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PROOF OF INSURANCE (2018) CLOSED Page 1 of 2 �� " DATE(MM/DD/YYYY) � CERTIFICATE OF LIABILITY INSURANCE lo/25/2017 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 rights to the certificate holder in lieu of such endorselrient(s). PRODUCER CONTACT NAp+lldw_ - IWillis of New York, Inc. PHONEFAX 1-877-945-7378 ,,�I1-888-467-2378 c/o 26 Century Blvd (Al�pN4s_�xtl� (AIqo?: � P.O. Box 305191 ADDREISS: certificates@willis.com ........................................... Nashville, TN 372305191 USA INSURER(S)AFFORDI,N,GCOVE,RA GE NAIC# INSURER A: Hartford Underwriters Insurance Company 30104 INSURED INSURER B: Hartford Casualty Insurance Company 29424 Elecnor Belco Electric, Inc. 4331 Schaefer Avenue INSURER C: Hartford Fire Insurance Company 19682 Chino, CA 91710 USA INSURER D: Navigators Insurance Company 42307 INSURER E: Markel Insurance Company 38970 INSURER F COVERAGES CERTIFICATE NUMBER:W4128091 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. INSRLTR TYPE OF INSURANCE IANBD DUL zPOLICY EX11 Y POLICY NUMBER IMMIDDIYYYYI IMM/DD/YY Y1 LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE PIENIIAC)OI4,pccY'D 100,000 X � OCCUR 4,I�kf=Ml_SB ti r:�evct��rserrce) $ . A MED EXP(Any one person) $ 5,000 Y Y 10 UEA EF1471 11/01/2017 11/01/2018 1,000,000 PERSONAL&ADV INJURY $ GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 — POLICY .X.. - LOC p L,... ..II f PROJECT I. RODUCTS-COMP/OP AGG 2,000,000$ AUTOMOBILE LIABILITY COMBINEDSINGLE L,IhMI I $ .............1..:..0.0.0.,0.0.0. X ANY AUTO BODILY INJURY(Per person) $ B OWNED "" SCHEDULED Y 10 UEA EF1837 11/01/2017 11/01/2018 BODILY INJURY(Per accident) $ X AUTOS ONLY AUTOS HIRED ...........'. NON-OWNED PRi5PERTY DAMAGC AUTOS ONLY AUTOS ONLY (Per Incident $ UMBRELLA OCCUR EACH OCCURRENCE $ EXCEAB SS LIA B CLAIMS-MADE AGGREGATE $ DIED I IIII ETENTION$ $ WORKERS COMPENSATION X PER I u OTH- C OFFICER/MEMBER EXCLUDED?ECUTIVE Y/N N/A Y 10 WEA AA6VQ6 11/01/2017 11/01/2018 ...E,L� EEACHACER 1,000,000 ST ACCIDENT $ (Mandatory in NH) DISEASEAE ............................ EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ D Excess Liability NY17EXC918906IV 11/01/2017 11/01/2018 $5,000,000 part of $10,000,000 excess of $5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Re: Fiber Optic Network Expansion - Project No, PW 16-33 SEE ATTACHED CERTIFICATE FOLDER 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 E1 Segundo - Dept. of Public Works AUTHORIZED REPRESENTATIVE Attn: John Gilmour 350 Main Street �� E1 Segundo, CA 90245 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 15238863 HATCH: 490879 AGENCY CUSTOMER ID: LOC#: A ADDITIONAL REMARKS SCHEDULE Page 2 of 2 (AGENCY NAMED INSURED Elecnor Belco Electric, Inc. Willis of New York, Inc, 4331 Schaefer Avenue POLICY NUMBER Chino, CA 91710 USA See Page 1 ...................................... .... . CARRIER NAIC CODE ............... ............. See Page 1 See Page 1EFFECTIVE DATE: See Page 1 ............ ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance ....................................................................... ............................._......................................... ......... The City of E1 Segundo, its officers, officials, employees and volunteers are included as Additional Insureds as respects to General Liability. General Liability policy shall be Primary to any other insurance in force for or which may be purchased by Additional Insureds. Waiver of Subrogation applies in favor of Additional Insureds with respects to General Liability, Auto Liability, and Workers Compensation, as permitted by law. INSURER AFFORDING COVERAGE: Markel Insurance Company NAIC#: 38970 POLICY NUMBER: MKLMIEUE100156 EFF DATE: 11/01/2017 EXP DATE: 11/01/2018 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Excess Liability $5,000,000 part of $10,000,000 excess of $5,000,000 ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 15238863 BAaCH: 430879 CERT. W'4128091 POLICY NUMBER: 10 AEA HF1471 t' THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - OPTION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Designated Project(s)Or Location(s) Or Organization(s): Of Covered Operations: City of E1 Segundo, its officers, Fiber Optic Network Expansion - Project officials, employees, and volunteers No, PW 16-33 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. With respect to those person(s) or organization(s) (3) In connection with "your work" for the shown in the Schedule above when you have additional insured at the project(s) or agreed in a written contract or written agreement location(s) designated in the Schedule to provide insurance such as is afforded under this and included within the "products- policy to them, Subparagraph f., Any Other completed operations hazard", but only if: Party, under the Additional Insureds When (a) The written contract or written Required By Written Contract, Written agreement requires you to provide Agreement Or Permit Paragraph of Section II — such coverage to such additional Who Is