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PROOF OF INSURANCE (2019) CLOSED I DATE(MMIDDIYYYY) AiCt RV CERTIFICATE OF LIABILITY INSURANCE 07/1112018 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 IN'SU'RED„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'($). PRODUCER CO'N'TACT Tina Cowie NAME; Cornerstone Specialty Insurance Services,Inc PHONEa, (714)731-7700 I FAX (714)731-7750 AIC,NExt): ('A/C„Noy: 14252 Culver Drive,A299 EMAIL tina@cornerstonespecialty.com ADDR'ESS': INSURER(S)AFFORDING COVERAGE NAIC# Irvine CA 92604 INSURERA: Valley Forge Insurance Company 20508 INSURED ............................................................................ INSURER B: RLI Insurance Company GEO-ADVANTEC,INC. INSURER C: Continental Casualty Company 20443 457 West Allen Ave Ste 113 INSURER D: Natl Fire Ins.Cc of Hartford 20478 INSURER E: Beazley USA Services,Inc. San Dimas CA 91773 INSURER F COVERAGES CERTIFICATE NUMBER: 18/19 COVERAGES 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 CONTRACTOR 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 Ta"ryDY:`S'Dt1b�""'""' ^ COMMERCIAL GENERAL LIABILITY POLICY EFF POLICY EXP EACH OCCURRENCE I LTR TYPE OF INSURANCE IN5D .3ML,J POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) LIMITS $ 1,000,000 _ DAMAGE TO RENTED 300,000 CLAIMS-MADE N OCCUR PREMISES(Ea occurrence) $ X ADDTL INSURED/PRIMARY MED EXP(Any one person) $ 10,000 A X BLNKT WVR OF SUBRO Y Y 5085116874 05/25/2018 05/25/2019 (PERSONAL&ADV INJURY $ 1,000,000 GEI,11AGGREGATE LIMIT tAPPLt'ES PER GENERAL AGGREGATE $ 2,000,000 POLICY [X PJEROC,TO( 2,000,000 L . PRODUCTS-COMP/OPAGG $ AUTOMOBILE LIABILITY COMBRNED SINGLE LIMIT $ 1,000,000 (Ea aaccldent) - X, ANYAUTO BODILY INJURY(Per person) $ B — OWNED SCHEDULED Y Y PSA0002021 05/25/2018 05/25/2019 I BODILY INJURY(Per accident) $ AUTOSONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY I(Pea accude°mdd UMBRELLA LIAB 3 X OCCUR EACH OCCURRENCE_ $ ,000,000 C EXCESS LIAR CLAIMS-MADE AGGREGATE $Y Y 6017156481 05/25/2018 05/25/2019 I 3,000,000 _ DEP RETENTION$ $ 'wORtC['RS COMPENSATION XI STATUTE �I ERH- AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNERIEXECUTIVE I EL EACH ACCIDENT $ 1,000,000 D OFFiCERIMEMBER EXCLUDED? NIA Y 5085120908 05125/2018 05/25/2019 iMandatory in NH) I E.L,DISEASE-EA EMPLOYEE $ 1,000,000 11 V05,descnbu under 1,000,000 DES4"RJPT'ION'O'OPERATIONS Wow E L,DISEASE-POLICY LIMIT $ PROFESSIONAL LIABILITY EACH CLAIM $2,000,000 E CLAIMS MADE V129138180701 05/25/2018 05/25/2019 ANNUALAGGREGATE $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be aftached if more space is required) City of EI Segundo and all its officers,volunteers,employees and representatives are Additional Insured for General Liability but only if required by written contract with the Named Insured prior to an occurrence and as per attached endorsement Coverage is subject to all policy terms and conditions"30 days notice of cancellation,except for 10 days notice for non-payment of premium.For Professional Liability coverage,the aggregate limit is the total insurance available for all covered claims reported within the policy period. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN CITY OF EL SEGUNDO ACCORDANCE WITH THE POLICY PROVISIONS. 350 MAIN STREET AUTHORIZED REPRESENTATIVE EL SEGUNDO CA 90245 I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD c�r�► INSURED: Geo-Advantec, Inc POLICY PERIOD: 5/25/2018 - 5/25/2019 POLICY NUMBER: 5085116874 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED WITH PRODUCTS-COMPLETED OPERATIONS COVERAGE AND BLANKET WAIVER OF SUBROGATION / AGGREGATE LIMIT (PER PROJECT) This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM BUSINESSOWNERS COMMON POLICY CONDITIONS 1. Blanket Additional Insured with Products-Completed Operations Coverage and Blanket Waiver of Subrogation A. Who Is An Insured is amended to include as an insured, any person or organization whom you are required to add as an additional insured on this policy under a written contract or written agreement, but the written contract or written agreement must be: 1. Currently in effect or becoming effective during the term of this policy; and 2. Executed prior to the: a. "Bodily injury" "property ; or 9a or ro " 1 rY, y dama �, ....,..... b. Offense that caused the personal and advertisinginjury;" for which the additional insured seeks coverage. B. The insurance provided to the additional insured is limited as follows: 1. That person or organization is an additional insured only with respect to such person or organization's liability for: a. "Bodily injury", "property damage"or"personal and advertising injury to the extent caused by: (1) Your acts or omissions; or (2) Acts or omissions of those acting on your behalf; in the performance of your ongoing operations specified in the written contract; or b. "Bodily injury" or "property damage" to the extent caused by "your work" specified in the written contract or written agreement and included in the "products-completed operations hazard", but only if: (1) The written contract or written agreement requires you to provide the additional insured such coverage; and (2) This Coverage Part provides such coverage. 2. The Limits of Insurance applicable to the additional insured are those specified in the written contract or written agreement or in the Declarations of this policy, whichever is less. These limits of Insurance are inclusive of, and not in addition to, the Limits of Insurance shown in the Declarations. 3. The insurance provided to the additional insured does not apply to "bodily injury," "property damage," "personal and advertising injury" arising out of an architect's, engineer's, or surveyor's rendering of or failure to render any professional services, including: SB300176D17(6-16) Page 1 of 3 Copyright,CNA All Rights Reserved, CNA a. The preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications by any architect, engineer or surveyor performing services on a project of which you serve as a construction manager; or b. Inspection, supervision, quality control, engineering or architectural services done by you on a project of which you serve as construction manager. 4. This insurance provided to the additional insured does not apply to"bodily injury," "property damage," or "personal and advertising injury" arising out of construction or demolition work while you are acting as a construction or demolition contractor. C. With respect only to the insurance provided by this endorsement, the condition entitled Other Insurance of the BUSINESSOWNERS COMMON POLICY CONDITIONS is amended to delete paragraphs 2. and 3., and replace them with the following: 2. This insurance is excess over any other insurance available to the additional insured, whether primary, excess, contingent or on any other basis. But if required by the written contract or written agreement, this insurance will be primary and noncontributory relative to insurance on which the additional insured is a Named Insured. 3. When this insurance is excess, we will have no duty under Business Liability insurance to defend the additional insured against any "suit" if any other insurer has a duty to defend the additional insured against that "suit" if no other insurer defends, we will undertake to do so, but we will be entitled to the additional insured's rights against all those other insurers. When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (a) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (b) The total of all deductible and self-insured amounts under all that other insurance. We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. D. Additional Insured —Extended Coverage When an additional insured is added by this or any other endorsement attached to this Coverage Part, Who Is An Insured is amended to make the following natural persons insureds. If the additional insured is: a. An individual, then his or her spouse is an insured; b. A partnership or joint venture, then its partners, members and their spouses are insureds; c. A limited liability company, then its members and managers are insureds; or d. An organization other than a partnership, joint venture or limited liability company, then its executive officers, directors and shareholders are additional insureds; but only with respect to locations and operations covered by the additional insured endorsement's provisions, and only with respect to their respective roles within their organizations. Please see the Estates, Legal Representatives and Spouses provision of this endorsement for additional coverage and restrictions applicable to spouses of natural person insureds. E. Blanket Waiver of Subrogation The condition entitled Transfer of Rights of Recovery Against Others To Us of the BUSINESSOWNERS COMMON POLICY CONDITIONS is amended to delete paragraph 2. and replace it with the following: 2. We waive any right of recovery we may have against any person or organization against whom you have agreed to waive such right of recovery in a written contract or agreement because of payments we make ..._........................................_............. SB300176D17 (6-16) Page 2of3 Copyright,CNA All Rights Reserved. CNA for injury or damage arising out of your ongoing operations or"your work"done under a contract with that person or organization and included within the"products-completed operations hazard." 2. Amendment-Aggregate Limits of Insurance(Per Project) A. For all sums which the insured becomes legally obligated to pay as damages caused by"occurrences" under Coverage A.1., and for all medical expenses caused by accidents under Coverage A.2., which can be attributed only to ongoing operations at a single construction project: 1. A separate Construction Project General Aggregate limit applies to each construction project. The Construction Project General Aggregate limit is equal to the amount of the General Aggregate limit shown in the Declarations. 2. The Construction Project General Aggregate limit is the most we will pay for the sum of all damages payable under Coverage A.1., except damages because of"bodily injury" or"property damage" included in the "products-completed operations hazard," and for medical expenses payable under Coverage A.2. regardless of the number of: a. Insureds; b. Claims made or"suits" brought; or c. Persons or organizations making claims or bringing "suits." 3. Any payments made under Coverage A.I. for damages or under Coverage A.2. for medical expenses shall reduce the Construction Project General Aggregate limit for the applicable construction project. Such payments shall not reduce the General Aggregate limit shown in the Declarations nor shall they reduce any Construction Project General Aggregate limit applicable to other construction projects. 4. The limits shown in the Declarations for Liability and Medical Expenses, Damage to Premises Rented to You, and Medical Expenses continue to apply. However, instead of being subject to the General Aggregate limit shown in the Declarations, such limits will be subject to the applicable Construction Project General Aggregate limit. B. All: 1. Damages because of"personal and advertising injury", regardless of the number of construction projects involved; 2. Damages under Coverage A.1. which cannot be attributed solely to ongoing operations at a single construction project, except damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard"; and 3. Medical expenses under Coverage A.2. caused by accidents which cannot be attributed solely to ongoing operations at a single construction project; will reduce the General Aggregate Limit shown in the Declarations, and shall not reduce any Construction Project General Aggregate Limit. C. When coverage for liability arising out of the "products-completed operations hazard" is provided, any payments for damages because of "bodily injury" or"property damage" included in the "products-completed operations hazard" will reduce the Products/Completed Operations Aggregate limit, and not reduce the General Aggregate limit nor any Construction Project General Aggregate limit. D. If a construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. E. The provisions of the Limits Of Insurance section not otherwise modified by this endorsement shall continue to apply as stipulated. All other terms and conditions of the Policy remain unchanged, SB300176D17 (6-16) ..._........... ...0 Page 3 of 3 Copyright,CNA All Rights Reserved. Policy Number: PSA0002021 PPA 300 03 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided un the following: BUSINESS AUTO COVERAGE FORM I. Blanket Additional Insured II. Blanket Waiver Of Subrogation The following is added to the SECTION II— The following is added to the SECTION IV— COVERED AUTOS LIABILITY COVERAGE, BUSINESS AUTO CONDITIONS, A. Loss Paragraph A.I.Who Is An Insured Provision: Conditions, 5. Transfer Of Rights Of Recovery Against Others To Us: Any person or organization that you are required to include as an additional insured We waive any right of recovery we may on this coverage form in a contract or have against any person or organization to agreement that is executed by you before the the extent required of you by a contract "bodily injury" or"property damage"occurs is executed prior to any"accident" or"loss", an"insured"for liability coverage, but only for provided that the"accident" or"loss"arises damages to which this insurance applies and out of the operations contemplated by such only to the extent that person or organization contract. The waiver applies only to the qualifies as an"insured" under the Who Is An person or organization designated in such Insured provision contained in SECTION II— contract. COVERED AUTOS LIABILITY COVERAGE. The insurance provided to the additional insured will be on a primary and non- contributory basis to the additional insured's own business auto coverage if you are required to do so in a contract or agreement that is executed by you before the "bodily injury" or"property damage" occurs. PPA 300 03 13 Page 1 of 1 POLICY NUMBER: PSA0002021 COMMERCIAL AUTO PPA 300 03 11 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. RLIPack® BUSINESS AUTO ENHANCEMENT SCHEDULE OF COVERAGES ADDRESSED BY THIS ENDORSEMENT D. Blanket Waiver Of Subrogation The following is added to the SECTION IV—BUSINESS AUTO CONDITIONS, A. Loss Conditions, 5. Transfer Of Rights Of Recovery Against Others To Us: We waive any right of recovery we may have against any person or organization to the extent required of you by a contract executed prior to any"accident' or"loss", provided that the"accident'or"loss"arises out of the operations contemplated by such contract. The waiver applies only to the person or organization designated in such contract. PPA 300 03 11 Page 1 of 1 INSURED: Geo-Advantec, Inc POLICY NUMBER: 5085120908 EXPIRATION DATE: 5/25/2019 WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS This endorsement changes the policy to which it is attached. It is agreed that Part One—Workers' Compensation Insurance G. Recovery From Others and Part Two— Employers' Liability Insurance H. Recovery From Others are amended by adding the following: We will not enforce our right to recover against persons or organizations. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) Premium Charge - $ - The charge will be an amount to which you and we agree that is a percentage of the total standard premium for California exposure. The amount is 2.%. G-1 9160-B Page 1 of 1 (Ed. 11/97)