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PROOF OF INSURANCE (2019) CLOSED A4CC)R O CERTIFICATE OF LIABILITY INSURANCE DATE09/221 / 1/2/201188 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 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), CONTACT PRODUCER ...... y... ..... ... .. .»i P McCar Insurance Services Lic. OD20867 1-3900 PHONEP ,_e -656-2409 C Nb):'951-281-3900 1'- 901 rY E-MAIL 19510 Van Buren Blvd. C AR(„��.s .pmCCarry@,.y m go com Ste. F3-142 wsu RAIC 0 .. .. RQ»RIS�AFFORDING COVERAGE lvarsl a A X250'8 __ INSLIRERA:NJOiked Na�icrrlal» nsurance Company ..... ., 1.31 4 INSURED 310-548-9292 310-548-9195 INSURER 13:WeSCO Insurance Co, ta@Dy Berg &Associates, Inc. INSURER..c;...Nati q l Q.l"!e.o.0....Fire_Insurance Co:....... _ ...11. X45 302 W. 5th Street, Suite 210 INSURER D Commerce_& Ilndjstry.In surance Co, _194,14 .. --- San Pedro, CA 90731 INs+JRERF U,Sape_gw,alty lnsU(anc 9lDppny».—._ 9 INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:02 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, LTR TYPE AND CONDITIONS OF SUCH POLICIES(LIMITS SHOWN MAY HAVE BEEN REDUCED E F Y PAID COLAI�MS� (NSR Y OCCURRENCE LIMITS GENERALCOMMERCIAL GENERAL ABILITY POLICY NUMBER IJAV-6c T(E"n.cciwrre�nw•;n) '„$,.1 rlrl0p i 0 ...... A FIRPO �4'a Iii hrYtmf 50 UOQ,... . _ ... ..... ..PED EXP I,ERSONAL&A&ADV INJURY,^n) $ one, .,._S_1,000, 010 ........ CLAIMS-MADE occuR L7221197 03/01/2018 10310 2 M ...................__.— ...................._.-----_ GENERAL AGGREGATE .....":.. 1aGQHQQ . ....... AV: PRODUCTS-COMP/OP AGG GEN'L AGGREGATE LIMIT AI'PI'�.9LS PER. l,n„cltlded .--,--- .. ICE ,, 1 � POLICYVia"T LOC _ 9' $ �TonnoelLlpLlABluPrYp ( WPP161147800 03/01/2018 03/01/2019 �����4�,rt�.rDnkSIG~Jd��LELuN1I C —.............I ✓ r,.......,...I_ � BODILY INJURY NJU l,.l..tY..F....(Per ,p,,,.,.—ersonB ANY AUTO ALL BODILYINJURY(Peraccide. o l)„,$UTS ----+N6ooWNED HIRED AUTOS AUTOS Bl ,.. ,OCQ UMBRELLA LIAB OCCUR 03/01/2018 03/01/2019 EACH OCCURRENCE $9,000,000 EXCESSABLCLAIMSAIADE EBU 080755665 AGGREGATE :9,000,000 Prod/C.O. Ag0,00.0 DED 4FTEhTI RETENTION .... q reg. ...........,... I WORKERS COMPENSATION 'ANG STA1U� 6TH. __-_ AND EMPLOYERS'LIABILITY yIN 03101/20181 03/01/2019 000,0 7 �Ihil�, I R ENT R1 ANY PROPRIETOR/PARTNER/EXECUTIVE E L DISEASE D (Man».Etovy in. R EXCLUDED? n N 1 A WC 012332162 E-EA EMPI.�YFr.,�_1',(�Qo fi�C�C ................. IMlan�daRor'y in NH) I4'-xes,describe under DESCRIPTION of(:]PERATnONS belowE.L.DISEASE-Pc.�I.u:Y LamrluT s 1.000.000 Liability each claim: $1,000,000 E Professional Liability USS 1828469 03/01/2018 03/01/2019 Aggregate: $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) USL&H coverage included as part of above referenced workers compensation insurance policy. CERTIFICATE HOLDER CANCELLATION City of EI Segundo Public Works SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 Main St. ACCORDANCE WITH THE POLICY PROVISIONS. EI Segundo, CA 90245 AUTHORIZED REPRESENTATIVE I , i ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: L7221197 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 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 4 Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations City of EI Segundo officers, officials, City of EI Segundo employees, agents, representatives Public works and certified volunteers 350 Main St. EI Segundo, CA 90245 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 organization(s) shown in the Schedule, but only exclusions 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 1. Your acts or omissions; or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the 1. The insurance afforded to such additional injury or damage arises has been put to its intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. 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. CG 20 10 04 13 ©Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these 2. Available under the applicable Limits of additional insureds, the following is added to Insurance shown in the Declarations; Section III—Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable Limits of Insurance shown in the will pay on behalf of the additional insured is the Declarations. amount of insurance: 1. Required by the contract or agreement; or Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13 POLICY NUMBER: L7221197 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OT"HER INSURANCE CONDITION ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and THIS ENDORSEMENT APPLIES TO THE FOLLOWING ENTITY: City of EI Segundo officers, officials, employees, agents, representatives, and certified volunteers. CG 20 01 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1 BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT Ths endorsement changes the p(.Acy to which is aaached affective on &ie inception 01 file policy U1116-SS @ dtlfel6fflt dai:e is ir6cate.d below. (rhe fc.)I[coorm "F4tacf I 1P 19 (LkIM&" n6e a be, I et ila, vrizWI: ffi!s HnrXv--VV--;Flt iw. iSS'UP'd p i epara I mon r,-,f thl- pxjkv, This endorsernent, effectnie, 'I 2:01 AM 03/01 20 forms a par', of Pok;v No WC 01.2--33-2162 Issued lo BERG & ASSOC 9ATES INC By COMMERCE AND I NDUSTRY I NSUIRANCE COMPANY We have a right to recover our payments front anyone liable for an injL]rj covered by this policV, 'Ale will not. onforce our right against any person or organi;,-3t0n, With WhOM YOU have a written contract that reqUireS you to obtain this agreement frorr us, as regards any work you perform for succi person or o(gar-tization. The addfitjona[ pre,rnum for this endorsernent shall be 2.00 llil of the total estimated wort ers conpensation premium for ,his Policy, Ll WC 04 03 61 Countersigned by (Ed. 11/90) Authorized Representative