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PROOF OF INSURANCE (2019) CLOSED 0
CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY)
,.' 11/26/2018
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(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 CO'NTACT'
NAME,
Dealey, Renton &Associates PHONE PAX
DRA License 0020739 jNc,rjo,Ext):'714-427-6810 (Arc,Nap,714 427-6818
E-MAIL
P.O. Box 10550 ADDRESS;
Santa Ana CA 92711-0550 INSURER(S)AFFORDING COVERAGE NAIC#
INSURER A:Travelers Property Casualty Co of Ameri 25674
INSURED Nr NlI_ i,-ANFf INSURER B:Travelers'Cassually&Surety Co.America 31194
NCM Engineering Corp.
22362 Gilberto, Suite 125 (NSuRElzcr
Rancho Santa Margarita CA 92688 INSURER D,
INSURER E:
INSURER F
COVERAGES CERTIFICATE NUMBER:2069614810 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,
INSRTYPE OF INSURANCE ,O bt SUeR POLICY EFF POLICY EXP INLIMITS
LTR J„y Vr) POLICY NUMBER (MMIDDIYYYYI_(MM/DD/YYYY)
A X COMMERCIAL GENERAL LIABILITY Y Y 6805HO6721A 12/5/2018 72l6C'Otn I ACI I 0(_'('11M21Z4-pJCC- 51,0no.Nu7
DAMAGE'0 IF;E NT 0'
CLAIMS-MADE X CICC UIR PREW�tu:alr,5 V('.a rsctiucr„ru:;a,y 'n 1 000 000
X Contractual [01 1)!-XP IAny one t)ersnn,l :,'10 oui.)
Liability r'I"'I?£!t".�Pd(-J 5 AI)V ftiIJ 6 S 1,n(10,000
fa.-PA AGGI;:CGAI1 I II-/11'I F PTLRFP,,PER, Cali NI F,'t1V ;1a".,GHL GAIN $2000000
POLICY X LOC PRCtiI.-IIVCI:i $2000000
JV-('r
C," qLR i
A AUTOMOBILE LIABILITY Y Y 11AI10'i}'1 l7 'i'_'(bt:.:01t3 '19/11I.?o'I9 0;r`A'u Lilr�k�'!1';k�:a'If+BC'.r Lk r.V�4flli'T S
F'n,fsCCi�tlCr"I,Iy 000 GOO
X ANY AI.!"I 0 Iry mil Y IN,II IRY lP,ar lirrsson) S
141...V ovvi,jrn SCHEDULED Iio[.?L Y'VIJ,�Iiw(dl-ui rs.:co ent) S
AIIIOG AUTOS
NON-OWNED PRCIPE',R'T"r'brIa°.r'�GE S
1-41PFF.+AlIIOc, "Y" AUTOS q',ReracodernIl,
. I
A X UMBRELLA LIAB X. OCCUR CUPOD565564 1?f('/"(l i'8 .1,,/t,1'10'1'T EACH OCCURRENCE S'_o(M 00
EXCESS LIAB 11Cl AIMS MAIDE AGGREGATE S;`000
UI:D RETENTION S
p, WORKERS COMPENSATION Y UBBJ242237 '1215120'18 1:IW"Iti19 x PER ID1 hH
AND EMPLOYERS'LIABILITY YIN STATUTE FR
ANY PROPRIETOR/PARTNER/EXECUTIVEN/A li I ri4..H A(.CIr1FN I 5 1,001)000
OFFICER/MEMBER EXCLUDED
(Mandatory in NH) E L DISEASE-EA(',:M.P@ OYEE S3'I O!M,000
If yes,describe under
DESCRIPTION OF OPERATIONS below I-I. hlc;l"r+.`ri C- Poi ICt'L..iw I S 1 000.00o
B Professional Liab, 1060989 12/5/2018 12/5/2019 Per Claim ^:1,000 000
Claims Made Annual Aggr �,O,000 000
Full Prior Acts
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
Umbrella policy is a follow-form to underlying General Liability/Auto Liability/Employers Liability.
Fie, Park Place Extension Pr°opect.
City of EI Segundo,its officers,employees or agents are additional insured on general&hired and non owned auto liability as per written contract.Coverage
a'ff'orded the additional insured is primary and non-contributory as respects to general liability coverage.Waiver of subrogation included in work comp,general,
hired and non-owned auto liability as per written contract.
CERTIFICATE HOLDER CANCELLATION 30 Days Notice of Cancellalion
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of EI Segundo
350 Main Street AUTHORI ED REPRESENTATIVE
EI Segundo CA 90245
M
©1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
COMMERCIAL GENERAL LIABILITY
POLICY NUMBER: 6805HO6721A ISSUED DATE: 11/26/2018
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES O
CONTRACTORS - COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organization(s):
Any person or organization that you agree in a written contract to include as an additional
insured on this Coverage Part for"bodily injury" or"property damage" included in the"products-
completed operations hazard", provided that such contract was signed and executed by you
before, and is in effect when, the bodily injury or property damage occurs.
Location And Description Of Completed Operations
Any project to which an applicable contract described in the Name of Additional
Insured Person(s) or Organization(s) section of this Schedule applies.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations,
Section II — Who Is An Insured is amended to in- location designated and described in the schedule of
clude as an additional insured the person(s) or or- this endorsement performed for that additional in-
ganization(s) shown in the Schedule, but only with sured and included in the "products-completed opera-
respect to liability for "bodily injury" or "property dam- tions hazard".
age" caused, in whole or in part, by"your work" at the
CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1
COMMERCIAL GENERAL LIABILITY
POLICY NUMBER 6805HO6721A ISSUED DATE: 11/26/2018
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
Names of Additional Insured Person(s) or Organization(s):
Any person or organization that you agree in a written contract, on this Coverage Part, provided
that such written contract was signed and executed by you before, and is in effect when the
"bodily injury" or"property damage" occurs or the "personal injury" or"advertising injury"offense
is committed.
Location of Covered Operations:
Any project to which an applicable written contract with the described in the Name of
Additional Insured Person(s) or Organization(s) section of this Schedule applies.
(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 in- This insurance does not apply to "bodily injury" or
clude as an additional insured the person(s) or "property damage" occurring, or "personal injury"
organization(s) shown in the Schedule, but only or "advertising injury" arising out of an offense
with respect to liability for"bodily injury", "property committed, after:
damage", "personal injury" or "advertising injury" 1. All work, including materials, parts or equip-
caused, in whole or in part, by: ment furnished in connection with such work,
1. Your acts or omissions; or on the project (other than service, mainte-
2. The acts or omissions of those acting on your nance or repairs) to be performed by or on
behalf; behalf of the additional insured(s) at the loca-
tion of the covered operations has been com-
in the performance of your ongoing operations for pleted; or
the additional insured(s) at the location(s) desig-
nated above. 2. That portion of "your work" out of which the
injury or damage arises has been put to its in-
B. With respect to the insurance afforded to these tended use by any person or organization
additional insureds, the following additional exclu- other than another contractor or subcontrac-
sions apply: for engaged in performing operations for a
principal as a part of the same project.
CG D3 61 03 05 Copyright 2005 The St. Paul Travelers Companies, Inc. All rights reserved. Page 1 of 1
Includes copyrighted material of Insurance Services Office, Inc. with its permission.
POLICY NUMBER: 6805HO6721A COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
OTHER INSURANCE - ADDITIONAL I SUREDS -
PRIMARY AND NON-CONTRIBUTORY WITH RESPECT TO
CERTAIN OTHER INSURANCE
This endorsement modifies insurance provided under the following.
COMMERCIAL GENERAL LIABILITY COVERAGE PART
The following is added to Paragraph 4. a., Primary (1) The "bodily injury" or"property damage"for which
Insurance, of SECTION IV — COMMERCIAL GEN- coverage is sought is caused by an 'occurrence"
ERAL LIABILITY CONDITIONS: that takes place; and
However, if you specifically agree in a written contract (2) The "personal injury" or "advertising injury" for
or agreement that the insurance afforded to an addi- which coverage is sought arises out of an offense
tional insured under this Coverage Part must apply on that is committed;
a primary basis, or a primary and non-contributory
basis, this insurance is primary to other insurance that subsequent to the signing and execution of that con-
is available to such additional insured which covers tract or agreement by you.
such additional insured as a named insured, and we
will not share with that other insurance, provided that:
CG D4 25 07 08 O 2008 The Travelers Companies, Inc. Page 1 of 1
COMMERCIAL GENERAL LIABILITY
POLICY NUMBER: 6805HO6721A ISSUED DATE: 11/26/2018
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
Any person or organization that you agree in a written contract
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement.)
The TRANSFER OF RIGHTS OF RECOVERY damage arising out of your ongoing operations or
AGAINST OTHERS TO US Condition (Section IV- "your work" done under a contract with that person
COMMERCIAL GENERAL LIABILITY CONDITIONS) or organization and included in the "products-
is amended by the addition of the following: completed operations hazards." This waiver applies
We waive any right of recovery we may have against only to the person or organization shown in the
the person or organization shown in the Schedule Schedule above.
above because of payments we make for injury or
CG 24 04 10 93 Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1
BAlD072177 COMMERCIAL AUTO
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
AUTO COVERAGE PLUS ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
GENERAL DESCRIPTION OF COVERAGE—This endorsement broadens coverage. However, coverage for any
injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or
limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to
the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover-
age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en-
dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered.
A. BLANKET ADDITIONAL INSURED H. AUDIO, VISUAL AND DATA ELECTRONIC
B. EMPLOYEE HIRED AUTO EQUIPMENT—INCREASED LIMIT
C. EMPLOYEES AS INSURED I. WAIVER OF DEDUCTIBLE—GLASS
D. SUPPLEMENTARY PAYMENTS — INCREASED J. PERSONAL PROPERTY
LIMITS K. AIRBAGS
E. TRAILERS—INCREASED LOAD CAPACITY L. AUTO LOAN LEASE GAP
F. HIRED AUTO PHYSICAL DAMAGE M. BLANKET WAIVER OF SUBROGATION
G. PHYSICAL DAMAGE — TRANSPORTATION
EXPENSES—INCREASED LIMIT
A. BLANKET ADDITIONAL INSURED performing duties related to the conduct of
The following is added to Paragraph A.1., Who Is your business.
An Insured, of SECTION II —COVERED AUTOS 2. The following replaces Paragraph b. in B.5.,
LIABILITY COVERAGE: Other Insurance, of SECTION IV — BUSI-
Any person or organization who is required under NESS AUTO CONDITIONS:
a written contract or agreement between you and b. For Hired Auto Physical Damage Cover-
that person or organization, that is signed and age, the following are deemed to be cov-
executed by you before the "bodily injury" or ered "autos"you own:
"property damage" occurs and that is in effect
during the policy period, to be named as an addi- (1) Any covered "auto" you lease, hire,
tional insured is an "insured" for Covered Autos rent or borrow; and
Liability Coverage, but only for damages to which (2) Any covered "auto" hired or rented by
this insurance applies and only to the extent that your "employee" under a contract in
person or organization qualifies as an "insured" an "employee's" name, with your
under the Who Is An Insured provision contained permission, while performing duties
in Section II. related to the conduct of your busi-
B. EMPLOYEE HIRED AUTO ness.
1. The following is added to Paragraph A.1., However, any "auto"that is leased, hired,
Who Is An Insured, of SECTION II — COV- rented or borrowed with a driver is not a
ERED AUTOS LIABILITY COVERAGE: covered "auto".
An "employee" of yours is an "insured" while C. EMPLOYEES AS INSURED
operating a covered "auto" hired or rented The following is added to Paragraph A.1., Who Is
under a contract or agreement in an em- An Insured, of SECTION II —COVERED AUTOS
ployee's" name, with your permission, while LIABILITY COVERAGE:
CA T4 20 02 15 ©2015 The Travelers Indemnity Company, All rights reserved, Page 1 of 3
Includes copyrighted material of Insurance Services Office, Inc with its permission
COMMERCIAL AUTO
Any "employee" of yours is an "insured"while us- (2) An adjustment for depreciation and physical
ing a covered "auto"you don't own, hire or borrow condition will be made in determining actual
in your business or your personal affairs. cash value in the event of a total "loss".
D. SUPPLEMENTARY PAYMENTS — INCREASED (3) If a repair or replacement results in better
LIMITS than like kind or quality, we will not pay for the
1. The following replaces Paragraph A.2.a.(2) of amount of betterment.
SECTION II —COVERED AUTOS LIABILITY (4) A deductible equal to the highest Physical
COVERAGE: Damage deductible applicable to any owned
(2) Up to $3,000 for cost of bail bonds (in- covered "auto".
cluding bonds for related traffic law viola- (5) This Coverage Extension does not apply to:
tions) required because of an "accident" (a) Any "auto" that is hired, rented or bor-
we cover. We do not have to furnish rowed with a driver; or
these bonds.
2. The following replaces Paragraph A.2.a.(4) of (b) Any "auto" that is hired, rented or bor-
SECTION II —COVERED AUTOS LIABILITY rowed from your"employee".
COVERAGE: G. PHYSICAL DAMAGE — TRANSPORTATION
EXPENSES—INCREASED LIMIT
(4) All reasonable expenses incurred by the
"insured" at our request, including actual The following replaces the first sentence in Para-
loss of earnings up to $500 a day be- graph A.4.a., Transportation Expenses, of
cause of time off from work. SECTION III — PHYSICAL DAMAGE COVER-
AGE:
E. TRAILERS—INCREASED LOAD CAPACITY
The following replaces Paragraph C.1. of SEC- We will pay up to $50 per day to a maximum of
TION I—COVERED AUTOS: $1,500 for temporary transportation expense in-
curred by you because of the total theft of a cov-
1. "Trailers" with a load capacity of 3,000 ered "auto" of the private passenger type.
pounds or less designed primarily for travel H. AUDIO, VISUAL AND DATA ELECTRONIC
on public roads. EQUIPMENT—INCREASED LIMIT
F. HIRED AUTO PHYSICAL DAMAGE Paragraph C.1.b. of SECTION III — PHYSICAL
The following is added to Paragraph AA., Cover- DAMAGE COVERAGE is deleted.
age Extensions, of SECTION III — PHYSICAL I. WAIVER OF DEDUCTIBLE—GLASS
DAMAGE COVERAGE:
The following is added to Paragraph D., Deducti-
Hired Auto Physical Damage Coverage ble, of SECTION III — PHYSICAL DAMAGE
If hired "autos" are covered "autos" for Covered COVERAGE:
Autos Liability Coverage but not covered "autos" No deductible for a covered "auto" will apply to
for Physical Damage Coverage, and this policy glass damage if the glass is repaired rather than
also provides Physical Damage Coverage for an replaced.
owned "auto", then the Physical Damage Cover- J. PERSONAL PROPERTY
age is extended to "autos" that you hire, rent or The following is added to Paragraph A.4., Cover-
borrow subject to the following: age Extensions, of SECTION III — PHYSICAL
(1) The most we will pay for "loss" to any one DAMAGE COVERAGE:
"auto" that you hire, rent or borrow is the Personal Property Coverage
lesser of: We will pay up to $400 for "loss" to wearing ap-
(a) $50,000; parel and other personal property which is:
(b) The actual cash value of the damaged or (1) Owned by an "insured"; and
stolen property as of the time of the (2) In or on your covered "auto".
"loss"; or
This coverage only applies in the event of a total
(c) The cost of repairing or replacing the theft of your covered "auto".
damaged or stolen property with other No deductibles apply to Personal Property cover-
property of like kind and quality. age.
Page 2 of 3 ©2015 The Travelers Indemnity Company. All rights reserved CA T4 20 02 15
Includes copyrighted material of Insurance Services Office, Inc.with its permission.
COMMERCIAL AUTO
K. AIRBAGS (2) Any:
The following is added to Paragraph B.3., Exclu- (a) Overdue lease or loan payments at the
sions, of SECTION III — PHYSICAL DAMAGE time of the "loss";
COVERAGE:
(b) Financial penalties imposed under a
Exclusion 3.a. does not apply to "loss" to one or lease for excessive use, abnormal wear
more airbags in a covered "auto" you own that in- and tear or high mileage;
flate due to a cause other than a cause of "loss"
set forth in Paragraphs A.1.b. and A.1.c., but (c) Security deposits not returned by the les-
only: sor;
a. If that "auto" is a covered "auto" for Compre- (d) Costs for extended warranties, Credit Life
hensive Coverage under this policy; Insurance, Health, Accident or Disability
b. The airbags are not covered under any war- Insurance purchased with the loan or
ranty; and lease; and
c. The airbags were not intentionally inflated. (e) Carry-over balances from previous loans
or leases.
We will pay up to a maximum of $1,000 for any M. BLANKET WAIVER OF SUBROGATION
one "loss".
L. AUTO LOAN LEASE GAP The following replaces Paragraph A.5., Transfer
Of Rights Of Recovery Against Others To Us,
The following is added to Paragraph AA., Cover- of SECTION IV — BUSINESS AUTO CONDI-
age Extensions, of SECTION III — PHYSICAL TIONS:
DAMAGE COVERAGE:
Auto Loan Lease Gap Coverage for Private 5. Transfer Of Rights Of Recovery Against
Passenger Type Vehicles Others To Us
In the event of a total "loss"to a covered "auto" of We waive any right of recovery we may have
the private passenger type shown in the Schedule against any person or organization to the ex-
or Declarations for which Physical Damage Cov- tent required of you by a written contract exe-
erage is provided, we will pay any unpaid amount cuted prior to any "accident" or "loss", pro-
due on the lease or loan for such covered "auto" vided that the "accident" or"loss" arises out of
less the following: the operations contemplated by such con-
(1) The amount paid under the Physical Damage tract. The waiver applies only to the person or
Coverage Section of the policy for that"auto"; organization designated in such contract.
and
CA T4 20 02 15 ©2015 The Travelers Indemnity company. All rights reserved Page 3 of 3
Includes copyrighted material of Insurance Services Office, Inc.with its permission.
TRAVELERS .1 WORKERS COMPENSATION
AND
EMPLOYERS LIABILITY POLICY
ENDORSEMENT WC 99 03 76(00)—001
POLICY NUMBER: UB8J242237
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS
ENDORSEMENT CALIFORNIA
(BLANKET WAIVER) �X�
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.
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 3.00 % of the California workers'
compensation premium otherwise due on such remuneration.
Schedule
Person or Organization Job Description
ALL PERSONS OR ORGANIZATIONS THAT ARE PARTIE TO A CONTRACT
THAT REQUIRES YOU TO OBTAIN THIS AGREEMENT, PROVIDED YOU
EXECUTED THE CONTRACT BEFORE THE LOSS.
DATE OF ISSUE: 11/26/2018 ST ASSIGN: CA
017106