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PROOF OF INSURANCE (2018 - 2019) CLOSED A �`"� DATE(MM/DD/YYYY) II LIABILITY I � 11/14/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO14 ONLY AND CONFERS 140 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 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 Y�yCONTACT Halidee Callejas MOC Insurance Services PHONE (415)957-0600(ACCBxtic FAX I iA/C,No)r�415)957-0577 License No. 0589960 r-MAIL hoallejas@mocins.com wA P1A4EES,�i;_ ........YN1'SI'.1ri' Pd',ISr A'rFOR'DNO COVERAGE NAq....«............... 44 MontgomerySt. 17th Fl. A 94104 INSURER Bay Ins. Co, 22306 S.an.....Francisco.... C................. __.......................... INSURED INSURER_BAllmerica Financial Benefit_ Co. 41840 Keyser Marston Associates, Inc. INSURERC:Hanover Insurance Company 22292 ....................... INSURERD:Republic Indemnity Company of 43753 1299 4th Street, Suite 408 INSURER E: San Rafael CA 94903 INSURER F: COVERAGES CERTIFICATE NUMBER:2017-2018 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. .. .,. ....................... , .,... ..,_� YNSR ADDL 'i16Fi POLICY EFF V POUCYEXPYY LTR TYPE OF INSURANCE tN,�,Q,\M1t\+(.t POLICY NUMBER (MMIDDI`IYYV)qq dMWMFDW636'�BYYYY'! LIMITS X COMMERCIAL GENERAL LIABILITY 17ACH d7d°CU'R'RFNt:E $ 1,000,000 . A CLAIMS-MADE X l OCCUR PRFf�5F i lu>�nu n nv� $ 500,000 V ZDFA49104903 12/l/2017 12/l/2018 M,ED,EXP(AnY.°n.e.Person).... ....$...............,.... 10,000. No Deductible Applies PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY �IA' LOC PRODUCTS-C .. .. OMPIOP AGO Included, $ ^^ AUTOMOBILE LIABILITY COMBINED S'M,,U:LIMP $ 1,000,000 B X ANY AUTO AWFA4 BODILY INJURY(Per person) $ ALL OWNED SCHEDULEDAUTX, 9004903 12/1/2017 12/1/2010 BODILY INJURY(Per accident) $ X Comp$500 0S X AAUTOS AUITOS NON-OWNED Uninsured mmotorist combined $ 1,000,000 X UMBRELLA LIAB MOCCUR EXCESS LIAB CLAIMS-MADE I AGGREGATE REN...... , $ 4 r"000 1.0 0001 000 1 DED I X RETENTION$ 0 X UHFA49117103 12/1/2017 12/1/2018 I $ _ WORKERS COMPENSATION X STATUTE H AND EMPLOYERS'LIABILITY Y/Np -__.`PLR .._ . ,_....._ER....-........m........................................ ANY PROPRIETORIPARTNERtEXECUTIVE DENT OFFICERIMEMBER EXCLUDED? „Y�,P N/AE.L.EACH I, 1,00,0,000 ID yes,de TION OF OPERATIONS below E L.DISEASE CIPOLICY LIMIT $ m 1,000,000 D Mandato In NH 3954623 12/1/2017 01/01/2018 E.L DISEASE-EA EMPLOYE „$ -1,000,000 C Professional Liability LHFD42616500 12/1/2017 12/1/2018 Each Wrongiul Act $1,000,000 Retention $25,000 Retro Date: 11/11/1976 AggregaleLimit $2,000,000 � DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) e The City of E1 Segundo, its officers, officials and employees are Additional Insured as respects their interest appears per written contract. Insurance is primary and non-contributory. 30 day notice of cancellation/10 day for non-payment of premium. r CERTIF=TE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of E1 Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo, CA 90245-3813 AUTHORIZED REPRESENTATIVE Halidee C:allejas/HCA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 POLICY NUMBER: ZDFA49104903 Effective Date: 12/01/2017 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) or Organization(s): Locations)of Covered Operations City of EI Segundo, its officers, officials and employees It is understood and agreed that this insurance is primary and any other insurance maintained by the Additional Insured shall be excess only and not contributing with this insurance in regards to all operations as pertains to the named insured. Information required to complete this Schedule, if not shown above,will be shown in the Declarations......... ......... _........................... A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional exclu- organization(s) shown in the Schedule, but only sions apply: with respect to liability for"bodily injury", "property This insurance does not apply to"bodily injury"or damage" or "personal and advertising injury" "property damage"occurring after: caused, in whole or in part, by: 1.All work,including materials,parts or equip-ment 1.Your acts or omissions;or furnished in connection with such work, on the 2. The acts or omissions of those acting on your project (other than service, maintenance or behalf; repairs)to be performed by or on behalf of the in the performance of your ongoing operations for additional insured(s) at the location of the the additional insured(s) at the locations) desig- covered operations has been completed;or nated above. 