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PROOF OF INSURANCE (2018 - 2018) CLOSED CERTIFICATE OF LIABILITY INSURANCE FDATE(MMIDDM(YY) 4r1,,,,,,w,. 12/12/2017 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). CONT PRODUCER NAHO NE ME: Marie SwaneyDealey, Renton ................................ .FAX ., e... 199 S Los Pasadena CA Robles #540 Associates E-MAILn. ss xtmswar$Y oeaNyr atl; .ppx...............................�...70 NS...:...t;...................... Lic#0020739 INSURERtS4,AF,F,ORDING COVERAGE NAIC# INSURERA:TraVelerS P y4 . ro ert Y INSURED CWAAIAINC INSURER B.Hartford atOrS Insurance &, COmIndemnity 22357 CWA,AIA, Inc. INSURER.C......... ...m............................... Co0 0 men 256 320 Arden Avenue, Suite 210 __.....-....................N........migat..s I surance p.._Y a o Glendale, CA v - 91203 Travelers Indemnity Co.of Connecticut 25682 818-240-5456 INSURER E: ...................................................... INSURER F: COVERAGES CERTIFICATE NUMBER: 1044807551 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE IN LN4 -....... POLICY.NUMBER.........................., .-----.—... F—PO– ------„ /NSR' AODL S POLICY EFF POLICY EXP LIMITS ,� ._._.,...... __ dMMrODJYYMYa (MMIDD/YYYY) A X COMMERCIAL GENERAL LIABILITY Y Y 6807H1772B2 10/9/2017 10/9/2018 EACH OCCURRENCE CLAIMS-MADE r X OCCUR RMA/„ EYO'R'NT encel ....$.. 000,000 ���P�EM SE, $1,000,000 ab...... ME ..m. .X Contractual.I .. atl�. ....b D EXP(Any one person) $10,000 I .. ,PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE .�..._. N C..m.., $ 4,000,000 FOX LOC PRODUCTS-COMP/OP AGG $4,000,000 OTI R $ _........ a ?... D AUTOMOBILE LIABILITY Y Y BA5367LOMBdh1d' 320 1019/2017 10/9/2018 SINGLEd.,IMI r tEaa ,cciden Id 1 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED 'SCHEDULED BODILY ..INJURY(Peraccident) $ .X HIRED AUTOS n.__m. ANON--O-OWNED M...e.......... X AGE. $ UTOS NOOwned Auto $ ....... , UMBRELLA .L.I.A...R........................ .O..... UR,,, W .u. L....A....C...H... OCCURRENCE $ EXCESS IAB CLAIMS-MADE EACH $ DED RETENTION$ $ B WORKERS COMPENSATIONY 72WEGGA4541 9/1/2017 9/1/2018 X V STATUTE ERH AND EMPLOYERS'LIABILITY Ipdp�Y�I N ANY 4... � N/A ....... ..................". OFFICER/MEMBEE,EXCLUDED? PROPRIETOR/PARTNER/EXECUTIVE E,L.DISEASE-,/DENT $1,000,000 L CC Mandato In NH E EA EMPLOYEE $1,000,000 If yes,desc ibe under DESCRIPTION OF OPERATIONS below E,L DISEASE-POLICY LIMIT $1,000,000 C Professional Liability DN17DPL0084291V 10/1/2017 10/1/2018 $1,000,000 per claim $2,000,000 Annual Aggregate DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Insured owns no company vehicles;therefore hired/non-owned auto is the maximum coverage that applies.WC Blanket waiver applies per attached policy endorsement. RE:Pro)#PW 18-04,EI Segundo City Library Interior Design for WiFi Station,350 Main St,EI Seundo,CA 90245 -- City of F'l Segundo,its officers, representatives,employees and volunteers are named as additional insured as respects general W auto liability as required per written contract or agreement. General Liability is Primary/Non-Contributory per policy form wording. Insurance coverage inOudos waiver of subrogation per the attached endorserrient(s). CERTIFICATE HOLDER CANCELLATION 30(fay Notice SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of EI Segundo, Public Works ACCORDANCE WITH THE POLICY PROVISIONS. Attn:Arianne Bola 350 Main St AUTHORIZED REPRESENTATIVE EI Segundo CA 90245 I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY POLICY NUMBER:68071-1177282 ISSUE DATE: 12/12/2017 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, SCHEDULED ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE NAME OF PERSONS OR ORGANIZATIONS: City of EI Segundo, Public Works Attn:Arianne Bola 350 Main St � EI Segundo CA 90245 PROJECT/LOCATION OF COVERED OPERATIONS: City of EI Segundo, its officers, representatives, employees and volunteers -- RE: Proj #PW 18-04, EI Segundo City Library Interior Design for WiFi Station, 350 Main St, EI Segundo, CA 90245 PROVISIONS 1. The following is added to SECTION II - WHO IS The insurance provided to such additional insured AN INSURED: is limited as follows: The person or organization shown in the Sched- e. 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: services". a. Only with respect to liability for"bodily injury", f. In the event that the Limits of Insurance of the "property damage"or"personal injury"; and Coverage Part shown in the Declarations ex- b. If, and only to the extent that, the injury or ceed the limits of liability required by the "writ- damage is caused by acts or omissions of ten contract requiring insurance", the insur- you or your subcontractor in the performance ance provided to the additional insured shall of "your work" to which the "written contract be limited to the limits of liability required by requiring insurance" applies, or in connection that "written contract requiring insurance". with premises owned by or rented to you. This endorsement does not increase the lim- its of insurance described in Section III - Lim- The person or organization does not qualify as an its Of Insurance. Lim- additional insured: g. This insurance does not apply to "bodily inju- c. With respect to the independent acts or orris- ry" or "property damage" caused by "your sions of such person or organizatioor work" and included in the "products- d. For"bodily injury", "property damage" or"per- completed operations hazard" unless the sonal injury" for which such person or organi- "written contract requiring insurance" specifi- zation has assumed liability in a contract or cally requires you to provide such coverage agreement. for that additional insured, and then the insur- ance provided to that additional insured ap- CG D3 82 09 15 ©2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 2 Includes the copyrighted material of Insurance Services Office, Inc., with its permission COMMERCIAL GENERAL LIABILITY plies only to such "bodily injury" or "property 3. The following is added to Paragraph 8., Transfer