PROOF OF INSURANCE (2018) CLOSED (2) � ��� ���DATE(MM/DD/YYYI� �
M�' CERTIFICATE OF LIABILITY INSURANCE o6,28iZo18
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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 i
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED '
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
the t�e�rms and conditio s'ofthehpolcy�certa n�polici�s�may S qRED,an endo se`mentnA s atement onthis certiROGe do�es not1confer�ri�hts����to
to the
certificate holder in lieu of such�rm�iq��trc���rat�s�.
PRODUCER CA LIC OB29370 1-925-244-7700 ����� � Certificates U��r�:rLazzt�rtt
Edgewood Partners Insurance Centere (EPIC) ppli��y;� ` ��� � �' ���� ���� ����� ---�
[Inland Em ire Branch ID 14542] ����� ���� �EPICcert„a�� �� � - �-d'�N� ��"�-'�m�925) 901-0671
P. _ (925) 244 77
P.O. Box 5003 �niAf�Fd�S'�� �r cbrokers.com
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INS41�L.��.a�l4f C_�kt�lhY93�..�NEF'k�W.'�3'�E NAIC#
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San Ramon, CA 94583 INSURERA: ARCH SPECIALTY INS CO 21199
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INSURED _,,,.,_,_, ,,,,,,,,,,, .......------ ,...�,. .........
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INSURERB. ZURICH AMER INS CO 16535
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A 1 American Asphalt INSURERC: AM$RICAN GUAR & LIAB INS 252¢�
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P.O. Box 2229 ,INSURERD.
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INSURER E:
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CoiOnd, CA 92878-2229 INSURERF:
COVERAGES CERTIFICATE NUMBER: 5326102o REVISION NUMBER:
THIS IS TO CERTUFY THAT THE POLICIES OF qNSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDpNG ANY REQUBREMENT„ TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THtlS
CERTIFICATE MAY BE ISSUED OR MAY PERTAINa �'h8� INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREGN IS SUBJECT TO ALL THE TERMSd
EXCLUStlONS AND CONDITIONS OF SUCH POLICIES.LIMITS',�HOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
�LTR r.. ......TYPEOF�INSUR.4NCE.. ......----- a�"�&Yf.��'��qk�,,,,,, ........ pQ4.IGYNUMBE.R „�,�„ .. tlW'III��I��.C�Jb��'� I���k'tT��.ICYEX&�........ ........ .�� ....... .___. ,,,, ....... .........
,. "!YM AA�OJ1dUd�P4"VYM'�. LIMITS
A X CO
MMERCIALGENERALLIABILITY DPC1005856�01 08/O1/17 �08/O1/18 �I EACHOCCURRENCE � ,$ 1,000,000
...... ... X���
,�CLAIMS-MADE � �OCCUR �a��p�,yg�p�;�tl�����pl"��' 100 000
.� e G��u�t���,-'.r��,�,�rv�,ri,irqpqFrr�;s�� $ .... .�...,
„ .,� ......... ....m� � �„...... ........--_ =MED EXP(Any one person) $
..._.„�,,,,, ,..�,.., ,_�.,_. .........
PERSONAL&ADVINJURY $ 1,000,000
POLICY ELIMITAPPLIESPER: GENERALAGGREGATE $ 2 000,000
GEN'L AGGREGAT
( .�f ,,,,,,,,,,,,, .... . ....
X...�f JECT � J;LOC PRODUCTS-COMP/OPAGG $ 2,000,000
,,,,,,,,, .. ....,_. .... .........
d N V"1��8k�`�.�'�'� $
B AUTOMOBILE LIABILITY HAP557108805 08/O1/17 08/O1/18 ���1�ICJf�1;Sq�d�s1�11MN1 000,000
� ANY AUTO BODILY W��� $ 2'
F�tur..�!� ... . .. ,.....
X JURY(Per person) ,...,$ ......... ........
BODILY IN m �
ALLOWNE� ;��� ��� SCHEDULED � � � JURY Peraccident $
.,,, ,,, AUTOS ,� AUTOS '� ( )
m. _..
' NON-OWNED p�f2�'7Y�tT�'7W'z}FtrvAht"a� ........ .........
................ HIRED AUTOS . AUTOS �4°"d.r w�ri�Ya,�ruR� $
. ...,,. .... ..... .,..$ ......... ..........
� UMBRELLA LIAB X OCCUR I SXS019797001 08/O1/17 08/O1/18 I EACH OCCURRENCE $ 10,000,000
$ EXCESSLIAB ,,,,,,, _,..__. ...,__.,.�..,, ................
CLAIMS-MADE. I�AGGREGATE $ 10,000,000
,�. I7EIJ..... g _R� , m ...,. ,,,.,.
._
ETENTION$ 10,000 F011Owing-FOrm $
''WORKERSCOMPENSATION �� I ��Y'2 OTH- �
B '�ANDEMPLOYERS'LIABILITY Y�N WC593205704 OB�01�17 08�01�18 � STATUTE ER,
X ......... ......__ �,.
ANY PROPRIETOR/PARTNER/EXECUTIVE '""""""""""'ry E L EACH ACCIDENT $ l,000,000
OFFICER/MEMBER EXCLUDED? �N I N I A .,, „....... .........
# , � ........._.. . ,� ............_
(Mandatory in NH) E L�,DISEASE-EA EMPLOYEE� $ 1,000,000
Ifyes,describeunder ��°-� � ��������� --�����-W����
DESCRIPTION OF OPERATIONS below E,L.DISEASE-POLICY LIMIT $ 1,000,000
V
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 107,�Addilional Remarks Schedule,may�be attached if more space is required)
#30408 / Project #PW18-16 / FY 17/18 Pavement Rehabilitation /
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Certificate Holder is Additional Inaured if Required by Written Contract Excluding Workers Compensation [2]
CERTIFICATE Hf1LC��F� ��t�J'C�LL�4TION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
'City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
350 Md1I1 Str6Et AUTHORIZED REPRESENTATIVE
E1 Segundo, CA 90245
� USA �� �"�r�^-^...
O 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
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53261020
Schedule Project
City of EI Segundo #30408/Project#PW18-18/FY 17/18 Pavement
Rehabilitation/
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