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PROOF OF INSURANCE (2019 - 2019) CLOSED AC6REP CERTIFICATE OF LIABILITY INSURANCE 10/11/201e 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 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). PRODUCER CONTACT Cora Lim NAME.', SelectSolutions Insurance Services PHONE (866)500-6359 I I`AX (925)951-0077 -'Ad No Exl'N� ....-,.......... CAIS,Nn), 1107 Investment Blvd E'° 'L coral@selectsolutionslns com ADDRESS: Suite 100 INSURER(S)AFFORDING COVERAGE •NAIC# . "I'll,..... EI Dorado Hills CA 95762 INSURER A: Travelers Property Casualty Company ofAmerica 25674 ......................... INSURED INSURER B: Continental Casualty Company 20443 Denn EngineersINSURER C ._............... VW. 3914 Del Amo Boulevard INSURER -_. .w.W..W ......... ............ Suite 921 INSURER E'; .......... Torrance CA 90503 II INSURER F t COVERAGES CERTIFICATE NUMBER: CL1883133842 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 MAYBE 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 ....'99................................... .................... A'UUL SUBH .,.,......... POLICY EFF....,e...POLICY EXP ILTRNSR TYPE OF INSURANCE POLICY NUMBER (MM/DD/YYYY (MMIDDIYYYY)I LIMITS ,......_ INSD V�IVD .............m .,..)_ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000 DAMAG� CLAIMS-MADE 19 OCCUR PREMISES((Ea loccccurrence) $ 1,000,000 MED EXP(Any one person) $ 10,000...,.,.... ......................... A Y 6801H8819461847 09/01/2018 09/01/2019 PERSONAL&ADV INJURY s 1,000,000 OEN`L"GG'R,FC"AIE LIMITAPPL n IES PER I GEPJERALAGGREGATE $ 2,000,000 �*w,,�,++ rroR l.. ❑ LOC PRODUCTS-COMP/OPAGG S 2,000,000 PIJUCY x- JECT .................. ¢?PIIFYi _ al, - AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT T (Ea accident) ANYAUTO BODILY INJURY(Per person) s OWNED •••••••••• SCHEDULED AUTOS ONLY AUTOS -•• PF S; r�PE INJURY(Per accident} HIRED NON-OWNED PTY'GTtiMAGE AUTOS ONLY AUTOS ONLY ¢Paer BcOdcntl� ............... ............. ,............ L AB - ........ UMBRELLA OCCUR EACH OCCURRENCE EXCESS L A $ HCLAIMS-MADE -- AGGREGATE S D 8 RETENTION$ .�....,...... DE $ WORK PER _ ERS COMPENSATION STATUTE ER AND E .",,.,,,,, MPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE � EL EACH ACCIDENT IS OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) EL DISEASE-..EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E I_ DISEASE-POLICY LIMIT 5 PROFESSIONAL LIABILITY B AEH113984368 11/07/2017 11/07/2018 PER CLAIM $1,000,000 AGGREGATE $1,000,000 I ..................... .. ....... ....... DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Re:As Per Contract or Agreement on File with Insured City of EI Segundo Public Works Department It's officers,elected and appointed officials,employees and voluteers are included as additional insured on General Liability policy per the attached endorsement CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of EI Segundo ACCORDANCE WITH THE POLICY PROVISIONS. Public Works Department Attn:Floriza Rivera AUTHORIZED REPRESENTATIVE 350 Main St EI Segundo CA 90245 . y. F @ 1988--✓2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 680-1H881946-18-47 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LANI T ADDITIONAL I SUR D (ARCHITECTS, ENGINEERS AICD SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. The following is added to SECTION II — WHO IS h. This insurance does not apply to "bodily AN INSURED: injury" or "property damage" caused by "your Any person or organization that you agree in a work" and included in the "products- "written contract requiring insurance"to include as completed operations hazard" unless the an additional insured on this Coverage Part, but: "written contract requiring insurance" specifically requires you to provide such a. Only with respect to liability for "bodily injury", coverage for that additional insured, and then "property damage" or"personal injury"; and the insurance provided to the additional b. If, and only to the extent that, the injury or insured applies only to such "bodily injury" or damage is caused by acts or omissions of "property damage" that occurs before the end you or your subcontractor in the performance of the period of time for which the "written of "your work" to which the "written contract contract requiring insurance" requires you to requiring insurance" applies, or in connection provide such coverage or the end of the with premises owned by or rented to you. policy period, whichever is earlier. The person or organization does not qualify as an 2. The following is added to Paragraph 4.a. of additional insured: SECTION IV — COMMERCIAL GENERAL c. With respect to the independent acts or LIABILITY CONDITIONS: omissions of such person or organization; or The insurance provided to the additional insured d. For "bodily injury', "property damage" or is excess over any valid and collectible other "personal injury" for which such person or insurance, whether primary, excess, contingent or organization has assumed liability in a on any other basis, that is available to the additional insured for a loss we cover. However, if contract or agreement. you specifically agree in the "written contract The insurance provided to such additional insured requiring insurance" that this insurance provided is limited as follows: to the additional insured under this Coverage Part must apply on a primary basis or a primary and e. This insurance does not apply on any basis to non-contributory basis, this insurance is primary any person or organization for which to other insurance available to the additional coverage as an additional insured specifically insured which covers that person or organizations is added by another endorsement to this as a named insured for such loss, and we will not Coverage Part. share with the other insurance, provided that: If. This insurance does not apply to the (1) The "bodily injury" or "property damage" for rendering of or failure to render any which coverage is sought occurs; and "professional services". In the event that the Limits of Insurance of the (2) The "personal injury" for which coverage is 9 sought arises out of an offense committed; Coverage Part shown in the Declarations exceed the limits of liability required by the after you have signed that "written contract "written contract requiring insurance", the requiring insurance". But this insurance provided insurance provided to the additional insured to the additional insured still is excess over valid shall be limited to the limits of liability required and collectible other insurance, whether primary, by that "written contract requiring insurance". excess, contingent or on any other basis, that is This endorsement does not increase the available to the additional insured when that limits of insurance described in Section III — person or organization is an additional insured Limits Of Insurance. under any other insurance. CG D3 81 09 15 ©2015 The Travelers Indemnity Company.All rights reserved. Page 1 of 2 Includes the copyrighted material of Insurance Services Office,Inc.,with its permission COMMERCIAL GENERAL LIABILITY 3. The following is added to Paragraph 8., Transfer 4. The following definition is added to the Of Rights Of Recovery Against Others To Us, DEFINITIONS Section: of SECTION IV — COMMERCIAL GENERAL "Written contract requiring insurance" means that LIABILITY CONDITIONS: part of any written contract under which you are We waive any right of recovery we may have required to include a person or organization as an against any person or organization because of additional insured on this Coverage Part, payments we make for "bodily injury", "property provided that the "bodily injury" and "property damage" or "personal injury" arising out of "your damage" occurs and the "personal injury" is work" performed by you, or on your behalf, done caused b an offense committed: under a "written contract requiring insurance" with y that person or organization. We waive this right a. After you have signed that written contract; only where you have agreed to do so as part of b. While that part of the written contract is in the "written contract requiring insurance" with effect; and such person or organization signed by you before, and in effect when, the "bodily injury" or c. Before the end of the policy period. "property damage" occurs, or the "personal injury" offense is committed. Page 2 of 2 ©2015 The Travelers Indemnity Company All rights reserved. CG D3 81 09 15 Includes the copyrighted material of Insurance Services Office,Inc.,with its permission ACCW CERTIFICATE OF LIABILITY INSURANCE DATE(MM;DDfYYYY) 08/2712018 THIS CERTIFICATE IS ISSUED ASA 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($),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the poli 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 I this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACTAVBlanca De La Hoz Danmar Insurance Services Inc. P wO E EA.' (951)5090509„ _ ... .@...rAX te�;e�; (951~jm509-051.5......... ... License#OD36873 AODRFSS: 9899 Indiana Avenue,Ste 101 INSURER(S)AFFORDING COVERAGE NAIL s Riverside CA 92503 INSURERA: Hartford Accident and Indemnity Cc 22357 ..................._. INSURED INSURER B: Preferred Employers Insurance Company 10900 Denn Engineers IncINSURER C: 3914 Del Arno Blvd Ste 921 INSURER D: INSURER E: Torrance CA 90503 INSURER F: COVERAGES CERTIFICATE NUMBER: CL1872306794 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 MAYBE 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 ✓+UUL SUBH POLICY EFF Pi.LILY CXF p y.1R TYPE OF INSURANCE PNSp yyup POLICY NUMBER (MMIDDIYYYY) (#AlAnDNyYY'I a LIMITS COMMERCIAL GENERAL LIABILITY V L.ACH OCCIURRFIQ:P. s T !",I AIPJI5 MAIN' 0 OCCUR mmG�t�C(':','mY.9�5,..�� I �.� fr"���.�MLrL�(ra�rG FYt-�..Cifl,.........._....�... ..... . L,ILI.J LoC (Arw pile oerrwu 5 l'I R2'-,0NAL e ADV IPJ-IdJlt`i S GEN'LAGGREGATE LIMITAPPLIES PER I Cli.awERAl..M-GrWPw GAI E S HC1 1ki'E'yt' ODUCTS-COMPIOPAGG S OLICY ._ $ .IECT LOG ....__.... .,..PRODUCTS ------.._.. AUTOMOBILE LIABILITYR; NA�'¢,gdl^aE',Cr SPtW10..5::�1.P�d�ltt $ 1,000,000 ""X AIJYAUTO If30oh_Y IINJUR'Y Wn' p,cvon) $ A OWNED CliuJul..o-wl. 72UECKC2774 07/17/2018 07/17/2019 ?t"uilY INVJKY(For ir:rd.n-J) 5 AUTOS ONLY ,AU l 0',r HIRED NON-OWNED P'C _&^_._ .. ........................._...._,.,.,..,.., .._.mi (,;1P'y':R'7"Y'DAMAGE $ AUTOS ONLY AUTOS ONLY mar a.&ovkaru�Xl Underinsured motorist S 1,000,000 UMBRELLA LIAB C RRENC R_AIMIG. EAGH OCURENCE 5 EXCESS LIAR MADE ACCRF.CATF S DED I M RI."PFNNON S 5 WORKERS COMPENSATION XLSTgTUTFI FRH- WW B AND EMPLOYERS'LIRTNEY YIN NIA WKN165362-1 02/01/2018 02/01/2019 ..-..•...-.....---.-•-•--•••••-••••••••••••••••••••••••••••. s 1,000,000 OFFICERIMEANY PROPRIETOR/PARTNERIEXECUTIVE E L EACH ACCIDENT (Mandatory in BER EXGLUDED7 1,000,000 (Manda4ory in NH) ILL,DISI-.:,:,tit-I:�},f,::;MPI,t.'jvY�F g If yes,descnbe under 1,000,000 DESCRIPTION OF OPERATIONS below II:..I..DI�'A-A,E 4"'(11,I(..v I YIAI P S DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if mare space Is required) CERTIFI'CAT'E HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of EI Segundo Public Works Department Atm:Floriza Rivera ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main St, AUTHORIZED REPRESENTATIVE I EI Segundo CA 90245 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD COMMERCIAL AUTOMOBILE HA 9916 0312 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL AUTOMOBILE BROAD FOR ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM To the extent that the provisions of this endorsement provide broader benefits to the "insured" than other provisions of the Coverage Form, the provisions of this endorsement apply. 1. BROAD FORM INSURED d. Any "employee" of yours while using a A. Subsidiaries and Newly Acquired or covered "auto" you don't own, hire or Formed Organizations borrow in your business or your The Named Insured shown in the personal affairs. Declarations is amended to include: C. Lessors as Insureds (1) Any legal business entity other than a Paragraph A.1. -WHO IS AN INSURED-of partnership or joint venture, formed as a Section II -Liability Coverage is amended to subsidiary in which you have an add: ownership interest of more than 50% on e. The lessor of a covered"auto"while the the effective date of the Coverage Form. "auto" is leased to you under a written However, the Named Insured does not agreement if: include any subsidiary that is an "insured" under any other automobile (1) The agreement requires you to policy or would be an "insured" under provide direct primary insurance for the lessor and such a policy but for its termination or the exhaustion of its Limit of Insurance. (2) The"auto"is leased without a driver. (2) Any organization that is acquired or Such a leased "auto" will be considered a formed by you and over which you covered "auto" you own and not a covered maintain majority ownership. However, "auto"you hire. the Named Insured does not include any D. Additional Insured if Required by Contract newly formed or acquired organization: (1) Paragraph A.1. -WHO IS AN INSURED (a) That is a partnership or joint - of Section II - Liability Coverage is venture, amended to add: (b) That is an"insured" under any other f. When you have agreed, in a written policy, contract or written agreement,that a (c) That has exhausted its Limit of person or organization be added as Insurance under any other policy, or an additional insured on your (d) 180 days or more after its business auto policy, such person or acquisition or. formation by you, organization is an"insured", but only unless you have given us notice of to the extent such person or the acquisition or formation. organization Is liable for "bodily Coverage does not apply to "bodily injury" or"property damage"caused injury" or"property damage"that results by the conduct of an "insured"under from an "accident" that occurred before paragraphs a. or b. of Who Is An you formed or acquired the organization. Insured with regard to the B. Employees as Insureds ownership, maintenance or use of a Paragraph A.1. -WHO IS AN INSURED -of covered"auto." SECTION II - LIABILITY COVERAGE is amended to add: ©2011,The Hartford(Includes copyrighted material Form HA 9916 0312 of ISO Properties, Inc.,with its permission.) Page 1 of 5 The insurance afforded to any such E. Primary and Non-Contributory If additional insured applies only if the Required by Contract "bodily injury" or "property damage" Only with respect to insurance provided to occurs: an additional insured in I.D. - Additional (1) During the policy period, and Insured If Required by Contract, the (2) Subsequent to the execution of such following provisions apply: written contract, and (3) Primary Insurance When Required By (3) Prior to the expiration of the period Contract of time that the written contract This insurance is primary if you have requires such insurance be provided agreed in a written contract or written to the additional insured. agreement that this insurance be (2) How Limits Apply primary. If other insurance is also primary, we will share with all that other If you have agreed in a written contract or written agreement that another insurance by the method described in person or organization be added as an Other Insurance 5.d. additional insured on your policy, the (4) Primary And Non-Contributory To Other most we will pay on behalf of such Insurance When Required By Contract additional insured is the lesser of: If you have agreed in a written contract (a) The limits of insurance specified in or written agreement that this insurance the written contract or written is primary and non-contributory with the agreement; or additional insured's own insurance, this (b) The Limits of Insurance shown in insurance is primary and we will not the Declarations. seek contribution from that other insurance. Such amount shall be a part of and not Paragraphs(3)and (4)do not apply to other in addition to Limits of Insurance shown insurance to which the additional insured in the Declarations and described in this Section. has been added as an additional insured, When this insurance is excess, we will have no (3) Additional Insureds Other Insurance duty to defend the insured against any "suit" if If we cover a claim or "suit" under this any other insurer has a duty to defend the Coverage Part that may also be covered insured against that "suit". If no other insurer by other insurance available to an defends, we will undertake to do so, but we will additional insured, such additional be entitled to the insured's rights against all insured must submit such claim or"suit" those other insurers. to the other insurer for defense and When this insurance is excess over other indemnity. insurance, we will pay only our share of the However, this provision does not apply amount of the loss, if any, that exceeds the sum to the extent that you have agreed in a of: written contract or written agreement (1) The total amount that all such other that this insurance is primary and non- insurance would pay for the loss in the contributory with the additional insured's absence of this insurance;and own insurance, (2) The total of all deductible and self-Insured (4) Duties in The Event Of Accident, Claim, Suitor Loss amounts under all that other insurance. We will share the remaining loss, if any, by the If you have agreed in a written contract or written agreement that another method described in Other Insurance 5.d.person or organization be added as an 2. AUTOS RENTED BY EMPLOYEES additional insured on your policy, the Any "auto" hired or rented by your "employee" additional insured shall be required to on your behalf and at your direction will be comply with the provisions in LOSS considered an"auto"you hire. CONDITIONS 2. - DUTIES IN THE The OTHER INSURANCE Condition is amended EVENT OF ACCIDENT, CLAIM , SUIT by adding the following: OR LOSS — OF SECTION IV — BUSINESS AUTO CONDITIONS, in the same manner as the Named Insured. ©2011,The Hartford(Includes copyrighted material Form HA 9916 0312 of ISO Properties, Inc.,with its permission.) Page 2 of 5 If an "employee's" personal insurance also 5. PHYSICAL DAMAGE - ADDITIONAL applies on an excess basis to a covered "auto" TEMPORARY TRANSPORTATION EXPENSE hired or rented by your "employee" on your COVERAGE behalf and at your direction, this insurance will Paragraph A.4.a. of SECTION III - PHYSICAL be primary to the "employee's" personal DAMAGE COVERAGE is amended to provide a insurance. limit of $50 per day and a maximum limit of 3. AMENDED FELLOW EMPLOYEE EXCLUSION $1,000. EXCLUSION 5. - FELLOW EMPLOYEE - of 6. LOANILEASE GAP COVERAGE SECTION II - LIABILITY COVERAGE does not Under SECTION III - PHYSICAL DAMAGE apply if you have workers' compensation COVERAGE, in the event of a total "loss" to a insurance in-force covering all of your covered "auto", we wi01 pay your additional legal "employees". obligation for any difference between the actual Coverage is excess over any other collectible cash value of the "auto"at the time of the"loss" insurance. and the"outstanding balance"of the loan/lease. 4. HIRED AUTO PHYSICAL DAMAGE COVERAGE "Outstanding balance" means the amount you If hired "autos" are covered "autos" for Liability owe on the loan/lease at the time of"loss" less Coverage and if Comprehensive, Specified any amounts representing taxes; overdue Causes of Loss, or Collision coverages are payments; penalties, interest or charges provided under this Coverage Form for any resulting from overdue payments; additional "auto" you own, then the Physical Damage mileage charges; excess wear and tear charges; Coverages provided are extended to"autos"you lease termination fees; security deposits not hire or borrow, subject to the following limit, returned by the lessor; costs for extended warranties credit life Insurance, health, accident The most we will pay for "loss" to any hired or disability insurance purchased with the loan or auto is; lease; and carry-over balances from previous (1) $100,000; loans or leases. (2) The actual cash value of the damaged or 7. AIRBAG COVERAGE stolen property at the time of the"loss";or Under Paragraph B. EXCLUSIONS - of (3) The cost of repairing or replacing the SECTION III - PHYSICAL DAMAGE damaged or stolen property, COVERAGE,the following is added: whichever is smallest, minus a deductible. The The exclusion relating to mechanical breakdown deductible will be equal to the largest deductible does not apply to the accidental discharge of an applicable to any owned "auto" for that airbag. coverage. No deductible applies to"loss"caused g, ELECTRONIC EQUIPMENT - BROADENED by fire or lightning. Hired Auto Physical Damage COVERAGE coverage is excess over any other collectible insurance. Subject to the above limit, deductible a. The exceptions to Paragraphs B.4 - and excess provisions, we will provide coverage EXCLUSIONS -of SECTION III -PHYSICAL equal to the broadest coverage applicable to any DAMAGE COVERAGE are replaced by the covered"auto"you own, following: We will also cover loss of use of the hired "auto" Exclusions 4.c. and 4.d. do not apply to if it results from an "accident", you are legally equipment designed to be operated solely liable and the lessor incurs an actual financial by use of the power from the "auto's" loss, subject to a maximum of $1000 per electrical system that, at the time of"loss", "accident". is: This extension of coverage does not apply to (1) Permanently installed in or upon any "auto" you hire or borrow from any of your the covered"auto"; "employees", partners (if you are a partnership), (2) Removable from a housing unit members (if you are a limited liability company), which is permanently installed in or members of their households, or upon the covered"auto"; (3) An integral part of the same unit housing any electronic equipment described in Paragraphs(1)and (2)above; or 0 2011,The Hartford(Includes copyrighted material Form HA 9916 0312 of ISO Properties, Inc.,with its permission.) Page 3 of 5 (4) Necessary for the normal If another Hartford Financial Services Group, operation of the covered"auto"or Inc. company policy or coverage form that is not the monitoring of the covered an automobile policy or coverage form applies to "auto's"operating system. the same"accident", the following applies: b.Section III — Version CA 00 01 03 10 of the (1) If the deductible under this Business Auto Business Auto Coverage Form, Physical Coverage Form is the smaller (or smallest) Damage Coverage, Limit of Insurance, deductible, it will be waived; Paragraph C.2 and Version CA 00 01 10 01 of (2) If the deductible under this Business Auto the Business Auto Coverage Form, Physical Coverage Form is not the smaller (or Damage Coverage, Limit of Insurance, smallest) deductible, it will be reduced by Paragraph C are each amended to add the the amount of the smaller (or smallest) following: deductible. $1,500 is the most we will pay for"loss" in 12. AMENDED DUTIES IN THE EVENT OF any one "accident" to all electronic ACCIDENT,CLAIM,SUIT OR LOSS equipment(other than equipment designed The requirement in LOSS CONDITIONS 2.a. - solely for the reproduction of sound, and DUTIES IN THE EVENT OF ACCIDENT,CLAIM, accessories used with such equipment) SUIT OR LOSS - of SECTION IV - BUSINESS that reproduces, receives or transmits AUTO CONDITIONS that you must notify us of audio, visual or data signals which, at the an "accident"applies only when the"accident"is time of"loss", is: known to: (1)Permanently installed in or upon (1) You, if you are an individual; the covered "auto" in a housing, opening or other location that is not (2) A partner, if you are a partnership; normally used by the "auto" (3) A member, if you are a limited liability manufacturer for the installation of company; or such equipment; 2 Removable from a permanently (4) An executive officer or insurance manager, if ( ) P y you are a corporation. installed housing unit as described 13. UNINTENTIONAL FAILURE TO DISCLOSE in Paragraph 2.a. above or is an HAZARDS integral part of that equipment; or If you unintentionally fail to disclose any hazards (3)An integral part of such equipment, existing at the inception date of your policy, we c.For each covered "auto", should loss be limited will not deny coverage under this Coverage to electronic equipment only, our obligation to Form because of such failure. pay for, repair, return or replace damaged or 14. HIRED AUTO-COVERAGE TERRITORY stolen electronic equipment will be reduced by the applicable deductible shown in the Paragraph e. of GENERAL CONDITIONS 7. - Declarations, or $250, whichever deductible is POLICY PERIOD, COVERAGE TERRITORY - less. of SECTION IV - BUSINESS AUTO 9. EXTRA EXPENSE BROADENED CONDITIONS is replaced by the following: COVERAGE e. For short-term hired "autos", the coverage Under Paragraph A. -COVERAGE-of SECTION territory with respect to Liability Coverage is III - PHYSICAL DAMAGE COVERAGE, we will anywhere in the world provided that if the pay for the expense of returning a stolen covered "insured's"responsibility to pay damages for "auto"to you. "bodily injury" or "property damage" is determined in a"suit,"the"suit" is brought in 10. GLASS REPAIR-WAIVER OF DEDUCTIBLE the United States of America, the territories Under Paragraph D,-DEDUCTIBLE-of SECTION and possessions of the United States of III - PHYSICAL DAMAGE COVERAGE, the America, Puerto Rico or Canada or in a following is added: settlement we agree to. No deductible applies to glass damage if the 15. WAIVER OF SUBROGATION glass is repaired rather than replaced. TRANSFER OF RIGHTS OF RECOVERY 11. TWO OR MORE DEDUCTIBLES AGAINST OTHERS TO US - of SECTION IV - Under Paragraph D.