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PROOF OF INSURANCE (2019 - 2019) CLOSED Client#:25181 PSOMAS ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 03/27/2018 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 have ADDITIONAL INSURED provisions or be endorsed, If 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 any rights to the certificate holder in lieu of such endorsement(s), MPRODUCER NAMEE: Katie Kresner Grey37801ing Ins.M Mansell Road,rSu to 370 ���mL�@Kate.K.... rS greylrng.com„ „ J/� 866.550.4082 ......... ........................................... Alpharetta,GA 30022 mAD[DE..w. INSURER(S) NA. w..........___ ........................................ _ ......... c u INSURER A:National Union Fire Ins.Co, 194.„„„„„„ „ INSURED .....,.�-..............................._.............�.... 45 INSURER B: I Psomas _.... . ........_ ........ 555 S. Flower StreetJ Rc' .... Suite 4300 —INSURER°i Los Angeles, CA 90071 INSURE: „ INSURERF: COVERAGES CERTIFICATE NUMBER: 18-19 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 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. YNSR 1-11111111-1.......................... ............................... ADDLSUBR'', POL....„.........._.......__ LTR TYPE OF INSURANCE ICY NUMBER tMMIDpIYYEYW ,Ml-0—YY1P' „m._.. LIMITS COMMERCIAL GENERAL LIABILITY RRENCE - $1,000,000 A X _ t A A T C�CLAIMS-MADE 41 OCCUR 'R doh S P REN IEI: GL5268212 04/01/2018 04/01/20191Eac�Hoccur��C��rtae� $500,000 MED EXP Any one person,) ($25,000 OTHER.' A T E �............._. „... mm.... ....................... PE.RSONA.L..&ADV....NJURY �,$..1,O..O._..D......,0.......0......0...... ......... ...................................... GEN'L AGGREGATE LIMIT APPLIES PER. GENERALAGGREGATE ' '000 PRO. ............... POLICY X JEOT X1LOC ERoDuCrs-COMP/OP AGG $2,000,000 ............... $ . A AUTOMOBILE LIABILITY CA4489706 04/01/2018 04/01/2019 COMBINED SINGLE LIM17 pccial�n?)................... $19000,,000 ...................................... XANY AUTO BODILY INJURY(Per person) $ OWNED EONLY X SCHEDULED BODILY INJURY..,.,,,, AUTOS URY(Peraccident) $ HIRED NON-OWNED AUTOS ONLY AUTOS ONLY Pe ucCldeinDAM{wreE $ PROPERTY) $ UMBRE ..LLA L.......IAB........... ,........ -.,.,., .,.,..,._ __. OCCUR EACH OCCURRENCE $ .1111. EXCESS LIAB CLAIMS-MADE AGGREGATE $ ...................�„ ,. .1.1.1.1... .... .......,..,..,... .,..............._.,.,..,.,....... $ A � T WC015893765........CA 04/01/201.8.... AND EMPLOYWORKERS ERS'LIABILITY m$„ „ UU A ANY PROPRIETOR/PARTNER/EXECUTIVEp ( ) 04/01/2019 E L,EACHACCIDENT SER OR H, $1,000,000 OFFICER/MEMBER EXCLUDED? l NJ NIA (AOS) E (Mandatory in NH) E -EA EMPLOYEE $1,000,000 4 04/01/2018 04/01/2019�L DISEASE If under EF OPERONS below - LIMIT $ ,000,600 es,describe DSCRIPTION..._.OATIE L DISEASE POLICY 1 ........,, .1.1.1.1 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 1AFBO10101; Project#PW 18-09-EI Segundo Blvd.Rehabilitation &Improvements Pre-Design Engineering Support Services.The City, its officials&employees are named as Additional Insureds with respects to General Liability where required by written contract.The above referenced liability policies with the exception of workers compensation are primary&non-contributory where required by written contract.Should any of the above described policies be cancelled by the issuing insurer before the expiration date thereof, (See Attached Descriptions) .. . .. ... .1.1.1.1 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 Arianne Bola ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street EI Segundo, CA 90245-0000 AUTHORIZED REPRESENTATIVE .1.1.1.1.. ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) 1 of 2 The ACORD name and logo are registered marks of ACORD #S1032878/M1032607 KKRE1 DESCRIPTIONS (Continued from Page 1) 30 days'written notice(except 10 days for nonpayment of premium)will be provided to the Certificate Holder.Waiver of Subrogation is applicable where required by written contract&allowed by law. SAGITTA 25.3(2016/03) 2 of 2 #S1032878/M1032607 POLICY NUMBER: GL5268212 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 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 PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE iNeme Of Additional Insured Personts) .. Location And Description Of Completed Operations Or Orgtanization(s) AKY ';dl'It'! lu 'Nii;W°I"it'f' fdlYltl�'I'.Illi',',I'J "�''V;.t;O! YOU PER THE CONTRACT OR AGREEMENT l""IdCr"r i!:il'IIW'1 K;iI'llk, 'fmf't i"VIII"ii;d 1144 f f..ItUf"ifi, AN 'til!"�IIIiiVIIVI"�"IC^'IIIIVII' �:91N "I"VMVI �.. .w . ... _ Information required to complete this Schedule, if no IT ^-_ t shown above, Wil be ... sown in the Declarations. A. Section I) - Who Is An Insured is amended to which you are required by the contract or include as an additional insured the personls) or agreement to provide for such additional organizationis) shown in the Schedule, but only insured. with respect to liability for "bodily injury" or B. With respect to the insurance afforded to these "property damage" caused, in whole or in part, additional insureds, the following is added to by "your work" at the location designated and Section III -Limits Of Insurance: described in the Schedule of this endorsement If coverage provided to the additional insured is performed for that additional insured and required by a contract or agreement, the most included in the "products-completed operations we will pay on behalf of the additional insured hazard". is the amount of insurance: However: 1. Required by the contract or agreement; or 1. The insurance afforded to such additional 2. Available under the applicable Limits of Insu- insured only applies to the extent permitted rance shown in the Declarations; by law; and whichever is less. 2. If coverage provided to the additional insured is required by o contract or agree- This endorsement shall not increase the appli- ment, the insurance afforded to such addi- cable Limits of Insurance shown in the Decla- tional insured will not be broader than that rations. CG 20 37 04 13 ff Insurance Services Office, Inc., 2012 Page 1 of 1 ❑ POLICY NUMBER:GL5268212 COMMERCIAL GENERAL LIABILITY CO 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 Name Of Additional Insured Personfs) Or Organization(s) Locations)Of Covered Operations ANY PERSON OR ORGANIZATION WHOM YOU I PER THE CONTRACT OR AGREEMENT. BECOME OBLIGATED TO INCLUDE AS AN ADDITIONAL INSURED AS A RESULT OF ANY CONTRACT OR AGREEMENT YOU HAVE ENTERED INTO. 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 that which you.are required by the contract include as an additional insured the persons) or or agreement to provide for such additional organization(s) shown in the Schedule, but only insured. with respect to liability for "bodily injury", B. With respect to the insurance afforded to these "property damage" or "personal and advertising additional insureds, the following additional injury" caused, in whole or in part, by: exclusions apply: 1. Your acts or omissions; or This insurance does not apply to "bodily injury" 2. The acts or omissions of those acting on or "property damage" occurring after: your behalf; 1. All' work, including materials, parts or in the performance of your ongoing operations equipment furnished in connection with such for the additional insured(s) at the location(s) work, on the project (other than service, designated above. maintenance or repairs) to be performed by or on behalf of the additional insured(s) at However: the location of the covered operations has 1. The insurance afforded to such additional been completed; or insured only applies to the extent permitted 2. That portion of "your work" out of which by law; and the injury or damage arises has been put to 2. If coverage provided to the additional its intended use by any person or insured is required by a contract or organization other than another contractor or agreement, the insurance afforded to such subcontractor engaged in performing additional insured will not be broader than operations for a principal as a part of the same project. CO 20 10 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 2 0 0 DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 10/2/2018 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: Dealey, Renton&Associates PHONE ....................... _ FAX uWAO EMtl:714-427-6810 �. ®._.m ........ Lic.#0020739 �AIc„Nmlc 714.47ITIT6818 E-MAIL 600 Anton Blvd., Suite 100 nr_989As' .. ................................ Costa Mesa CA 92626 INSURER(S)_AFFORDING COVERAGE NAIC# INSURER A:XL Specialty Insurance Co. 37885 INSUREDPSOMAS PSOMAS INSURER B 555 South Flower Street, Suite 4300 INSURERC: ............... ...................................................................................................................... Los Angeles CA 90071 INSURER D INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:724699587 RE'VI'SION 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. LTR.-. TYPE OF INSURANCE IN,2 y%p/n POLICY NUMBER {MMl'D,P'Y'My"YI'....................... ......______......l INSR ADDL SUBR POLICY'EFF' POLICY EXP' LIMITS PMMPDDCYYYY9 COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ b_ARArai"f AirN"I"6...,.,_... .._.......................""•__ —�CLAIMS-MADE OCCUR Pr;B'�11'SE5 Ea oggtgre%col $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ JECT POLICY= PRO ❑ LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ................. m acddn Y ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY era AUTOS _,_,. AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS AUTOSNNONOWNED (PRPO uR 7M( A^M7 GE .....IT..........$. UMBRELLA LIAR OCCUR EACH OCCURRENCE $ —ww....._........ . EXCES"SLI"TAB HCLAIMS-MADE AGGREGATE $ �ITITIT_....OEDITmmITIT. ..RETENTION$ $ RKERS N PER T 11111111 OFYCER/MEM ER EXCLUDE D7 Y❑ N/A �.�.....L EACH ACCIDENT ORH .$...................................._-. ANY PROPRIETOR/PARTNER/EXECUTIVE E.L .............w w ,.,.,.,.,.,.,.,.,.,. (Mandatory In NH) E.L DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ A Professional Liability DPR9932582 10/15/2018 10/15/2019 Per Claim $1,000,000 Claims Made Ann;Aate $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) IAFB010101,Project#PW 18-09,EI Segundo Blvd.Rehabilitation And Improvements Pre-Design Engineering Sup ces.SEE CANCELLATION SECTION of Certificate for 30 Days Notice of Cancellation. CERTIFICATE HOLDER CANCELLATION30 Day Notice of 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 Attn:Arianne Bola 350 Main Street AUTHORIZED REPRESENTATIVE EI Segundo CA 90245 — I % ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD