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PROOF OF INSURANCE (2019) CLOSED ACCOR"® CERTIFICATE OF LIABILITY INSURANCE I DATE6/15/2018 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 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). PRODUCER Edgewood Partners Insurance Center (EPIC) I CONTACT 19000 MacArthur Blvd. PH FloorPHONE FAx Irvine, CA 92612 I(A/C,No.Ext): (949)263-0606 (A/C.No): (949)263-0906 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# www.edgewoodins.com INSURERA: Travelers Property Casualty Company of America 25674 INSURED INSURER B: Travelers Casualty and Surety Co America 31194 JM Diaz, Inc. I DBA: JMD INSURERC: Travelers Indemnity Company of CT 25682 18645 E. Gale Ave., Ste#212 I INSURER D: City of Industry CA 91748 I INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 42556608 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A / COMMERCIAL GENERAL LIABILITY / / 680-2J330994 6/27/2018 6/27/2019 EACH OCCURRENCE $1,000,000 DAMAGE RENTE CLAIMS-MADE 1✓ OCCUR PREM SESO(Ea occur ence) $1,000,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $2,000,000 POLICY PE LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: Deductible $None C AUTOMOBILE LIABILITY ✓ ✓ BA-4J373941 6/27/2018 6/27/2019 (EaacccidentSINGLE LIMIT $1,000,000 ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ ✓ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ ✓ AUTOS ONLY ✓ AUTOS ONLY (Per accident) A / UMBRELLALIAB ,/ OCCUR ,/ CUP-7E606764 6/27/2018 6/27/2019 EACH OCCURRENCE $2,000,000 EXCESS LAB H CLAIMS-MADE AGGREGATE $2,000,000 DED I I RETENTION$0 Prod/Co-Ops $2,000,000 A WORKERS COMPENSATION ✓ UB-6K869402 6/27/2018 6/27/2019 / SPER TATUTE OERH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $1,000,000 OFFICE R/M EMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1.000.000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 B Professional Liability 105263164 6/27/2018 6/27/2019 $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/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) RE: EI Segundo Bikeway Project Agreement Certificate holder(s)are named as Additional Insureds as respects General Liability per endorsement CG D3 81 09/15 and as respects 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. CERTIFICATE HOLDER CANCELLATION City of EI Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 350 Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN EI Segundo CA 90220 ACCORDANCE WITH THE POLICY PROVISIONS. 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 42556608 118-19 GL, AU, w;AI, WC, Umb, Prof. I Kim Pechar 16;15;2018 10:13:56 AM (PDT) I Page I of 4 JM Diaz,— COMMERCIAL GENERAL LIABILITY 680-2J330994 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ����N������N 0������ ��^�m�m�� m ADDITIONAL mu������� (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1' The following is added to SECTION W — WHO IS h. This insurance does not apply to "bodily ANINSURED: injury" or "property damage" caused by "your Any person or organization that you agree in a work" and included in the "produds- "xxrbtencontract requiring insurance"buinclude as completed operations hazard" unless the anadditional insured onthis Coverage Part, but: "written contract requiring insurance" specifically requires you to provide such a, Only with respect to liability for "bodily injury', coverage for that additional inuured, and then "property damage" or"personal in]ury'; 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 acts 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" mppUes, or in connection provide such coverage or the end of the with premises owned byorrented hmyou. policy period, whichever isearlier. The person ororganization does not qualify as an 2. The following is added to Paragraph 4.a. of additional insured: SECTION IV — COMMERCIAL GENERAL c. With �k����U�1l������P���U�|«�A|��' h respect to the independent acts or ' omissions ofsuch person ororganization; or The insurance provided tothe additional insured is excess over any valid and collectible other �^ For "bodily injury", "property damage" or insurance, m/hetherphnoaDKexcess, contingent or "personal injury" for which such person or on any other basis, that is available to the organization has assumed liability in a additional insured for m loss we cover. Hom/ever, if contract nragreement. you specifically agree in the "written contract The insurance provided tusuch additional insured requiring insurance" that this insurance provided iylimited asfollows: tothe additional insured under this Coverage Part must apply on a primary basis or a primary and �^ Thi� in�ur�ncedoe� nota �nybasist» non-contributory bayis, this insurance is primaryany person or organization for whicht� other insuran�� �v�i|ab|� to �he additional as an additional insured spechicaUv insured which covers that person or organizations i� added by another endorsement to this as ananned insured for such loss, and vxewill not Coverage Part. share with the other insurance, provided that: f. This insurance does not apply to the (1) The "bodily injury' or "property damage" for rendering of or failure to render any which coverage \ssought occurs; and "professional services", (2) The "personal injury" for which coverage is g. |nthe event that the Limits mfInsurance ofthe sought arises out nfanoffense curnrnh1ed� Coverage Part shown in the Declarations exceed the limits of liability required by after you have signed that "written contract �mrkten contract requiring insurance"'~ the requiring insurance". But this insurance provided iuthe addi�ona! insured still is excess over valid insurance provided to the additional insured shall be limited to the |(nnhs of liability required and collectible other insurance, whether primary,~ excesscnnting�ntorun anyoth�r basisthat is bvthat "m/rh1�n �ontra�� requiring insuranc�". ' ' `^ available to the additional insured when that This endorsement does not increase the limits of insurance described in Section ||| — person or organization is an additional insured under any other insurance Lin}hs �f|nsur�nc�. ' CG D3 81 09 15 2o1sThe Travelers Indemnity Company.All rights reserved. Page 1 of mdudom 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 toinclude aperson ororganization asan 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 cf "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. VVewaive 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 ineffect when, the "bodily injury" or c, Before the end nfthe policy period. "property damage" occurs, or the "personal injury" offense iscommitted. Page 2 of Q 2n1xThe Travelers Indemnity Company.All rights reserved. CG D3 81 09 15 Includes the copyrighted material of Insurance Services Office,Inc.,with its permission 014149 Jmoiaz Inc. BA-4J373941 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY' BLANKET ��������^���U U������n ���.��n�n��~ o ���w�rnno��n���u~ no�����n��~�� 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.i.. Who between you and that person or organization, that is Is An Insured, of SECTION || — COVERED AUTOS signed by you before the "bodily injury or "property LIABILITY COVERAGE in the BUSINESS AUTO domaga" occurs and that ia in effect during the policy COVERAGE FORM and Paragraph m. inA'1,Who |s period, tuname moanadditional insured for Covered An Insured, of SECTION || — COVERED AUTOS Autos Liability Covenoga, but only for damages to LIABILITY COVERAGE in the K0C2TK}R CARRIER which this insurance applies and only tuthe extent of COVERAGE FORM, whichever Coverage Form in that person's or organization's liability for the conduct part cfyour policy: ofanother"inoured" This includes any person ororganization who you are required under m written contract or agreement CAT4370318 @xu10The Travelers Indemnity Company.All rights moeme . Page 1cf1 Includes copyrighted material mInsurance Services Office, Inc.with its permission. ACCOR"® CERTIFICATE OF LIABILITY INSURANCE I DATE6/15/2018 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 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). PRODUCER Edgewood Partners Insurance Center (EPIC) I CONTACT 19000 MacArthur Blvd. PH FloorPHONE FAx Irvine, CA 92612 I(A/C,No.Ext): (949)263-0606 (A/C.No): (949)263-0906 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# www.edgewoodins.com INSURERA: Travelers Property Casualty Company of America 25674 INSURED INSURER B: Travelers Casualty and Surety Co America 31194 JM Diaz, Inc. I DBA: JMD INSURERC: Travelers Indemnity Company of CT 25682 18645 E. Gale Ave., Ste#212 I INSURER D: City of Industry CA 91748 I INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 42556609 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A / COMMERCIAL GENERAL LIABILITY / / 680-2J330994 6/27/2018 6/27/2019 EACH OCCURRENCE $1,000,000 DAMAGE RENTE CLAIMS-MADE 1✓ OCCUR PREM SESO(Ea occur ence) $1,000,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $2,000,000 POLICY PE LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: Deductible $None C AUTOMOBILE LIABILITY ✓ ✓ BA-4J373941 6/27/2018 6/27/2019 (EaacccidentSINGLE LIMIT $1,000,000 ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ ✓ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ ✓ AUTOS ONLY ✓ AUTOS ONLY (Per accident) A / UMBRELLALIAB ,/ OCCUR ,/ CUP-7E606764 6/27/2018 6/27/2019 EACH OCCURRENCE $2,000,000 EXCESS LAB H CLAIMS-MADE AGGREGATE $2,000,000 DED I I RETENTION$0 Prod/Co-Ops $2,000,000 A WORKERS COMPENSATION ✓ UB-6K869402 6/27/2018 6/27/2019 / SPER TATUTE OERH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $1,000,000 OFFICE R/M EMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1.000.000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 B Professional Liability 105263164 6/27/2018 6/27/2019 $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/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe 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 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) CERTIFICATE HOLDER CANCELLATION CIt of EI Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Pu lun ic 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 42556609 118-19 GL, AU, w;AI, WC, Umb, Prof. I Kim Pechar 16;15;2018 10:13:56 AM (PDT) I Page I of 5 JM Diaz,— COMMERCIAL GENERAL LIABILITY 680-2J330994 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ����N������N 0������ ��^�m�m�� m ADDITIONAL mu������� (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1' The following is added to SECTION W — WHO IS h. This insurance does not apply to "bodily ANINSURED: injury" or "property damage" caused by "your Any person or organization that you agree in a work" and included in the "produds- "xxrbtencontract requiring insurance"buinclude as completed operations hazard" unless the anadditional insured onthis Coverage Part, but: "written contract requiring insurance" specifically requires you to provide such a, Only with respect to liability for "bodily injury', coverage for that additional inuured, and then "property damage" or"personal in]ury'; 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 acts 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" mppUes, or in connection provide such coverage or the end of the with premises owned byorrented hmyou. policy period, whichever isearlier. The person ororganization does not qualify as an 2. The following is added to Paragraph 4.a. of additional insured: SECTION IV — COMMERCIAL GENERAL c. With �k����U�1l������P���U�|«�A|��' h respect to the independent acts or ' omissions ofsuch person ororganization; or The insurance provided tothe additional insured is excess over any valid and collectible other �^ For "bodily injury", "property damage" or insurance, m/hetherphnoaDKexcess, contingent or "personal injury" for which such person or on any other basis, that is available to the organization has assumed liability in a additional insured for m loss we cover. Hom/ever, if contract nragreement. you specifically agree in the "written contract The insurance provided tusuch additional insured requiring insurance" that this insurance provided iylimited asfollows: tothe additional insured under this Coverage Part must apply on a primary basis or a primary and �^ Thi� in�ur�ncedoe� nota �nybasist» non-contributory bayis, this insurance is primaryany person or organization for whicht� other insuran�� �v�i|ab|� to �he additional as an additional insured spechicaUv insured which covers that person or organizations i� added by another endorsement to this as ananned insured for such loss, and vxewill not Coverage Part. share with the other insurance, provided that: f. This insurance does not apply to the (1) The "bodily injury' or "property damage" for rendering of or failure to render any which coverage \ssought occurs; and "professional services", (2) The "personal injury" for which coverage is g. |nthe event that the Limits mfInsurance ofthe sought arises out nfanoffense curnrnh1ed� Coverage Part shown in the Declarations exceed the limits of liability required by after you have signed that "written contract �mrkten contract requiring insurance"'~ the requiring insurance". But this insurance provided iuthe addi�ona! insured still is excess over valid insurance provided to the additional insured shall be limited to the |(nnhs of liability required and collectible other insurance, whether primary,~ excesscnnting�ntorun anyoth�r basisthat is bvthat "m/rh1�n �ontra�� requiring insuranc�". ' ' `^ available to the additional insured when that This endorsement does not increase the limits of insurance described in Section ||| — person or organization is an additional insured under any other insurance Lin}hs �f|nsur�nc�. ' CG D3 81 09 15 2o1sThe Travelers Indemnity Company.All rights reserved. Page 1 of mdudom 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 toinclude aperson ororganization asan 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 cf "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. VVewaive 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 ineffect when, the "bodily injury" or c, Before the end nfthe policy period. "property damage" occurs, or the "personal injury" offense iscommitted. Page 2 of Q 2n1xThe Travelers Indemnity Company.All rights reserved. CG D3 81 09 15 Includes the copyrighted material of Insurance Services Office,Inc.,with its permission 014149 Jmoiaz Inc. BA-4J373941 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY' BLANKET ��������^���U U������n ���.��n�n��~ o ���w�rnno��n���u~ no�����n��~�� 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.i.. Who between you and that person or organization, that is Is An Insured, of SECTION || — COVERED AUTOS signed by you before the "bodily injury or "property LIABILITY COVERAGE in the BUSINESS AUTO domaga" occurs and that ia in effect during the policy COVERAGE FORM and Paragraph m. inA'1,Who |s period, tuname moanadditional insured for Covered An Insured, of SECTION || — COVERED AUTOS Autos Liability Covenoga, but only for damages to LIABILITY COVERAGE in the K0C2TK}R CARRIER which this insurance applies and only tuthe extent of COVERAGE FORM, whichever Coverage Form in that person's or organization's liability for the conduct part cfyour policy: ofanother"inoured" This includes any person ororganization who you are required under m written contract or agreement CAT4370318 @xu10The Travelers Indemnity Company.All rights moeme . Page 1cf1 Includes copyrighted material mInsurance Services Office, Inc.with its permission. A41k WORKERS COMPENSATION TRAVELERSJ AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD, CT 06183 ENDORSEMENT WC 99 03 76 ( A)— 001 POLICY NUMBER*UB-6K869402 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA (BLANKET WAIVER) We have the right to recover our payments frorn anyone liable for, an mjm-y covered by this policy. We will not enforce our right against the person or organization nary,,ed in the Schedule. The additional promium for this endorsement ,hall be % of the California workers' compensation pre- rniurn. Schedule Person or Organization Job Description ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CON-rRACT EXECUTED PRIOR TO [-OSS TO FURNISH THIS WAIVER This endorsement changes the policy to which it is attached and is effective on the date, issued unless otherwise stated, (The information below is required only when this endarsernent is issued subsequent to preparation of the policy.) Endorsement t�Etfectjve6/27/2018 Policy No, UB-6K869402 Endorsement No. Insured JM Diaz, Inc. PremiLIM DBA: JMD Insurance carllpany Countersigned by__ DATE OF ISSUE:6/15/2018 ST ASSIGN. P:.ge I of I 42556609 118-19 GL, AU, w/AI, WC, Umb, Prof. I Kim Pechar 1 6/15/2012 10:13:56 AM (PDT) I Page 5 of 5 ACCOR"® CERTIFICATE OF LIABILITY INSURANCE I DATE6/15/2018 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 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). PRODUCER Edgewood Partners Insurance Center (EPIC) I CONTACT 19000 MacArthur Blvd. PH FloorPHONE FAx Irvine, CA 92612 I(A/C,No.Ext): (949)263-0606 (A/C.No): (949)263-0906 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# www.edgewoodins.com INSURERA: Travelers Property Casualty Company of America 25674 INSURED INSURER B: Travelers Casualty and Surety Co America 31194 JM Diaz, Inc. I DBA: JMD INSURERC: Travelers Indemnity Company of CT 25682 18645 E. Gale Ave., Ste#212 I INSURER D: City of Industry CA 91748 I INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 42556610 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A / COMMERCIAL GENERAL LIABILITY / / 680-2J330994 6/27/2018 6/27/2019 EACH OCCURRENCE $1,000,000 DAMAGE RENTE CLAIMS-MADE 1✓ OCCUR PREM SESO(Ea occur ence) $1,000,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $2,000,000 POLICY PE LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: Deductible $None C AUTOMOBILE LIABILITY ✓ ✓ BA-4J373941 6/27/2018 6/27/2019 (EaacccidentSINGLE LIMIT $1,000,000 ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ ✓ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ ✓ AUTOS ONLY ✓ AUTOS ONLY (Per accident) A / UMBRELLALIAB ,/ OCCUR ,/ CUP-7E606764 6/27/2018 6/27/2019 EACH OCCURRENCE $2,000,000 EXCESS LAB H CLAIMS-MADE AGGREGATE $2,000,000 DED I I RETENTION$0 Prod/Co-Ops $2,000,000 A WORKERS COMPENSATION ✓ UB-6K869402 6/27/2018 6/27/2019 / SPER TATUTE OERH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $1,000,000 OFFICE R/M EMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1.000.000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 B Professional Liability 105263164 6/27/2018 6/27/2019 $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/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) RE: Rosecrans Avenue Striping Design-Project PW-17-41 Certificate holder(s)are named as Additional Insureds as respects General Liability per endorsement CG D3 81 09/15 and as respects 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) CERTIFICATE HOLDER CANCELLATION CIt of EI Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Pu lun ic 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 42556610 118-19 GL, AU, w;AI, WC, Umb, Prof. I Kim Pechar 16;15;2018 10:13:56 AM (PDT) I Page I of 5 JM Diaz,— COMMERCIAL GENERAL LIABILITY 680-2J330994 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ����N������N 0������ ��^�m�m�� m ADDITIONAL mu������� (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1' The following is added to SECTION W — WHO IS h. This insurance does not apply to "bodily ANINSURED: injury" or "property damage" caused by "your Any person or organization that you agree in a work" and included in the "produds- "xxrbtencontract requiring insurance"buinclude as completed operations hazard" unless the anadditional insured onthis Coverage Part, but: "written contract requiring insurance" specifically requires you to provide such a, Only with respect to liability for "bodily injury', coverage for that additional inuured, and then "property damage" or"personal in]ury'; 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 acts 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" mppUes, or in connection provide such coverage or the end of the with premises owned byorrented hmyou. policy period, whichever isearlier. The person ororganization does not qualify as an 2. The following is added to Paragraph 4.a. of additional insured: SECTION IV — COMMERCIAL GENERAL c. With �k����U�1l������P���U�|«�A|��' h respect to the independent acts or ' omissions ofsuch person ororganization; or The insurance provided tothe additional insured is excess over any valid and collectible other �^ For "bodily injury", "property damage" or insurance, m/hetherphnoaDKexcess, contingent or "personal injury" for which such person or on any other basis, that is available to the organization has assumed liability in a additional insured for m loss we cover. Hom/ever, if contract nragreement. you specifically agree in the "written contract The insurance provided tusuch additional insured requiring insurance" that this insurance provided iylimited asfollows: tothe additional insured under this Coverage Part must apply on a primary basis or a primary and �^ Thi� in�ur�ncedoe� nota �nybasist» non-contributory bayis, this insurance is primaryany person or organization for whicht� other insuran�� �v�i|ab|� to �he additional as an additional insured spechicaUv insured which covers that person or organizations i� added by another endorsement to this as ananned insured for such loss, and vxewill not Coverage Part. share with the other insurance, provided that: f. This insurance does not apply to the (1) The "bodily injury' or "property damage" for rendering of or failure to render any which coverage \ssought occurs; and "professional services", (2) The "personal injury" for which coverage is g. |nthe event that the Limits mfInsurance ofthe sought arises out nfanoffense curnrnh1ed� Coverage Part shown in the Declarations exceed the limits of liability required by after you have signed that "written contract �mrkten contract requiring insurance"'~ the requiring insurance". But this insurance provided iuthe addi�ona! insured still is excess over valid insurance provided to the additional insured shall be limited to the |(nnhs of liability required and collectible other insurance, whether primary,~ excesscnnting�ntorun anyoth�r basisthat is bvthat "m/rh1�n �ontra�� requiring insuranc�". ' ' `^ available to the additional insured when that This endorsement does not increase the limits of insurance described in Section ||| — person or organization is an additional insured under any other insurance Lin}hs �f|nsur�nc�. ' CG D3 81 09 15 2o1sThe Travelers Indemnity Company.All rights reserved. Page 1 of mdudom 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 toinclude aperson ororganization asan 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 cf "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. VVewaive 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 ineffect when, the "bodily injury" or c, Before the end nfthe policy period. "property damage" occurs, or the "personal injury" offense iscommitted. Page 2 of Q 2n1xThe Travelers Indemnity Company.All rights reserved. CG D3 81 09 15 Includes the copyrighted material of Insurance Services Office,Inc.,with its permission 014149 Jmoiaz Inc. BA-4J373941 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY' BLANKET ��������^���U U������n ���.��n�n��~ o ���w�rnno��n���u~ no�����n��~�� 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.i.. Who between you and that person or organization, that is Is An Insured, of SECTION || — COVERED AUTOS signed by you before the "bodily injury or "property LIABILITY COVERAGE in the BUSINESS AUTO domaga" occurs and that ia in effect during the policy COVERAGE FORM and Paragraph m. inA'1,Who |s period, tuname moanadditional insured for Covered An Insured, of SECTION || — COVERED AUTOS Autos Liability Covenoga, but only for damages to LIABILITY COVERAGE in the K0C2TK}R CARRIER which this insurance applies and only tuthe extent of COVERAGE FORM, whichever Coverage Form in that person's or organization's liability for the conduct part cfyour policy: ofanother"inoured" This includes any person ororganization who you are required under m written contract or agreement CAT4370318 @xu10The Travelers Indemnity Company.All rights moeme . Page 1cf1 Includes copyrighted material mInsurance Services Office, Inc.with its permission. A41k WORKERS COMPENSATION TRAVELERSJ AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD, CT 06183 ENDORSEMENT WC 99 03 76 ( A)— 001 POLICY NUMBER*UB-6K869402 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA (BLANKET WAIVER) We have the right to recover our payments frorn anyone liable for, an mjm-y covered by this policy. We will not enforce our right against the person or organization nary,,ed in the Schedule. The additional promium for this endorsement ,hall be % of the California workers' compensation pre- rniurn. Schedule Person or Organization Job Description ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CON-rRACT EXECUTED PRIOR TO [-OSS TO FURNISH THIS WAIVER This endorsement changes the policy to which it is attached and is effective on the date, issued unless otherwise stated, (The information below is required only when this endarsernent is issued subsequent to preparation of the policy.) Endorsement t�Etfectjve6/27/2018 Policy No, UB-6K869402 Endorsement No. Insured JM Diaz, Inc. PremiLIM DBA: JMD Insurance carllpany Countersigned by__ DATE OF ISSUE:6/15/2018 ST ASSIGN. P:.ge I of I 42556610 118-19 GL, AU, w/AI, WC, Umb, Prof. I Kim Pechar 1 6/15/2012 10:13:56 AM (PDT) I Page 5 of 5