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PROOF OF INSURANCE (2019) CLOSED WILLIA1 OP ID: LA CERTIFICATE OF LIABILITY (MMIDD/YYYY) TY INSURANCE 1 09/28/2018 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. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les) 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 CONTACT NAME� Rohm Insurance Agency LLC PHONE 714-516-2960 �� .______..............-...m License#OK07568 I.4&I1N,.FxI�.................................... .N.I; 714-516-2965 26 Plaza Square,Suite 200 E-MAIL Orange,CA 92866 INSURER(S)AFFORDING COVERAGENAIC# INSURER A:Travelers Indemnity Co of CT 25682 ............................................................................................................. .,�mm.......�.,..... .,.,.,.,.,.,...,.,.,.,.,.,.,.,.,.,.__�..,.,.,.,.,.,. ,..............................._.,�.......... ,....... INSURED Williams Pipeline Contractors, INSURER 8:Travelers Prop Cas Co of Amer 25674 Inc. _._._....._ _.................................................. P.O.Box 1120 INSURER C: mm SOmis,CA 93066 INSURER D: INSURER E: ..................... INSURER F; COVERAGES CERTIFICATE NUMBER 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. N .' , -. ' ' LIMITSS.1............................................................... ............................................................. E XP LTR TYPE OF INSURANCE POLICY NUMBER IMMJDDNYYYLIMMPDDIYYYY$ GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X X X COMMERCIAL GENERAL LIABILITY OT22CO2L477380TCT18 09/01/2018 09/01/2019 OATvTAGETO RENTEu 11 PRE .ISES,(Eaoccurrence) $ 300,000 I FX w�....(An oneperson.),.. $ 5,000 (Any CLAIMS-MADE OCCUR MED EXP An ................. PERSONAL&ADV INJURY $ 1,000,000 TE._...............- 2,000,000 ................"..............................................................................................m GENERALAGGREGA $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000 POLICY I-..X...I PRO I..............I LOC I$ MOBILE COM INED SINGLE LIMI T d13 XTOANYYAUTOABILITY DT810331K3836TIL18 09/01/2018 09/01/2019 BODIBLY INJURY(Per per on) I$ 1'000,OOO, ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS . HIRED AUTOS AUTOS JP .........._. NON-OWNED $ P,EmR4V mVEN X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 B .EXCESS LIAB CLAIMS-MADE CUPBJ3874141826 09/01/2018 09/01/2019 AGGREGATE $ 1,000,000 ...�.�....DEO..... __ ...RETENTL.........._.....,, ... 0'N_$, $ WORKERS COMPENSATION WCSTATU- I MOTH B ANY PROPRIETOR/PARTNER/EXECUTIVEY X UB4J5734651826G 09/01/2018 09/01/2019 EACH ACCIDENT $ 1,000,0000 OFFICER/MEMBER EXCLUDED? AND EMPLOYERS'LIABILITY ` , rl._(,1MITS ER N I A (Mandatory in NH) E,L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E L,DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) RE: PROJECT #18-10 WATER MAIN IMPROVEMENTS ON CEDAR STREET AND WALNUT AVENUE PROJECT. CITY OF EL SEGUNDO ITS OFFICIALS, AND EMPLOYEES ARE NAMED AS ADDITIONAL INSURED, PRIMARY 6 NON—CONTRIBUTORY AND WAIVER OF SUBROGATION AS RESPECTS TO GENERAL LIABILITY PER ENDORSEMENTS ATTACHED. WORKERS COMPENSATION WAIVER OF SUBROGATION APPLIES PER ENDORSEMENT ATTACHED. CERTIFICATE HOLDER CANCELLATION ELSEGUN 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 EL SEGUNDO,CA 90245 AUTHORIZED REPRESENTATIVE I� ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD INSURED:Williams Pipeline Contractors, Inc. POLICY NUMBER: DT22CO331 K3836TCT1 8 POLICY TERM: 0910112018 TO 0910112019 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED— (Section ll) is amended c) The insurance provided to the additional in- to include any person or organization that you sured does not apply to "bodily injury" or agree in a "written contract requiring insurance" "property damage" caused by "your work" to include as an additional insured on this Cover- and included in the "products-completed op- age Part, but: erations hazard" unless the "written contract a) Only with respect to liability for"bodily injury", requiring insurance" specifically requires you "property damage"or"personal injury"; and to provide such coverage for that additional insured, and then the insurance provided to b) If, and only to the extent that, the injury or the additional insured applies only to such damage is caused by acts or omissions of "bodily injury" or "property damage" that oc- you or your subcontractor in the performance curs before the end of the period of time for of "your work" to which the "written contract which the "written contract requiring insur- requiring insurance" applies. The person or ance" requires you to provide such coverage organization does not qualify as an additional or the end of the policy period, whichever is insured with respect to the independent acts earlier. or omissions of such person or organization. 3. The insurance provided to the additional insured 2. The insurance provided to the additional insured by this endorsement is excess over any valid and by this endorsement is limited as follows: collectible "other insurance", whether primary, a) In the event that the Limits of Insurance of excess, contingent or on any other basis, that is this Coverage Part shown in the Declarations available to the additional insured for a loss we exceed the limits of liability required by the cover under this endorsement. However, if the "written contract requiring insurance", the in- "written contract requiring insurance" specifically surance provided to the additional insured requires that this insurance apply on a primary shall be limited to the limits of liability re- basis or a primary and non-contributory basis, quired by that "written contract requiring in- this insurance is primary to "other insurance" surance". This endorsement shall not in- available to the additional insured which covers crease the limits of insurance described in that person or organization as a named insured Section III—Limits Of Insurance. for such loss, and we will not share with that b) The insurance provided to the additional in- "other insurance". But the insurance provided to sured does nota I to "bodily injury", " ro the additional insured by this endorsement still is apply y "prop- excess over any valid and collectible "other in- ofdamage" or 'personal injury" arising out surance", whether primary, excess, contingent or of the rendering of, or failure to render, any on any other basis, that is available to the addi- professional architectural, engineering or sur- tional insured when that person or organization is veying services, including: an additional insured under such "other insur- I. The preparing, approving, or failing to ance". prepare or approve, maps, shop draw- 4. As a condition of coverage provided to the ings, opinions, reports, surveys, field or- additional insured by this endorsement: ders or change orders, or the preparing, approving, or failing to prepare or ap- a) The additional insured must give us written prove, drawings and specifications; and notice as soon as practicable of an "occur- 11. Supervisory, inspection, architectural or rence" or an offense which may result in a engineering activities. claim. To the extent possible, such notice should include: CG D2 46 08 05 0 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 COMMERCIAL GENERAL LIABILITY I. How, when and where the "occurrence" any provider of"other insurance"which would or offense took place; cover the additional insured for a loss we II. The names and addresses of any injured cover under this endorsement. However, this persons and witnesses;and condition does not affect whether the insur- ance provided to the additional insured by III. The nature and location of any injury or this endorsement is primary to "other insur- damage arising out of the "occurrence"or ance" available to the additional insured offense. which covers that person or organization as a b) If a claim is made or "suit' is brought against named insured as described in paragraph 3. the additional insured, the additional insured above. must: S. The following definition is added to SECTION V. I. Immediately record the specifics of the —DEFINITIONS: claim or"suit"and the date received; and "Written contract requiring insurance" means ii. Notify us as soon as practicable. that part of any written contract or agreement The additional insured must see to it that we under which you are required to include a receive written notice of the claim or"suit'as person or organization as an additional in- soon as practicable. sured on this Coverage Part, provided that the "bodily injury" and "property damage" oc- c) The additional insured must immediately curs and the "personal injury" is caused by an send us copies of all legal papers received in offense committed: connection with the claim or "suit", cooperate a. After the signing and execution of the with us in the investigation or settlement of contract or agreement by you; the claim or defense against the "suit", and otherwise comply with all policy conditions. b. While that part of the contract or d) The additional insured must tender the de- agreement is in effect;and fense and indemnity of any claim or "suit" to c. Before the end of the policy period. Page 2 of 2 0 2005 The St. Paul Travelers Companies, Inc. CG D2 46 08 05 INSURED: Williams Pipeline Contractors, Inc. COMMERCIAL GENERAL LIABILITY POLICY NUMBER: DT22CO331K3836TCT18 POLICY TERM: 09101/2018 TO 0910112019 BLANKET WAIVER OF SUBROGATION by any ordinance, law or building code to include (ii) A manager of any limited liability as an additional insured on this Coverage Part is company;or an insured, but only with respect to liability for (iii) An executive officer or director of "bodily injury", "property damage". "personal in- any other organization; jury" or"advertising injury" arising out of such op- that is your partner, joint venture erations. member or manager; or The insurance provided to such state or political (b) Any "employee" authorized by such subdivision does not apply to: partnership, joint venture, limited li- a. Any "bodily injury," "property damage," "per- ability company or other organization sonal injury" or"advertising injury"arising out to give notice of an "occurrence" or of operations performed for that state or po- offense. litical subdivision;or (3) Notice to us of such "occurrence"or of an b. Any "bodily injury" or "property damage" in- offense will be deemed to be given as cluded in the "products-completed operations soon as practicable if it is given in good hazard". faith as soon as practicable to your work- J. KNOWLEDGE AND NOTICE OF OCCUR- ers' compensation insurer. This applies RENCE OR OFFENSE only if you subsequently give notice to us The following is added to Paragraph 2., Duties In of the"occurrence" or offense as soon as The Event of Occurrence, Offense, Claim or practicable after any of the persons de- Suit. of SECTION IV — COMMERCIAL GEN- scribed in Paragraphs e. (1) or(2) above ERAL LIABILITY CONDITIONS: discovers that the"occurrence"or offense may result in sums to which the insurance e. The following provisions apply to Paragraph provided under this Coverage Part may a. above, but only for the purposes of the in- apply. surance provided under this Coverage Part to you or any insured listed in Paragraph 1.or 2. However, if this Coverage Part includes an en- ol Section II—Who Is An Insured: dorsement that provides limited coverage for "bodily injury" or "property damage" or pollution (1) Notice to us of such "occurrence" or of- costs arising out of a discharge, release or es- fense must be given as soon as practica- cape of "pollutants"which contains a requirement ble only after the "occurrence" or offense that the discharge, release or escape of "pollut- is known by you (if you are an individual), ants" must be reported to us within a specific any of your partners or members who is number of days after its abrupt commencement, an individual (if you are a partnership or this Paragraph e. does not affect that require- joint venture), any of your managers who ment. is an individual (if you are a limited liability K. UNINTENTIONAL OMISSION company), any of your "executive offi- cers"or directors (if you are an organiza- The following is added to Paragraph 6., Repre- tion other than a partnership,joint venture sentations, of SECTION IV — COMMERCIAL or limited liability company) or any "em- GENERAL LIABILITY CONDITIONS: ployee" authorized by you to give notice The unintentional omission of, or unintentional of an"occurrence"or offense. error in, any information provided by you which (2) If you are a partnership, joint venture or we relied upon in issuing this policy will not preju- limited liability company, and none of your dice your rights under this insurance. However, partners. joint venture members or man- this provision does not affect our right to collect agers are individuals, notice to us of such additional premium or to exercise our rights of "occurrence" or offense must be given as cancellation or nonrenewal in accordance with soon as practicable only after the "occur- applicable insurance laws or regulations. rence"or offense is known by: L. BLANKET WAIVER OF SUBROGATION (a) Any individual who is: The following is added to Paragraph 8., Transfer (i) A partner or member of any part- Of Rights Of Recovery Against Others To Us, nership or joint venture; of SECTION IV— COMMERCIAL GENERAL LI- ABILITY CONDITIONS: CG D3 16 11 11 ©2011 The Travelers Indemnity Company.All rights reserved. Page 5 of 6 COMMERCIAL GENERAL LIABILITY If the insured has agreed in a contract or agree- 3. "Bodily injury" means bodily injury, mental ment to waive that insured's right of recovery anguish, mental injury,shock, fright,disability, against any person or organization, we waive our humiliation, sickness or disease sustained by right of recovery against such person or organiza- a person, including death resulting from any tion, but only for payments we make because of: of these at any time. a. "Bodily injury" or "property damage" that oc- N. CONTRACTUAL LIABILITY—RAILROADS curs;or 1. The following replaces Paragraph c. of the b. "Personal injury" or "advertising injury" definition of "insured contract" in the DEFINI- caused by an offense that is committed; TIONS Section: subsequent to the execution of that contract or c. Any easement or license agreement; agreement. 2. Paragraph C(1) of the definition of "insured M. AMENDED BODILY INJURY DEFINITION contract" in the DEFINITIONS Section is de- The following replaces the definition of "bodily leted. injury" in the DEFINITIONS Section: Page 6 of 6 0 2011 The Travelers Indemnity Company.All rights reserved. CG D3 16 11 11 �� ���.���" WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD, CT 06183 ENDORSEMENT WC 99 03 76( A)— 001 POLICY NUMBER: (UB4J5734651826G) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA (BLANKET WAIVER) 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. The additional premium for this endorsement shall be 3 % of the California workers' compensation pre- mium. Schedule Person or Organization Job Description ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 09/01/2018 Policy No. (URQ5734651826G) Endorsement No. Insured WILLIAMS PIPELINE CONTRACTORS, INC. Premium Insurance Company Countersigned by TRAVELERS PROP CAS CO OF AMR DATE OF ISSUE: 08/24/2018 ST ASSIGN: Page 1 of 1