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PROOF OF INSURANCE (2019) CLOSED DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 08,24/2018 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. O a 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). c PRODUCER CONTACTNAME 4f Aon Risk Services Central, Inc. PE (866) 283-7122 FAX (800) 363-0105 d Pittsburgh PA office (A)C.No.Ext); I INC.N*3I EQT Plaza -- Suite 2700 E-MAIL 625 Liberty Avenue ADDRESS: Pittsburgh PA 15222-3110 USA INSURERS)AFFORDING COVERAGE NAIC# INSURED INSURERA: Liberty Mutual Fire Ins Co 23035 Michael Baker international, Inc INSURER B: Liberty Insurance Corporation 42404 5 Hutton Centre Drive Suite 500 INSURER C: Lloyd's Syndicate NO. 2623 AA1128623 Santa Ana CA 92707 USA INSURER D: XL Insurance America Inc 24554 INSURER E: 1 INSURER F: COVERAGES CERT)FICATE NUMBER: 570072755508 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. Limits shown are as requested IN'SR TYPE OF INSURANCE AOD�Y�SUER POLICY NUMBER POLICY EHF POLI,C�1Y tAR IY LIMITS LTR INS0 WVO (MMPOr1r1,rY"YYJ. fIMNMf11 J2 9 A X COMMERCIAL GENERAL LIABILITY TB2b81004145'718 Il tS/3l5"/201YS t"yF/'3 / 1 EACH OCCURRENCE $2,000,000 General Liability DAMAGE TO RENTED $300,000 CLAIMS-MADE II X OCCUR PREMISES(Ea occurrence) V-1 I MED EXP(Any one person) $10,000 PERSONAL 8 ADV INJURY $2,000,000 0 GEMLAGGREGATE LIMITAPPLIES PER: I GENERALAGGREGATE $4,000,000 POLICY E PEOLOC PRODUCTS-COMP/OPAGG $4,000,000 r- � M OTHER: CD A AUTOMOBILE LIABILITY A52-681-004145-728 08/30/2018 08/30/201.91 COMBINED SINGLE LIMIT $2,000,000 Commercial Auto - A05 BODILY INJURY Per person) .. (Ea accident) X ANYAUTO I ( P ) Z — OWNED SCHEDULED BODILY INJURY(Per accident) d AUTOS ONLY AUTOS 10 HIRED AUTOS NON-OWNED PROPERTY DAMAGE —I ONLY AUTOS ONLY (Per accident) ;w t: d D X UMBRELLALIAB OCCUR �usOOU799521_118A 08/30/2018 08/30/2019 AEACH GGREGATE OCCURRENCE J $10,000,000 V IY EXCESS LIAB CLAIMS-MADE umbrella $10,000,000 B WORKERS COMPENSA ION AND YINP wA�696004145778 08/30/' DED I X JR'ETENTICIN$10,000 2018 08/30/2019 PER I, IoTH-) workers Comp - AOS X STATUTE lI_- ANY PROPRIETOR I PARTNER/EXECUTIVE E.L.EACH ACCIDENT I $1,000,000 OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) E,L DISEASE-EA EMPLOYEE I $1,000,000 If yes,descn�6e under DESCRI'PTIO'N OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 C E&O-PL-Primary PSDEF1800460 08/31/2018 08/30/2019 Per Claim V $5,000,000/Professional Liab. and CP Aggregate V $5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,AOdnionsl Remarks Schedule,may be attached if more space is required) I � For Named Insured only: Attn: Kim Hartsfield. RE: Project: All Operations City of El Segundo, its officials y and employees are included as Additional Insured in accordance with the policy provisions of the General Liability policy. General Liability policy evidenced herein is Primary and Non-Contributory to other insurance available to Additional Insured, , but only in accordance with the policy's provisions. A waiver of Subrogation is granted in favor of Certificate Holder in e' accordancwith the po'l'icy provisions of the workers' Compensation policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WALL BE DELIVERED IN ACCORDANCE PATH THE POLICY PROVISIONS. City of El Segundo AUTHORIZED REPRESENTATIVE 350 Main Street E1 Segundo CA 90245 USA IQC ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD POLICYNUMBER: T132-681-004145-718 COMMERCIAL GENERAL LIABILITY CG 20 10 0413 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 A. Section II — Who Is An Insured is amended to 1. All work, including materials, parts or include as an additional insured the person(s) or equipment famished in connection with such organization(s) shown in the Schedule, but only with work, on the project (other than service, respect to liability for "bodily injury', "property maintenance or repairs) to be performed by or damage" or "personal and advertising injury' on behalf of the additional insured(s) at the caused,in whole or in part,by location of the covered operations has been 1. Your acts or omissions;or completed;or 2. The acts or omissions of those acting on your 2. That portion of "your work" out of which the behalf; injury or damage arises has been put to its in the performance of your ongoing operations for intended use by any person or organization the additional insured(s) at the location(s) other than another contractor or subcontractor designated above. engaged in performing operations for a principal as apart of the same project. However. C. With respect to the insurance afforded to these 1. The insurance afforded to such additional additional insureds, the following is added to insured only applies to the extent permitted by Section III—Limits Of Insurance: law,and If coverage provided to the additional insured is 2. If coverage provided to the additional insured is required by a contract or agreement, the most we required by a contract or agreement, the will pay on behalf of the additional insured is the insurance afforded to such additional insured will amount of insurance: not be broader than that which you are required 1. Required by the contractor agreement;or by the contract or agreement to provide for such additional insured. 2. Available under the applicable Limits of B. With respect to the insurance afforded to these Insurance shown in the Declarations; additional insureds, the following additional whichever is less. exclusions apply. This endorsement shall not increase the This insurance does not apply to "bodily injury' or applicable Limits of Insurance shown in the "property damage"occurring after: Declarations. SCHEDULE Name Of Additional Insured Person(s) Location(s) Of Covered Operations Or Organization(s): All persons or organizations with whom you have All locations as required by a written contract or entered into a written contract or agreement,prior to an agreement entered into prior to an"occurrence"or "occurrence"or offense,to provide additional insured offense. status. Information required to complete this Schedule,if not shown above,will be shown in the Declarations. CG 20 10 0413 ©Insurance Services Office,Inc.,2012 Page 1 of 1 POLICY NUMBER: TB2-681-004145-718 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART 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 is added to organization(s) shown in the Schedule, but only Section III—Limits Of Insurance: with respect to liability for "bodily injury' or If coverage provided to the additional insured is "property damage" caused, in whole or in part, by required by a contract or agreement, the most we "your work" at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement amount of insurance: performed for that additional insured and included in the"products-completed operations hazard". 1. Required by the contractor agreement;or However. 2. Available under the applicable Limits of 1. The insurance afforded to such additional Insurance shown in the Declarations; insured only applies to the extent permitted by whichever is less. law;and This endorsement shall not increase the applicable 2. If coverage provided to the additional insured is Limits of Insurance shown in the Declarations. required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations All persons or organizations with whom you have All locations as required by a written contractor entered into a written contract or agreement,prior to an agreement entered into prior to an"occurrence"or "occurrence"or offense,to provide additional insured offense. status. Information required to complete this Schedule,if not shown above,will be shown in the Declarations. CG 20 37 04 13 ©Insurance Services Office,Inc.,2012 Page 1 of 1 Policy Number TB2-681-004145-718 Issued by Liberty Mutual Fire Insurance Co. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE AMENDMENT—SCHEDULED ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART LIQUOR LIABILfTYCOVERAGE PART If you are obligated under a written agreement to provide liability insurance on a primary, excess, contingent, or any other basis for any person or organization shown in the Schedule of this endorsement that qualifies as an additional insured on this policy, this policy will appy solely on the basis required by such written agreement and Paragraph 4. Other Insurance of Section IV - Conditions will not apply. If the applicable written agreement does not specify on what basis the liability insurance will appy, the provisions of Paragraph 4. Other Insurance of Section IV- Conditions will govem. However, this insurance is excess over any other insurance available to the additional insured for which it is also covered as an additional insured by attachment of an endorsement to another policy providing coverage for the same"occurrence",claim or"suit". Schedule Person or Organization: All persons or organizations with whom you have entered into a written contract or agreement, prior to an "occurrence"or offense,to provide additional insured status. LC 24 20 02 13 ©2013 Liberty Mutual Insurance.All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT- CALIFORNIA 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 2% of the California workers' compensation premium otherwise due on such remuneration. Schedule Additional premium is a percent of the California Manual Workers Compensation premium. Subject to a minimum premium charge of$250 aerson or Oroa,nization Job DescriDtion Where required by contract or written agreement prior to loss and allowed by law. Issued by Liberty Insurance Corporation 21814 For attachment to Policy No.WA7-68D-004145-778 Effective Date Premium$ Issued to Michael Baker International, LLC WC 04 03 06 Page I of 1 Ed: 04/1984