-DEDUCTIBLE-of SECTION BUSINESS AUTO CONDITIONS is amended by III - PHYSICAL DAMAGE COVERAGE, the adding the following: following is added: 0 2011, The Hartford(Includes copyrighted material Form HA 9916 0312 of ISO Properties, Inc.,with its permission.) Page 4 of 5 We waive any right of recovery we may have a Regardless of the number of autos deemed a against any person or organization with whom total loss, the most we will pay under this you have a written contract that requires such Hybrid, Electric, or Natural Gas Vehicle waiver because of payments we make for Payment Coverage provision for any one damages under this Coverage Form, "loss"is$10,000. 16. RESULTANT MENTAL ANGUISH COVERAGE For the purposes of the coverage provision, The definition of "bodily injury" in SECTION V- a.A "non-hybrid" auto is defined as an auto that DEFINITIONS is replaced by the following: uses only an internal combustion engine to "Bodily injury" means bodily injury, sickness or move the auto but does not include autos disease sustained by any person, including powered solely by electricity or natural gas. mental anguish or death resulting from any of b.A "hybrid" auto is defined as an auto with an these. internal combustion engine and one or more 17, EXTENDED CANCELLATION CONDITION electric motors; and that uses the internal Paragraph 2. of the COMMON POLICY combustion engine and one or more electric CONDITIONS - CANCELLATION - applies motors to move the auto, or the internal except as follows: combustion engine to charge one or more electric motors,which move the auto. If we cancel for any reason other than 19. VEHICLE WRAP COVERAGE nonpayment of premium, we will mail or deliver to the first Named Insured written notice of In the event of a total loss to an"auto"for which cancellation at least 60 days before the effective Comprehensive, Specified Causes of Loss, or date of cancellation. Collision coverages are provided under this 18. HYBRID, ELECTRIC, OR NATURAL GAS Coverage Form, then such Physical Damage VEHICLE PAYMENT COVERAGE Coverages are amended to add the following: In the event of a total loss to a "non-hybrid"auto In addition to the actual cash value of the"auto", we will pay up to $1,000 for vinyl vehicle wraps for which Comprehensive, Specified Causes of which are displayed on the covered "auto" at the Loss, or Collision coverages are provided under time of total loss. Regardless of the number of this Coverage Form, then such Physical autos deemed a total loss, the most we will pay Damage Coverages are emended as follows: under this Vehicle Wrap Coverage provision for a,lf the auto Is replaced with a "hybrid" auto or any one "loss" is $5,000. For purposes of this an auto powered solely by electricity or natural coverage provision, signs or other graphics gas, we will pay an additional 10%, to a painted or magnetically affixed to the vehicle are maximum of$2,500, of the "non-hybrid"auto's not considered vehicle wraps. actual cash value or replacement cost, whichever is less, b.The auto must be replaced and a copy of a bill of sale or new lease agreement received by us within 60 calendar days of the date of"loss," ©2011,The Hartford(includes copyrighted material Form HA 99 10 03 12 of ISO Properties, Inc.,with its permission.) Page 5 of 5 Workers Compensation and Employers Liability Preferred EmpjqySrs Insurance Policy I N S 'ID '11 A N C li C 0 M P A N Y 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 determined by multiplying the California workers' compensation premium due on such remuneration by the factor 0.050 Schedule Person or Or4anization Jots Descri qty City of EI Segundo RE: Engineering work Public Works Department 350 Main Street EI Segundo,CA 90245 This endorsement is subject to a minimum premium charge of $ 200 Nothing in this endorsement shall vary,alter,waive or extend any of the terms,conditions or limitations of this policy other than as stated above. Nothing elsewhere in this policy shall be held to vary,alter,waive or limit the terms,conditions,agreements or limitations of this endorsement. This Endorsement when attached to Policy Number:WKN 165362-1 issued to DENN ENGINEERS,INC. shall be valid and shall form part of referenced policy. The effective date of this endorsement is 02101/18 at 12:01 AM. Endorsement No.: 20 Date Issued: 02108118 Producer Number: 12885 Agency Name: DANMAR INSURANCE SERVICES Refer To Signature Page Authorized Representative PEI1 D4 05/01198