An Insured is replaced with the following: insured at the project(s) or location(s) f. Any Other Party designated in the Schedule; and Any other person or organization who is not (b) This Coverage Part provides an insured under Paragraphs a. through e. coverage for "bodily injury" or above, but only with respect to liability for "property damage" included within the "bodily injury", "property damage"or"personal "products-completed operations and advertising injury" caused, in whole or in hazard". part, by your acts or omissions or the acts or The insurance afforded to the additional omissions of those acting on your behalf: insured shown in the Schedule applies: (1) In the performance of your ongoing (1) Only if the "bodily injury" or "property operations for such additional insured at damage" occurs, or the "personal and the project(s) or location(s) designated in advertising injury"offense is committed: the Schedule; (a) During the policy period; and (2) In connection with your premises owned by or rented to you and shown in the (b) Subsequent to the execution of such Schedule; or written contract or written agreement; and Form HS 24 80 07 13 Page 1 of 2 © 2013, The Hartford (Includes copyrighted material of Insurance Services Office, Inc., with its permission.) (c) Prior to the expiration of the period of When You Add Others As An Additional time that the written contract or written Insured To This Insurance agreement requires such insurance (a) Primary Insurance When Required By be provided to the additional insured. Contract (2) Only to the extent permitted by law; and This insurance is primary if you have agreed (3) Will not be broader than that which you in a written contract or written agreement that are required by the written contract or this insurance be primary. If other insurance written agreement to provide for such is also primary, we will share with all that additional insured. other insurance by the method described in With respect to the insurance afforded to the Paragraph (c) below. This insurance does not person(s) or organization(s)that are additional apply to other insurance to which the insureds under this endorsement, the additional insured in the Schedule has been following additional exclusion applies: added as an additional insured. This insurance does not apply to "bodily (b) Primary And Non-Contributory To Other injury", "property damage" or "personal and Insurance When Required By Contract advertising injury" arising out of the rendering This insurance is primary to and will not seek of, or the failure to render, any professional contribution from any other insurance architectural, engineering or surveying available to an additional insured under your services, including: policy provided that: (1) The preparing, approving, or failing to (i) The additional insured in the Schedule is prepare or approve maps, shop drawings, a Named Insured under such other opinions, reports, surveys, field orders, insurance; and change orders, designs or specifications; (ii) You have agreed in a written contract or or written agreement that this insurance (2) Supervisory, inspection, architectural or would be primary and would not seek engineering activities. contribution from any other insurance The limits of insurance that apply to the additional available to the additional insured in the insured shown in the Schedule are described in the Schedule. Limits Of Insurance section. (c) Method Of Sharing How this insurance applies when other insurance is If all of the other insurance permits available to the additional insured is described in the contribution by equal shares, we will follow Other Insurance Condition in Section IV — this method also. Under this approach, each Commercial General Liability Conditions, except as insurer contributes equal amounts until it has otherwise amended below. paid its applicable limit of insurance or none of B. With respect to insurance provided to the the loss remains,whichever comes first. person(s) or organization(s) that are additional If any of the other insurance does not permit insureds under this endorsement, the When You contribution by equal shares, we will Add Others As An Additional Insured To This contribute by limits. Under this method, each Insurance subparagraph, under the Other insurer's share is based on the ratio of its Insurance Condition of Section IV—Commercial applicable limit of insurance to the total General Liability Conditions is replaced with the applicable limits of insurance of all insurers. following: All other terms and conditions in the policy remain unchanged. Page 2 of 2 Form HS 24 80 07 13 Policy No. 10 WEA AA6VQ6 it' THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA ok- 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 otherWAWdbe Galdbahiaenu*eraticam pen sation premium SCHEDULE Person or Organization City of El Segundo, its officers, officials, employees and volunteers RE: Fiber Optic Network Expansion - Project No. , PW 16-33 Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date: Policy Expiration Date: