 07 04 0 ISO Properties, Inc.,2004 Page 1 of 1 ❑ NOHO CONST ACORO` gMMroDrYYYYI CERTIFICATE OF LIABILITY INSURANCE DATE111742017 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 confer rights to the certifi'ca'te holder I"Il'ou of such ndorsome'n't�$I. PRODUCER License#0252636 _ Unied Agencies Blvd., v Eats y 626)535-8300 mm �PHONE (nl�.-kc�p 25�J5T7-1346 mm m 301 E.Co E Pasadena,CA 91101 .._............... unsuRERa:Progressive,,,,CasualtyInsurance,Company2426Q„ NoHo Constructors Attn:Bryce Greenstein ? S[I1 ?. 1....._. p... . w.. _ .......w 4554 Willowcrst Ave .iii)tax n;_W_...w_.........................................._._.._......._.._...._..-__.. __ _ _..__ _ .........._.w..' North Hollywood,CA 91602 §gnEr? w....... ..............___._ _._....._.__ INSURER F: WI „, CERTIFICATE NUMBER: 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, wF�CU IONANDCDN0IT10NS..O...F....S...U.C..H..'..w�. IM I S SHOWN MAY HAVE .°_5.... .'.CLAIMS. ....,...,_- S _..n...,._....................... .... .. ....... A PSLIC �EFF Fp.7CYCXp TYPEOFINSURANCEPOLICY NUMBER LIMTS Jz _ . COMMERCIAL GENERAL LIABILITY pNCLAIMS-MADE C—., 0Aq�EESWq.NcTErrD OCCUR PAF1au pa��5....... S ..,C...N�1ARE� G.A,,.Tq!I'pLRIMITAPPLIESPER: � _gQAEPATE SPOLICYLOC PR I MPPWAGG. _S O76IPrr __•,w.......,...._......_�..�.....,._. C(RABINEO SINGLE LIMIT 1,000,000 A AUTOMOBILE UABIUTY .t1µaIRq'd49PlL.,.,._..�__.__�___.. _...._w,.�,_.. X ANY AUTO 04193975-0 10/09!2017 10/0912018 _qpp&y INy RY _ W ... .. ....i_. P �l OWNED ISCHEDULED V,X AUTOS% ONLY X 'AUTOS AUTOS ONLY ��r}�y�y�y� � t7PCR'Y MADE �. FII ,..,,.... ALF7'OS OMII.Y 'td.?ucc�..�a19 ,........�.,-...........�.., UMBRELLA B LIAR OCC l OCCUR .i»A.,:.. f G R,k?EN,GE.,......_.._,....,..,»._,_..._-.,.....�..._.......................... EXCESS UAB„. .- ._. CLAIMS-MADE ..A.��„REGA� $_......w........ .._ ,.. . J� r WORKERS''i DED RETENTIONS I U -- ......__.........m,m,.. �I'�....�...,..._.. � P COMPELI A IUT �... � FICERiaA ffiR EXCLUDED? NIA L S ION ANY PROPRIETORIPARTNERIEXECUTIVE E yV AN.dEMPrWYER i LUI6WTY ,L. - ...... ..T .` If yos,deenbe uPldor ,DE�SCRIP CION OF OPERATIONS below„_,,,_,_,_,,,,,,m ,„,,,,-, _ El DISEASE-POLICY!)AAIT, 5 DESC'RIPTI'ON OF OPERATIONS R LOCATIONS I VE�NnCLES (ACOR�D 1IbI AddMonal Remar6a Schedule ^ray be atuctied If more apace Is required) Project:George E.Gordon Clubhouse Playground Rasuaacin,g Project—Project No.PW 14-10 City of EI Segundo CA,Its officers and employees,and Los Angeles Region Park and Open Space District are listed as additional insured for Automobile in regards to services performed by the Insured during the referenced project,on a primary and non-contributory basis when required by written contract. .+ ,RTIFICATE'HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of EI Segundo ACCORDANCE WITH THE POLICY OION DATE VISIONSCE WILL BE DELIVERED IN City Clerk 350 Main Street __— EI Segundo,CA 90245 AUTHORIZEDREPRESENTAVVE, ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD W Additional Insured Endorsement City of EI Segundo, CA its officers and employees 350 Main Street EI Segundo, CA 90245 The person or organization named above is an insured with respect to such liability coverage as is afforded by the policy but this Insurance applies to said insured only as a person liable for the conduct of another Insured and then only to the extent of that liability.We also agree with you that insurance provided by this endorsement will be primary for any power unit specifically described on the Declarations Page. Limit of Liability Bodily Injury each person/ each accident PropertyDamage each acddent Combined Liability$1,000,000.00 each accident All other terms,limits and provisions of this policy remain unchanged. This endorsement applies to Policy Number: 04193975.0 Issued to(Name of Insured): NoHo Constructors Effective date of endorsement: 1'0109/2017 Policy expiration date: 10/09/2018 Form 1198(01104) NOHO CONST MARIA-M ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 164 � 11129/2017 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 confer ri hts to the certificate holder in lieu of such endorsement(s). _.........................................................................._9.................................................................................................................... ......................_..................._...... ............................................................................................................................................................................................ PRODUCER License#0252636 CONTACT NAME United Agencies PHONE FAx 301 E.Colorado Blvd.,#200 (AIC,No,Ext):(626)535-8300 JAIC,Nol,(626)577-1346 Pasadena,CA 91101 A 'AI INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:National Union Fire Insurance Company of Pittsburgh,Pa.19445 INSURED INSURER B: NOHo Constructors INSURER C: Attn:Bryce Greenstein 4554 Willowcrst Ave INSURER D: North Hollywood,CA 91602 INSURER E: INSURER ................... ...................................................._.,.,., F: �......................-... ..........,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.. COVERAGES ___ __ CERTIFICATE NUMBER;. REVISION NUMBER; _1.__11........1.1.._11 IIS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD RIOD 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 'OLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL.SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD W'VD (MM/DDIYYYI/I (MM/DD/YYY1/1 COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE 10 RENTED RCM !in'q.�r��rrtt',rllrr,+) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENT AC."'4REGAIT LIMIT APPLIES PER: GENERAL AGGREGATE $ ................. RO- -- ------ .......... IPOLIC'Y PR PECT LOC .... PRODUCTS-COMP/OP AGG_. $ C l"t11R .................. __. $ AUTOMOBILE LIABILITY C;'OMBIINE��D�SiNGLIE LVMtIT ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED dNP�ECRit Y DAMAGE AUTOS ONLY A"TOw� I "SII $ I A1,000,0001 AB_ I,X CLA X EXCESSLABIMS-MADE EBU034236747 11/29/2017 11/29/2018 AGER GA ERRENCE $ 1100010001 I ......_...D ED. .,,I RETENTION$ $ D WORKERS COMPENSATION V PER OTH- AND EMPLOYERS'LIABILITY STATUTE FIR ANY PROPRIETOR/PARTNER/EXECUTIVE Y d N'� EL EACH ACCIDENT „$ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) F L DISEASE FA EMPLOYE F_„ If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remark's Schedule,may be attached if more space is required) Project:George E.Gordon Clubhouse Playground Resurfacing Project 'Project No,PW 14-10 City of EI Segundo CA,its officers and employees,and Los Angeles Region Park and Open Space District are listed as additional insured. _............................................................... CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ci of EI Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City 9 ACCORDANCE WITH THE POLICY PROVISIONS. City Clerk 350 Main Street EI Segundo,CA 90245 AUTHORIZED REPRE'SEN'TATIVE' II ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NOHO CONST ALhtLRIAiVr P1 ATE(MMIDD/Y17Y) CERTIFICATE OF LIABILITY INSURANCE 1/1712017 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 Ucense#0252536 _..9.. �oVA ,en62)s535-8�,°,... _ I. Ii28w 6 PRODUCE (8 to the certificate holder In!leu of such e W encies R United .N `J` 77,-1,34 _ ._1 L( -, �.__.._ .._.., _ this certificate does not confer rl 301 E.Colorado Blvd.,#200 300 ._._._.. Pasadena,CA 91101F° �....._.....w........m............ _._.w....... ..,........... INSURERt iAFF0. D1 ,�n�.W1GE _ _..,_...-..w................_„___. .._..........m..m-__ .._ _.., m, m _....,.,..._m....F!s�+8€R _,State Campensalion.lnsurance Fund of Califomla-,3150176°°___..., INSURED MSURE 6,m,....._... ......................................_. ..�...�... NoHo Constructors Attn:Bryce Greenstein ILruwf�P.p_;_. ................ _... ..w...._. r_........__.. °°,^....r... ... 