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PROOF OF INSURANCE (2018) CLOSED (2) DATE(MMIDD/YYYY) C�i � CERTIFICATE OF LIABILITY INSURANCE 12/512017 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 certificate holder in lieu of such endorsement(s). TACT PRODUCER N gg CN 19000 MacArthur Blvd. PH Floor PHONE (EPIC) NAME; XNo ' (9as)263-0606 ( FAX No): (949)263-0906 Irvine, CA 92612 -MAID. AQPRIs0; INSURERS)AFFORDING COVERAGE NAIC# www.edgewoodins.com INSURER A: Travelers,Property Casualty Company of America 25674 INSURED INSURER B: Travelers JM Diaz, Inc. INSURER c: Travelers Casualty and Surety194 I Indemnity Company of CT DBA: JMD p Y„ encs 25682 Coo m.... 18645 E. Gale Ave., Ste#212 INSURER D: City of Industry CA 91748 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 39102660 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 'OLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL BURR POLICY EFF PWdY EXP LIMITS LTR IN�,p POLICY NUMBER IMMIDD/YYYYI IMMPDOfYY'Y'Yh RAL LIABILITY `/ `/ 680-2J330994 6/27/2017 6/27/2018 EACH OCCURRENCE CLAIMS-MADE $1,000,040 A A COMMERCIAL GENE (OCCUR L)AMAG �l7 ES(Ea orrurrPnra) $1,000,000 MED EXP(Any one person) $5,,000 PERSONAL&ADV INJURY $1,004,000 'E.N L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $2,000,000 Gx PE POI.,Id:Y wLOC PRODUCTS-COMP/OP AGG $2,000„000 I•.. GT'HER Deductible $None C AUTOMOBILE LIABILITY BA-4J373941 6/27/2017 6/27/2018 COMBINED SING'LE''LIMIT $1,000,000 ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS NON-OWNEDHIRED (Peraccident)YAMAGE $ D J AUTOS ONLY ✓ AUTOS ONLY (Per ryryry $ A UMBRELLA AB � OCCUR CUP-71606764 6/27/2017 6/27/2018 OCCURRENCE EXCESS LABLAIMS-MADE AGGREGATE $z 00 m404 DED Q I RETENTION$0 Prod/Co-Ops $2,000000 A WORKERS COMPENSATION UB-4288T923 6/27/2017 6/27/2018 ,/ (STATUTEETH AND OFFICER/MEMBER EXCLUDEDX ECUTIVE Y%N NIA E.L.EACH ACCIDENT $$1,000,000 L L L 1,QO .. ...., ibe under DIf ESCRIPTION OF OPERATIONS be o � � E.L.DISEASE-POLICY LIMIT E $1,000.000 000 B,..,Professional Liability 105263164 6/27/2017 6/27/2018 $2,000,000 per Claim Claims Made Form $2,000,000 Aggregate Knowledge Date:4/8/2005 $10,000 Per Claim Deductible DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: PW 17-35 On-Call Traffic Engineering Services Certificate holder(s)are named as Additional Insureds as respects General Liability per endorsement CG D3 81 09/15 and as respects Hired and Non-Owned Automobile Liability per endorsement CA T4 37 02/16,but only where required by written contract with the Named Insured prior to an occurrence and subject to all policy terms,conditions and exclusions. Work Comp Waiver of Subrogation per WC 99 03 76(A) i, CERTIFICATE HOLDER CANCELLATION City of EI Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PUNIC Works ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street EI Segundo CA 90220 AUTHORIZED REPRESENTATIVE Todd Holliday `” ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 39102660 1 17-18 GL, AU, w/AI, WC, Umb, Prof. Kim Pechar 1 12/5/2017 4:32:25 PM (PST) I Page 1 of 5 uwDiaz,Inc. COMMERCIAL GENERAL LIABILITY 680-2J330894 THIS ENDORSEMENT CHANGES THE POLACY, PLEASE READ Ul[CAREFULLY. BLANKET ����8�8^����N U���N0���� �����*�m�� m ADDITIONAL �m��������� (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART m 1. The following is added to SECTION 11 — WHO IS h. This insurance does not apply to "bodily AyA |NS0RED: injury' or "property damage" caused by "your � Any person or organization that you agree in a work" and included in the "'products- "written insurance" completed operations hazard" unless the anadditional insured unthis Coverage Part, but: '\wrbten contract requiring insurance" specifically requires you to provide such a' Only with respect to liability for"bodily inju0°, coverage for that additional insumed, and then "property damage"mr"personal injury"; and the insurance provided to the additional b. if, and only to the extent that. the injury or insured applies only to such "bodily injury" or damage is caused by ado or omissions of "property damage"that occurs before the end you oryour subcontractor in the performance of the period of time for which the "written of "Your work" to which the "written contract contract requiring insurance" requires you to requiring insurance" applies, or in connection provide such coverage or the end of the with premises owned byorrented toyou. policy period, whichever isearlier. The person ororganization does not qualify asan 2. The following is added to Paragraph 4La' of additional insured: SECTION IV — COMMERCIAL GENERAL c. With respect to the independent acts CONU�KTI«��0��' � m, ' omnissionsofsuch person ororganizmbon; pr The insurance provided tothe additional insured is excess over any valid and collectible other �, For "bodily injury", "property damage" or insurance, whether prin�ar� excess, conbnQerdor "personal injury" for which such person or on any other baais, that is available to the organization has assumed liability in a additional insured for a |mso we cover. However, if contract oragreement. you specifically agree in the "written contract The insurance provided Umsuch additional insured requiring insurance" that this insurance provided islimited msfollows: kothe additional insured tinder this Coverage Part must apply on a primary basis or pr\ � �, �hisin�unanc� doe� nota�p�omanybas|stn non-contributory basis, this insurance is primary any person or organization for which to other insurance available to the additional coverage as an additional insured specifically insured which covers that person or organizations is added by another endorsement to this amanamed insured for such loss, and m/ewill not Coverage Part. share with the other insurance, provided that: f. This insurance does not aPP|X to the (1) The "bodily injury" ur "property damage" for rendering of or failure to render any which coverage issought occurs; and "professional services". (2) The "personal injury' for which coverage is |nthe event that the Linm�sofinsurance mfthe soughtoriaesuutanofensecomnmitted; Coverage part shown in the Declarations exceed the limits of liability required by the after you have signed �hs� "written contract "written contract requiring imsuramce.., the requiring insurance". But this insurance provided inourancvid tmthe addhiona\ insured still is excess over valid d to the additional insured~ provided shaUbelimited tmthe limits ofliability required and collectible other insurance, whether primary, "y, " enzea� contingent or any basis, that is by that "written contract requiring insurance". ' ' additional insured when that This endorsement does not increase the available to the add limits of insurance described in Section \|| _ person or organization is an additional insured Limits OfInsurance. under any other insurance. CG D3 81 09 15 Q 2o1sThe Travelers indemnity Company.All rights reserved. Page of includes the copyrighted material of Insurance Services Office,Inc.,with its permission COMMERCIAL GENERAL LIABILITY 3. The following is added to Paragraph 8., Transfer 4. The following definition is added to the Of Rights Of Recovery Against Others To Us, DEFINITIONS Section: of SECTION IV — COMMERCIAL GENERAL "Written contract requiring insurance" means that LIABILITY CONDITIONS: part of any written contract under which you are We waive any right of recovery we may have required to include a person or organization as an against any person or organization because of additional insured on this Coverage Part, payments we make for "bodily Injury", "property provided that the "bodily injury" and "property damage" or "personal injury" arising out of "your damage" occurs and the "personal injury' is work" performed by you, or on your behalf, done caused by an offense committed: under a "written contract requiring insurance" with that person or organization. We waive this right a. After you have signed that written contract; only where you have agreed to do so as pad of b. While that part of the written contract is in the "written contract requiring insurance"' with effect; and such person or organization signed by YOU before, and in effect when, the "bodily injury" or c. Before the end of the policy period. "property damage" occurs, or the"personal injury" offense is committed. O U OEM Page 2 of 2 032015 The Travelers Indemnity Company,All rights reserved. CG D3 8109 15 Includes the copyrighted material of Insurance Services Office,Inc.,with its permission 014149 39102660 1 17-16 GL, AU, w/Af, WC, Umb, Prof. I Kim Pechar 1 12/5/2017 4:32:25 PM (PST) I Page 3 of 5 JM Diaz, Inc. BA-4J373941 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM The following is added to Paragraph c. in A.1., Who between you and that person or organization, that is Is An Insured, of SECTION 11 — COVERED AUTOS signed by you before the "bodily injury" or "property LIABILITY COVERAGE in the BUSINESS AUTO damage" occurs and that is in effect during the policy COVERAGE FORM and Paragraph e.in A.1.,Who Is period, to name as an additional insured for Covered An Insured, of SECTION II — COVERED AUTOS Autos Liability Coverage, but only for damages to LIABILITY COVERAGE in the MOTOR CARRIER which this insurance applies and only to the extent of COVERAGE FORM, whichever Coverage Form is that person's or organization's liability for the conduct part of your policy: of another"insured". This includes any person or organization who you are required under a written contract or agreement CA T4 37 02 16 ©2016 The Travelers Indemnity Company.All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office,Inc,with its permission. ( ,r ,n 0k, AU, W/All, WC, umb, x<<r. ( rn r<<<a oiv a:sc:c; (W (E'ST) I U-3o n of Agbk TRAVELWORKERS CONMPENSATION ONE TOWER SWARE EMPLOYERS LIABILITY POLICY HARTFORD, CT 06183 ENDORSEMENT WC 99 03 76 ( A)-- 001 POLICY NUMBER:UB-4288T923 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 hot enforce our right against the person or organization narned in the Schedule. The additional prernium for this endorsement shall be % of the California workers' compensation pre- mium, Schedule Person or Organization Job Description ANY PERSON OR ORGANIZATION EOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER T This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. l(The information below is required only when this endorsement is issued subsequent to preparation of the policy.) "—' Endorsement Effective6/27/2017 Policy No. UB-4288T923 Endorsement No. Insured JM Diaz, Inc. Premium DBA: JMD Insurance Company Countersigned by._,µ __._ DATE OF ISSUE:12/5/2017 ST ASSIGN: Page T of 1 )Jtl6C2 39102660 1 17-18 GL, AU, w/AI, WC, Umb, Prof. I Kim Pechar 112/5/2017 4:32:25 PM (PST) I Page 5 of 5