2.That portion of"your work"out of which the injury or damage arises has been put to its in-tended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a princi-pal as a part of the same project. CG 20 10 07 04 ©ISO Properties, Inc.,2004 Page 1 of 1 0 Keyser Marston Associates, Inc COMMERCIAL AUTO CA 00 0103 06 BUSINESS AUTO COVERAGE FORM Various provisions in this policy restrict coverage. SECTION I—COVERED AUTOS Read the entire policy carefully to determine rights, Item Two of the Declarations shows the "autos" that duties and what is and is not covered. are covered "autos" for each of your coverages. The Throughout this policy the words"you"and"your" refer following numerical symbols describe the "autos" that to the Named Insured shown in the Declarations. The may be covered "autos". The symbols entered next to words "we", "us" and "our" refer to the Company pro- a coverage on the Declarations designate the only viding this insurance. "autos"that are covered"autos". Other words and phrases that appear in quotation A. Description Of Covered Auto Designation marks have special meaning. Refer to Section V — Symbols Definitions. Symbol Description Of Covered Auto Designation Symbols 1 Any"Auto" 2 Owned"Autos" Only those"autos"you own (and for Liability Coverage any"trailers"you don't own Only while attached to power units you own).This includes those"autos"you acquire ownership of after the policy begins. 3 Owned Private Only the private passenger"autos"you own.This includes those private passenger Passenger "autos"you acquire ownership of after the policy begins. "Autos"Only 4 Owned"Autos" Only those"autos"you own that are not of the private passenger type(and for Li- Other Than Pri- ability Coverage any"trailers"you don't own while attached to power units you vate Passenger own). This includes those"autos"not of the private passenger type you acquire "Autos"Only ownership of after the policy begins. 5 Owned"Autos" Only those"autos"you own that are required to have No-Fault benefits in the state Subject To No- where they are licensed or principally garaged.This includes those"autos"you ac- Fault quire ownership of after the policy begins provided they are required to have No- Fault benefits in the state where they are licensed or principally garaged. 6 Owned "Autos" Only those"autos"you own that because of the law in the state where they are li- Subject To A tensed or principally garaged are required to have and cannot reject Uninsured Compulsory Un- Motorists Coverage.This includes those"autos"you acquire ownership of after the insured Motor- policy begins provided they are subject to the same state uninsured motorists re- ists Law quirement, 7 Specifically De- Only those"autos"described in Item Three of the Declarations for which a pre- scribed"Autos" mium charge is shown(and for Liability Coverage any"trailers"you don't own while attached to any power unit described in Item Three). 6 Hired"Autos" Only those"autos"you lease, hire, rent or borrow.This does not include any"auto" Only you lease, hire, rent,or borrow from any of your"employees", partners(if you are a partnership), members (if you are a limited liability company)or members of their households. 9 Nonowned Only those"autos"you do not own, lease, hire, rent or borrow that are used in con- "Autos"Only nection with your business.This includes"autos"owned by your"employees", part- ners (if you are a partnership), members(if you are a limited liability company), or members of their households but only while used in your business or your personal affairs. CA 00 0103 06 ©ISO Properties, Inc., 2005 Page 1 of 12 ❑ 19 Mobile Equip- Only those"autos"that are land vehicles and that would qualify under the definition ment Subject To of"mobile equipment"under this policy if they were not subject to a compulsory or Compulsory Or financial responsibility law or other motor vehicle insurance law where they are li- Financial Re- censed or principally garaged. sponsibility Or Other Motor Ve- hicle Insurance Law Only N Y B. Owned Autos You Acquire After The Policy SECTION II—LIABILITY COVERAGE Begins A. Coverage 1. If Symbols 1, 2, 3, 4, 5, 6 or 19 are entered We will pay all sums an "insured" legally must pay next to a coverage in Item Two of the Declara- as damages because of"bodily injury"or"property tions, then you have coverage for "autos" that damage" to which this insurance applies, caused you acquire of the type described for the re- by an "accident" and resulting from the ownership, mainder of the policy period. maintenance or use of a covered"auto". 2. But, if Symbol 7 is entered next to a coverage We will also pay all sums an"insured" legally must in Item Two of the Declarations, an "auto" you pay as a "covered pollution cost or expense" to acquire will be a covered "auto"for that cover- which this insurance applies, caused by an "acci- age only if: dent" and resulting from the ownership, mainte- a. We already cover all "autos" that you own nance or use of covered "autos". However, we will for that coverage or it replaces an "auto" only pay for the "covered pollution cost or ex- you previously owned that had that cover- pense" if there is either "bodily injury" or "property age;and damage" to which this insurance applies that is b. You tell us within 30 days after you acquire caused by the same"accident". it that you want us to cover it for that cover- We have the right and duty to defend any"insured" age. against a "suit" asking for such damages or a C. Certain Trailers,Mobile Equipment And "covered pollution cost or expense". However, we Temporary Substitute Autos have no duty to defend any "insured" against a If Liability Coverage is provided b this Coverage "suit" seeking damages for"bodily injury" or"prop- If g p y g erty damage ora covered pollution cost or ex- Form, the following types of vehicles are also cov- pense"to which this insurance does not apply. We ered"autos"for Liability Coverage: may investigate and settle any claim or"suit"as we 1. "Trailers"with a load capacity of 2,000 pounds consider appropriate. Our duty to defend or settle or less designed primarily for travel on public ends when the Liability Coverage Limit of Insur- roads. ance has been exhausted by payment of judg- 2. "Mobile equipment" while being carried or menta or settlements. towed by a covered"auto". 1. Who Is An Insured 3. Any "auto" you do not own while used with the The following are"insureds": permission of its owner as a temporary substi- a. You for any covered"auto". tute for a covered auto you own that is out of service because of its: b. Anyone else while using with your permis- sion a covered "auto" you own, hire or bor- a. Breakdown; row except: b. Repair; (1) The owner or anyone else from whom c. Servicing; you hire or borrow a covered"auto".This d. "Loss"; or exception does not apply if the covered "auto" is a "trailer" connected to a cov- e. Destruction. ered"auto"you own. i Page 2 of 12 ©ISO Properties, Inc.,2005 CA 00 0103 06 11 (2) Your "employee" if the covered "auto" is b. Out-Of-State Coverage Extensions owned by that "employee" or a member While a covered "auto" is away from the of his or her household. state where it is licensed we will: (3) Someone using a covered "auto" while (1) Increase the Limit of Insurance for Li- he- or she is working in a business of ability Coverage to meet the limits speci- selling, servicing, repairing, parking or fied by a compulsory or financial re- storing "autos" unless that business is sponsibility law of the jurisdiction where yours. the covered "auto" is being used. This (4) Anyone other than your "employees", extension does not apply to the limit or partners (if you are a partnership), limits specified by any law governing members (if you are a limited liability motor carriers of passengers or prop- company), or a lessee or borrower or erty. any of their "employees", while moving (2) Provide the minimum amounts and property to or from a covered"auto". types of other coverages, such as no- (5) A partner(if you are a partnership), or a fault, required of out-of-state vehicles by member (if you are a limited liability the jurisdiction where the covered"auto" company)for a covered "auto" owned by is being used. him or her or a member of his or her We will not pay anyone more than once for household. the same elements of loss because of c. Anyone liable for the conduct of an "in- these extensions. sured" described above but only to the ex- B. Exclusions tent of that liability. This insurance does not apply to any of the follow- 2. Coverage Extensions ing: a. Supplementary Payments 1. Expected Or Intended Injury We will payfor the"insured": "Bodily injury" or "property damage" expected (1) All expenses we incur, or intended from the standpoint of the "in- (2) Up to $2,000 for cost of bail bonds (in- sured". cluding bonds for related traffic law vio- 2. Contractual lations) required because of an "acci- Liability assumed under any contract or agree- dent" we cover. We do not have to fur- ment. nish these bonds. (3) The cost of bonds to release attach- But this exclusion does not apply to liability for damages: ments in any suit against the "insured" we defend, but only for bond amounts a. Assumed in a contract or agreement that is within our Limit of Insurance. an"insured contract"provided the"bodily in- (4) All reasonable expenses incurred by the jury" or "property damage" occurs subse- "insured"at our request, including actual quent to the execution of the contract or loss of earnings up to $250 a day be- agreement; or cause of time off from work. b. That the "insured" would have in the ab- (6) All costs taxed against the "insured" in sence of the contract or agreement. any "suit" against'the "insured" we de- 3. Workers'Compensation fend. Any obligation for which the "insured" or the (6) All interest on the full amount of any "insured's" insurer may be held liable under any judgment that accrues after entry of the workers' compensation, disability benefits or judgment in any "suit" against the "in- unemployment compensation law or any similar sured"we defend, but our duty to pay in- law. terest ends when we have paid, offered 4. Employee Indemnification And Employer's to pay or deposited in court the part of Liability the judgment that is within our Limit of "Bodily injury"to: Insurance. These payments will not reduce the Limit of a. An"employee"of the"insured"arising out of Insurance. and in the course of: (1) Employment by the"insured";or CA 00 0103 06 ©ISO Properties, Inc., 2005 Page 3 of 12 ❑ AC 066/08/CERTIFICATE OF LIABILITY INSURANCE I DATE /08/,8 r�IYYY�' .. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS 1 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 AND THE CERTIFICATE HOLDER. REPRESENTATIVE sed. If SUBROGhe ATION IS WAIVificate ED, subject is an to to ms ndEi INSURED, conditionsthe ofthe policy,certain policiehave sAL mayrr require a endoSURED rsement be PRODUCER,, or endorsed. If SU n endo A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Aon Risk Services,Inc of Florida NAME: Aon Risk Services,Inc of Florida 1001 Brickell Bay Drive,Suite#1100 PHONE I FAX Miami,FL 33131-4937 JIWC,No,ExW 80'0"743'8130 (ANC„No)::800-522-7514 EMAIL ADDRESS: ADP.COI.Centenpep on com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: American Home Assurance Cc 19380 INSURED ADP TotalSource DE IV,Inc INSURER B 10200 Sunset Drive (INSURER C Miami,FL 33173 UCIF (INSURER D: Keyser Marston Associates,Inc 1299 Fourth Street,Suite 408, INSURER E San Rafael,CA 94901 I INSURER F COVERAGES CERTIFICATE NUMBER:2103943 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 j INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS i 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. LIMITS SHOWN ARE AS REQUESTED, INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDDIYYYY)I(MMIDDIYYYY) EACH OCCURRENCE I LIMITS _ COMMERCIAL GENERAL LIABILITY $ (_ CLAIMS-MADE ❑, OCCUR DAMA�PPREMI$TO RENTED REMISES(Ea 9c.CPn-pnce) 5 I�MED EXP(Any one person) $ PERSONAL&ADV INJURY 5 , GEN'L AGGREGATE LIMIT APPLIES PER I GENERAL AGGREGATE 5 _ POLICY �PROJECT FI LOC PRODUCTS-COMP/OP AGG $ OTHER I 5 COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accident) 5 ANY AUTO BODILY INJURY(Per Person) 5 OWNED SCHEDULED AUTOS ONLY _ AUTOS BODILY INJURY(Per accident) $ _ HIRED NON-OWNED PROPERTY DAMAGE _ AUTOS ONLY AUTOS ONLY (Per accident) $ 5 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE 5 I DEC I I RETENTION$ WORKERS COMPENSATION X I STER ATUTE I I EORH AND EMPLOYERS'LIABILITY Y I N A ANY PROPRIETOR/PARTNER/EXECUTIVEF] WC 047016568 CA 7/1/2018 7/1/2019 E L EACH ACCIDENT $ 2,000,000 OFFICER/MEMBER EXCLUDED? N I A 1 (Mandatory in NH) E L DISEASE-EA EMPLOYEE''', $ 2,000,000 If yes,describe under +_+ DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT 1 $ 2,000,0001 u DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) All worksile employees working for KEYSER MARSTON ASSOCIATES,INC,paid under ADP TOTALSOURCE,INC's payroll,are covered under the above stated policy L� CERTIFICATE HOLDER CANCELLATION City of EI Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn: Risk Manager THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. EI Segundo,CA 90245 AUTHORIZED REPRESENTATIVE 0401z0UA "ltrtV&G,6, QRa o f d%ttda @11956.2015 ACORD CORPORATION,All rights reserved, ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD POLICY HOLDER NOTICE CERTIFICATE HOLDER CANCELLATION NOTICE SCHEDULE Should this policy be cancelled before the expiration date hereof, the producer will endeavor to mail 30 days written notice to the certificate holder named herein, but failure to do so shall impose no obligation or liability of any kind upon the insurer, the producer, or the respective agents or representatives of each. SCHEDULE• CERTIFICATE HOLDERS AS IDENTIFIED ON THE MOST RECENT QUARTERLY SCHEDULE OF CERTIFICATE HOLDERS PROVIDED BY THE INSURED'S BROKER OF RECORD TO THE INSURER.