4564 Willowcrst Ave T��uRIrR._._�,,..,,.._,�.°....�...._.°..,......... North Hollywood,CA 91602 LN_kUP INSURER F COVERAGES CERTIFICATE NUMB'E'R RVISgON N'13M6ER. HIS 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AF'F'OR'D'ED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH 'OLICIES.LIMIT'S'SHOWN MAY HAVE BEEN RE'DU'CED BY PAID CLAIMS. _ _..... !NSR ..""__,m.... ._ ..... _ ADDL SUOR .. .,...,.,.POLICY EPF POLICY EXP' LIM173 COMMERCIAL TYPE t3ENERAt LIE POLICY NUMBER IatkJYl' J._tRtltal,'B.00aYY7Yt r ttt£t0.'r�Ybt... LIABILITY ,EACH pCC. RRENCE I$ ISOCCUR ES .., ...,,�_,...... .. .....m.... I CLAIMS-MADE pp m�� MAGE 0 RENTED f� .$Ev.R�3attel._ou£ ..MF.�!SMP t�?Y.��.t Pe!ac1nJ�.5�.........,............._..__..._.. - __._ ._.............._,.�,..,�m._.,......._....__...._.,.., -!?.EvR.a?. .�-8A4V IN,JURY......i..5 ,.... CIV'L......fCr AGGREGATE LIMIT APPLIES PER: 1 JEC� LOC.__.. _, .....,,.._.._... ..,,...,.....w... yPROD1TS- P. ..N ..^._COM . ,. $ , P AGO.. ................... .._..,....... .�.,.._,.....�....,,..._.�.�.,.� _� eIL,E�...... /0 POI U _ H CLbhN80FJ�E�'[7"EPhBCrG�'��I„iIA,1T A..TOIMO IL ANY AU1ORAeNI.ITW t �I�Y„I,NJ.4RV.(Pat,6aeison,..�.,�.rS._......�...w....,..,_..,.........�..�___..... CmIEUi ! SCH.�yEDULEDgq�q� _ AUTOS ONLr P..,T..°. AUT'olm,lr C ea d9aa 1 AAM'AG............ .._5.. ._,_......_. P AUTOS ODILV INJURY(Per�Ecidenll S °__m _._.. H'ur +��t;:ral.Y NLS ,...,__. �. m.,.... UMBREL1A .....7..r_..W...� ,� �.....»,»., ...,.,..W...�....�. ..,�,CF!., TRRENC ..n..,»..,,._._ .....w..__...,_,_...�.............�.._... .. FXCESSBAB ._,. . CLAOCCUR IMIi_MADE A��..+.f3 L?A.E...... °....�.,�.�__..,.........3...... ........,... A Y4ioRN;ERSCOMPENSATIONJ._., ._.�,-..,.,... ,,. .,,.,�,....,..�.._,....�... R 0 Y 01 H. �.°...., AND EMPIL ERLI N s YIN .,m_�...._.. 921858417 0912712017 09!2712018 " A�. F.. .�_..,..,........,�..._.....__�_.._...00 OED RETE AyNY� PE aa.t M - AR1NER& ,. �,� .. 1,000,000 (M�snris�dry�a'WffFrARPNE'NtPlr.k,E�CU'T'GVk�. NIA LQ.�M.�..,.�..:_�—..�.....�.,....�...__.._�...W.__....° a EIw....PISFEI--_EA.B. OYES 5 1,0 0,000 Ifyes descalate under 1,000,000 DESCRIPTION'OF OPERATIONS below E L.,,, S,,EA$E„PQL,IC�Y LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I'�A�CORD 101 Addlttnnst�Rsa'nsrko S'chsc9ula rosy be�sttachad H mon space Is requtred) Proj'el:t:George E°Gordon Clubhouse Playgroland Resul aDirlyy Project-ProJ'oct Ifo.PW t4'-10 City of EI Segundo CA,Its officers and employees,and Los Angeles Region Park and Open Space District are listed as additional insured.A Waiver of Subrogal'ion applies in favor of the additiotial Insureds on the Workers Componsallon policy,when required by written contract. CERTIFICATE„11 1�j3ER - C&NQe JPN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of EI Segundo ACCORDANCE WITH THE POLICY PROVISIONS. City Clerk 350 Main Street EI Segundo,CA 90245 AUTHORIZED R'EPRESENTA7IVYE ACORD 25(2016/1033) ®1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ENDORSEMENT AGREEMENT ROKER COPY WAIVER OF SUBROGATION 9218584-17 NEW NA HOME OFFICE SAN FRANCISCO PAGE 1 OF 1 ALL EFFECTIVE DATES ARE AT 12.01 AM PACIFIC EFFECTIVE OCTOBER 7, 2017 AT 12.01 A.M. STANDARD TIME THE TIME INDICATED ATT AND EXPIRING SEPTEMBER 27, 2018 AT 12.01 A.X. PACIFIC STANDARD TIME NOHO GENERAL ENGINEERING CONSTRUCT 4554 WILLOWCREST AVE NORTH HOLLYWOOD, CA 91602 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND � ._. WAIVES ANY RIGHT OF SUBROGATION AGAINST, City of EI Segundo, CA its officers and employees WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, NOHO GENERAL ENGINEERING CONSTRUCT IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER. IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH EMPLOYEES SHALL BE INCREASED BY 03%. NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED, NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: OCTOBER 10, 2017 2570 AUTHOnIZCD RE'PSESENT IVE PRESIDENT AND CEO SCIF FORM 10217 IREV.7.2014) OLD OP 317