damage"that occurs before the end of the pe- Of Rights Of Recovery Against Others To Us, riod of time for which the "written contract re- of SECTION IV - COMMERCIAL GENERAL LI- quiring insurance" requires you to provide ABILITY CONDITIONS: such coverage or the end of the policy period, We waive any right of recovery we may have whichever is earlier. against the additional insured shown in the 2. The following is added to Paragraph 4.a. of SEC- Schedule above because of payments we make TION IV - COMMERCIAL GENERAL LIABILITY for"bodily injury", "property damage" or"personal CONDITIONS: injury" arising out of"your work" on or for the pro- The insurance provided to the additional insured ject, or at the location, shown in the Schedule shown in the Schedule above is excess over any above, performed by you or on your behalf, done valid and collectible other insurance, whether under a "written contract requiring insurance"with primary, excess, contingent or on any other basis, that person or organization. We waive this right that is available to the additional insured for a loss only where you have agreed to do so as part of we cover. However, if you specifically agree in the the "written contract requiring insurance" with "written contract requiring insurance" that this in- such person or organization signed by you be- surance provided to the additional insured under fore, and in effect when, the "bodily injury" or this Coverage Part must apply on a primary basis "property damage" occurs, or the "personal injury" or a primary and non-contributory basis, this in- offense is committed. surance is primary to other insurance available to 4. The following definition is added to the DEFINI- the additional insured which covers that person or TIONS Section: organization as a named insured for such loss, "Written contract requiring insurance" means that and we will not share with the other insurance, part of any written contract with the person or or- provided that: ganizations shown in the Schedule above, under (1) The "bodily injury" or "property damage" for which you are required to include that person or which coverage is sought occurs; and organization as an additional insured on this Cov- (2) The "personal injury" for which coverage is erage Part, provided that the "bodily injury" and sought arises out of an offense committed; "property damage" occurs and the "personal inju- after you have signed that"written contract requir- ry" is caused by an offense committed: ing insurance". But this insurance provided to the a. After you have signed that written contract; additional insured still is excess over valid and b. While that part of the written contract is in ef- collectible other insurance, whether primary, ex- fect; and cess, contingent or on any other basis, that is c. Before the end of the policy period. available to the additional insured when that per- son or organization is an additional insured under any other insurance. Page 2 of 2 0 2015 The Travelers Indemnity Company. All rights reserved. CG D3 82 09 15 Includes the copyrighted material of Insurance Services Office, Inc.,with its permission POLICY NUMBER:BA5367L320 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:CWA, AIA, Inc. Endorsement Effective Date: 10/9/2017 SCHEDULE Name Of Person(s)Or Organization(s):City of EI Segundo, its officers, representatives, employees and volunteers -- RE: Proj #PW 18-04, EI Segundo City Library Interior Design for WiFi 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.I. 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 10 13 ©Insurance Services Office, Inc., 2011 Page 1 of 1 Policy Number: BA5367L320 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM The following replaces Paragraph A.5., Transfer of required of you by a written contract executed Rights Of Recovery Against Others To Us, of the prior to any "accident" or'loss", provided that the CONDITIONS Section: "accident" or "loss" arises out of the operations 5. Transfer Of Rights Of Recovery Against Oth- contemplated by such contract. The waiver ap- ers To Us plies only to the person or organization desig- We waive any right of recovery we may have nated in such contract. against any person or organization to the extent CA T3 40 02 15 ©2015 The Travelers Indemnity Company.All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc.with its permission. Workers' Compensation and Employers' Liability Insurance Policy Waiver of Our Right to Recover From Others Endorsement - California WC 04 03 06 If the following information is not complete, refer to the appropriate Schedule attached to the policy. Insured: CWA, AIA, Inc. Policy Number 72WEGGA4541 Producer: Dealey, Renton&Associates Effective Date 9/1/2017 Schedule Person or Organization Job Description City of El Segundo, Public Works Insured owns no company vehicles; therefore Attn: Arianne Bola hired/non-owned auto is the maximum coverage that 350 Main St applies. WC Blanket waiver applies per attached policy EI Segundo CA 90245 endorsement. RE: Proj#PW 18-04, EI Segundo City Library Interior Design for WiFi Station, 350 Main St, EI Segundo, CA 90245 -- City of EI Segundo, its officers, representatives, Additional Premium % employees and volunteers are named as additional insured as respects general &auto liability as required per We have the right to recover our payments from any- You must maintain payroll records accurately segre- one liable for an injury- covered by this policy. We gating the remuneration of your employees while en- will not enforce our right against the person or gaged in the work described in the Schedule. organization named in the Schedule. (This agreement applies only to the extent that you perform work The additional premium for this endorsement shall be under a written contract that requires you to obtain the percentage, as shown in the Schedule applicable this agreement from us.) to this endorsement, of the California workers' compensation premium otherwise due on such remuneration. Authorized Representative WC040306