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PROOF OF INSURANCE (2019 - 2020) CLOSED
_ "f W,, p DATE(MMIDD/YYYYI ^ C"RV CERTIFICATE OF LIABILITY INSURANCE 11 k.--- 6/13/2018 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(los)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 endorsoment(s). ' CONTACT PRODUCER Adamson &McGoldrick Insurance Solutions NAME; Account Managers 1150 E. Oran et'hlor a Ave., Suite 100 PHONE FAX tAX,No.EO' 7'14-257-9644 l'A AC,Nu) 714-257-9833 Placentia, CA 9287 E 4AIL AUPRCSS. policies@pdarnsorimcgoddrlck.com ,tr GE NAIL# 9NSURERfS AFFOROINGCOVE�RA . wwwv,snsins,com INSURER A: T'rave'lers Property Casualty Co of America 25674 INSURED INSURER 31neowsCorporation IRc B C , City of Industry CA 91789 INSURER DJ INSURER E,: INSURER P: COVERAGES CERTIFICATE NUMBER: 42517436 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. INSR` TYPE OF INSURANC __,,,_ iADDL'"�.°i,6'""" u'A�Cip.;gCYEFIr POLICYEXP LTR E p56a1 POLrCY NUMaER llNdlm,4d'ODPYY'YY1 tM�MrD1Y/1PK'V"Yl LIMITS A I,f' COMMERCIAL GENERAL LIABILITY �/ VTC2J-CO-9322B094-18 7/1/2018 17/1/2019 J';r:".V1gG-1.:Pi":I $1Aa0=0 A11110;s Iwi I..lu.: :r.;.l1u- OC&P BXCU INCLUDE rkp%.IaJ,Ifau UluRl u,;.:::; 300,0(10 Aw 1[.a 1!.:'I`o„rr, xiu versos, 5,t)l'0 «! Blanket Cont.L � , V BFPD;Croes Lia I"LFS(,AJA1..W Au.o,Ir kjo s'l,l;G00,000 GENT AGGREGATE LIMIT APPLIES PER: FA^";C':NL.'A 1,�I!:. 2,00O,000 I;>m,,;, K'I"trd' I PRODUCTS-COMP/OP AGO 52000,000_ I ✓ .IlRO r --'- r E 550.0001 DedUctible I isCCW - NED SINGLE LIMP A AUTOMOBILE VTECAP9322B126-18 1 7/1/2018 7/1/2019 ('41arrwrj� .uRv(Perper�vn7 1 51"000'000_ ANY AUTO BODILY IN 5 OWNED SCHEDULED I BODILY INJURY(Per accident) T- AUTOS ONLY AUTOS HIRED I,o, NON-OWNED PROPERTYC:n,hMlaGE 5, ✓ AUTOS ONLY AUTOS ONLY $ UMBRELLA LIAB I OCCUR EACH OCCURRENCE S Er�dea"1'k";P„ITi CLAIMS-MADE: EXCESS LIAB u � ON5 A WORKERS COMPENSATION V7C2J-UB-9494A622-18 7/1/2018 7/1/2019AND ANYP OPRI TORI ARTNER VrN EXECUTIVE EL EACH A OFFICER/M EMBER EXCLUDED? N NIA ACCIDENT 1 S1, .13N.,a (Mandatory in NH) ...... I I A 1::::Mk^1 CY,I,�J 1.000A00_------ If yes,describe under DESCRIPTION OF OPERATIONS blow_ E L DISEASE-POLICY LIMIT $1,000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Re'Job#215507„El Segundo Instrumentation&SCADA Serv'Ic'es,350 Main'.Street,EI Segundo,CA 90245.3813.City of EI Segundo,Its officials and employ'ee's are ad''dlfional Insured to General Liability policy per the attached endorsement.Primary wording applies to General Lrabillty policy par the attached endorsement.Waiver of'subrogallon applies to Worker's Compensation policy per the attached endorsemeni "10 days notice of cancellation for non-payment of premium. CERTIFICATE HOLDER CANCELLATION 215507 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo/Public Works THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Llfan Xu ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street EI Segundo, CA 90245-3813 AUTHORIZED REPRESENTATIVE Ted Adamson `” ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 42517436 1 MORRO-1 1 18/19 DL AU WC UMB $SM 'Master Template- I Sandy Staley 1 6/13/2016 3:16:09 PM (PDT) I Page 1 of 11 ,rp�,yr^-� DATE(MM/DD/YYYY) .+`7t�R.-..P.R,[....+^ CERTIFICATE OF LIABILITY INSURANCE 1/7o019 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). TACT PRODUCER Adamson & McGoldrick Insurance Solutions NAME: Account Managers 1150 E. Oranget'borp'e Ave., Suite 100 PHONE FAX Placentia, CA 92870 (A/c,No.Ealt): 714-257-9644 (A1C,No): 714-257-9833 ADDRESS: -MAI usergiliDape , d f�a'sfrr�rm gald�i k.c rm INSURER(S)AFFORDING COVERAGE NAIC# !:w ww.snalns com INSURERA: St Paul Surplus Lines Insurance Company 30481 INSURED INSURER B: Morrow-Meadows Corporation 231 Benton Court 'NSURERG: City of Industry CA 91789 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 46414549 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. INSR TYPE OF INSURANCE 'AboL'sunk POLICY EFF POLICY EXP LIMITS LTR INRs WVD POLICYNUMBER (MM/DD/YYYYI (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE $ ... bAMAG'EI'D RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) S PERSONAL&,ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- LOG PRODUCTS-COMP/OP AGG S PRO- C?1 HE:R. $ AUTOMOBILE LIABILITY C;O"49BMNEDSdNGtFLIMP $ Fa arcidenf) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident)'$ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE, $ AUTOS ONLY AUTOS ONLY (Pe'r ti,.r;lnnl;q UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS AB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER ORfH- AND EMPLOYERS'LIABILITY Y/N „STATUTE ANYPROPRIETOR/PARTNERIE (MandaRIMEn NH)EXCLUDED?SCUT VE n N/A EL DISEASE ACCIDENTAEMPLDYES $ EL EACH $ OFFICEtory If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE POLICY LIMIT $ A 'Professional Liability 16NO9466 1/21/2019 1/21/2020 Per Claim $5,000,000 Aggregate $10,000,000 Deductible$150,000 Retro Date 1-21-06 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Re:Job#215507,EI Segundo Instrumentation&SCADA Services,350 Main Street,EI Segundo,CA 90245-3813. CERTIFICATE (HOLDER CANCELLATION 215507 City of EI Segundo/ Public Works SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Y 9 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Llfan Xu ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street EI Segundo, CA 90245-3813 AUTHORIZED REPRESENTATIVE Brian McGoldrick ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 46414599 I MORRO-1 1 "19/20 PROF Reduce Limits I Brigid Lopez 11/7/2019 10:10:19 AM (PST) I Page 1 of 1 POLICY NUMBER: VTC2J-CO-93228094-18 COMMERCIAL GENEW LIABILITY CQ 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ R CAREFULLY. ADDITIONAL INSURE - 0 ERS, LESSEES OR CONTRACTORS "- COMPLETED OERATIO S This endorsement rradlfles Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Mame Of o ��a) Adclitional Iro Peon(a).. or Looetlon And Daacrlptton Of Corrpl*ed Opeiratbns ,ify�otSlifd�,Roifl�'fa�rlI'erfit51l3�e�e�ct ALL LOCATIONS EIggeq1)nd0 Insaru menta len&SCANA Services,350 Mein 5drgel,EI Segundo.CA 00246.3313 i Information required to complete this Schedule,If not shown above,will be shown In the Declarations. 1 Section 11 —Who Is An Ir»urod Is amended to in- clude as an additional Insured the person(s)or or- ganl atlon�s) shown In the Schedule, but only with respect to liability for "bodily Injury* or "properly darnaga"caused, In whole or in part, by "your mrk"' at the location designated and described In the schedule of this endorsermnt perforrned for that addlticnal Insured and Included In the "products- completad operations hazard". CO 20 37 07 04 0 ISO Properties, Inc.,2004 pry 1 of 1 O awed esav 42B17436 I MORRO-1 1 16/19 OL AU WC UMB 65M 'Master Template- I Bandy Staley 16/13/7016 3:16"09 PM (PDT) I Page 10 06 11 Morrow-Meadows Corporation POLICY NUMBER:VrCU-Co-93228094-18 COMMERCIAL GENERAL LIABILITY CG 2010 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURE - 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 Person(s)Or Organization(s) q City of EI Segundo,its officials and employees Location(s) Of Covered Operations EI Segundo Instrumentation&SCADA Services,350 Main Street,EI Segundo,CA 90245-3813 Information required to complete this .. . ..m _ __. _._ _._... Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to 2. If coverage provided to the additional insured is include as an additional insured the person(s) or required by a contract or agreement, the organization(s) shown in the Schedule: but only insurance afforded to such additional insured with respect to liability for "bodily injury", "property will not be broader than that which you are damage" or "personal and advertising injury" required by the contract or agreement to caused, in whole or in part, by: provide for such additional insured. 1. Your acts or omissions; or B. With respect to the insurance afforded to these 2. The acts or omissions of those acting on your additional insureds, the following additional behalf; exclusions apply: in the performance of your ongoing operations for This insurance does not apply to "bodily injury" or the additional insured(s) at the locations) "property damage" occurring after: designated above. 1. All work, including materials, parts or However: equipment furnished in connection with such 1. The insurance afforded to such additional work, on the project (other than service, insured only applies to the extent permitted by maintenance or repairs) to be performed by or law; and on behalf of the additional insured(s) at the location of the covered operations has been completed;or CG 20 10 04 13 ©Insurance Services Office, Inc., 2012 Page 1 of 2 42517436 I MORRO.1 1 15/19 OL AU WC UMB $5M 'Master Template• I sandy Staley 1 6/13/2018 3:16:09 PM (PDT) I Page a of 11 CG 20 10 04 13 2. That portion of "your work" out of which the 1. Required by the contract or agreement;or injury or damage arises has been put to its 2. Available under the applicable Limits of intended use by any person or organization Insurance shown in the Declarations; other than another contractor or subcontractor whichever is less. engaged in performing operations for a principal as a part of the same project. This endorsement shall not increase the C. With respect to the insurance afforded to these applicable Limits of Insurance shown in the additional insureds, the following is added to Declarations. Section III— Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: All terms and conditions apply unless modified by this endorsement. Page 2 of 2 ©Insurance Services Office, Inc., 2012 CG 2010 04 13 42517636 1 MORRO-1 1 16/19 OL AD WC UMB $5M •MBate! Template- I Sandy Staley 1 6/13/2016 3:16:09 PM (PDT) I Pa9a 5 Of 11 Morrow-Meadows Corporation COMMERCIAL GENERAL LIABILITY VTC2J-CO-9322 B094-18 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS XTE 'D ENDORSEMENT This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 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 this 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. Aircraft Chartered With Pilot H. Blanket Additional Insured — Lessors Of Leased B. Damage To Premises Rented To You Equipment C. Increased Supplementary Payments I. Blanket Additional Insured — States Or Political Subdivisions—Permits D. Incidental Medical Malpractice EJ. Knowledge And Notice Of Occurrence Or Offense E. Who Is An Insured — Newly Acquired Or Formed K. Unintentional Omission Organizations F. Who Is An Insured — Broadened Named Insured L. Blanket Waiver Of Subrogation —Unnamed Subsidiaries M. Amended Bodily Injury Definition G. Blanket Additional Insured — Owners, Managers N. Contractual Liability—Railroads Or Lessors Of Premises PROVISIONS INJURY AND PROPERTY DAMAGE LI- A. AIRCRAFT CHARTERED WITH PILOT ABILITY: The following is added to Exclusion g., Aircraft, Exclusions c. and g.through n. do not apply Auto Or Watercraft,in Paragraph 2.of SECTION to premises damage". Exclusion f.(1)(a) 1 —COVERAGES — COVERAGE A BODILY IN- does not apply to "premises damage" caused JURY AND PROPERTY DAMAGE LIABILITY: by: This exclusion does not apply to an aircraft that a. Fire; is: b. Explosion; (a) Chartered with a pilot to any insured; c. Lightning; (b) Not owned by any insured;and d. Smoke resulting from such fire,explosion, (c) Not being used to carry any person or prop- or lightning;or erty for a charge. O. Water; B. DAMAGE TO PREMISES RENTED TO YOU unless Exclusion f. of Section I—Coverage A 1. The first paragraph of the exceptions in Ex- —Bodily Injury And Property Damage Liability clusion j., Damage To Property, in Para- is replaced by another endorsement to this graph 2. of SECTION I — COVERAGES — Coverage Part that has Exclusion—All Pollu- COVERAGE A BODILY INJURY AND tion Injury Or Damage or Total Pollution Ex- PROPERTY DAMAGE LIABILITY is deleted. clusion in its title. 2. The following replaces the last paragraph of A separate limit of insurance applies to Paragraph 2., Exclusions, of SECTION I — "premises damage" as described in Para- COVERAGES — COVERAGE A. BODILY graph 6. of SECTION III — LIMITS OF IN- SURANCE, CG D3 16 11 11 m 2011 The Travelers Indemnity Company.All rights reserved. Page 1 of 6 42517436 MORRO-1 1 16/19 OL AU NC UMs $5M -Master TeRplate• l sandy Staley 1 6/13/9018 3:16:09 PM (PDT) I Page 2 of 11 COMMERCIAL GENERAL LIABILITY 3. The following replaces Paragraph 6. of SEC- C. INCREASED SUPPLEMENTARY PAYMENTS TION III—LIMITS OF INSURANCE; 1. The following replaces Paragraph 1.b. of Subject to 5. above, the Damage To Prem- SUPPLEMENTARY PAYMENTS — COVER- ises Rented To You Limit is the most we will AGES A AND B of SECTION I — COVER- pay under Coverage A for damages because AGE: of "premises damage" to any one premises. b. Up to $2,500 for the cost of bail bonds The Damage To Premises Rented To You required because of accidents or traffic Limit will apply to all "property damage" law violations arising out of the use of any proximately caused by the same "occur- vehicle to which the Bodily Injury Liability rence", whether such damage results from: Coverage applies. We do not have to fur- fire; explosion; lightning; smoke resulting from nish these bonds. such fire, explosion, or lightning; or water; or 2. The following replaces Paragraph 1.d. of any combination of any of these causes. SUPPLEMENTARY PAYMENTS — COVER- The Damage To Premises Rented To You AGES A AND B of SECTION I — COVER- Limit will be: AGES: a. The amount shown for the Damage To d. All reasonable expenses incurred by the Premises Rented To You Limit on the insured at our request to assist us in the Declarations of this Coverage Part; or investigation or defense of the claim or b. $300,000 if no amount is shown for the "suit", including actual loss of earnings up Damage To Premises Rented To You to $500 a day because of time off from Limit on the Declarations of this Coverage work. Part. D. INCIDENTAL MEDICAL MALPRACTICE 4. The following replaces Paragraph a. of the 1. The following is added to the definition of"oc- definition of"insured contract" in the DEFINI- currence"in the DEFINITIONS Section: TIONS Section: "Occurrence" also means an act or omission a. A contract for a lease of premises. How- committed in providing or failing to provide ever, that portion of the contract for a "incidental medical services", first aid or lease of premises that indemnifies any "Good Samaritan services"to a person. person or organization for "premises damage"is not an"insured contract"; 2. The following is added to Paragraph 2.a.(1)of SECTION II—WHO IS AN INSURED: S. The following is added to the DEFINITIONS Section: Paragraph (1)(d) above does not apply to bodily injuryarising out of providing or fail- "Premises damage" means "property dam- ing to provide: age"to: (I) "Incidental medical services" by any of a. Any premises while rented to you or tem- your employees who is a nurse practi- porarily occupied by you with permission tioner, registered nurse, licensed practical of the owner;or nurse, nurse assistant, emergency medi- b. The contents of any premises while such cal technician or paramedic; or premises is rented to you, if you rent such (ii) First aid or"Good Samaritan services" by premises for a period of seven or fewer any of your "employees" or "volunteer consecutive days. workers", other than an employed or vol- 6. The following replaces Paragraph 4.b.(1)(b) unteer doctor. Any such "employees" or of SECTION IV—COMMERCIAL GENERAL "volunteer workers" providing or failing to LIABILITY CONDITIONS: provide first aid or "Good Samaritan ser- (b) That is insurance for"premises damage"; vices" during their work hours for you will or be deemed to be acting within the scope 7. Paragraph 4.b.(1)(c) of SECTION IV — of their employment by you or performing COMMERCIAL GENERAL LIABILITY CON- duties related to the conduct of your busi- DITIONS is deleted. ness• Page 2 of 6 ®2011 The Travelers Indemnity Company.All rights reserved. CG D3 16 11 11 47517436 i MORRO-1 18/19 OL AU WC UMB $5M 'Mester Teffqlata• I Sandy Staley 1 6/13/2018 3:16:09 PM (PDTI i Page 2 of 11 COMMERCIAL GENERAL LIABILITY 3. The following is added to Paragraph 5. of 4. Any organization you newly acquire or form, SECTION III—LIMITS OF INSURANCE: other than a partnership, joint venture or lim- For the purposes of determining the applica- ited liability company, of which you are the ble Each Occurrence Limit, all related acts or sole owner or in which you maintain the ma- omissions committed in providing or failing to jority ownership interest, will qualify as a provide "incidental medical services", first aid Named Insured if there is no other insurance or"Good Samaritan services"to any one per- which provides similar coverage to that Or- son will be deemed to be one"occurrence". ganization. However: 4. The following exclusion is added to Para- a. Coverage under this provision is afforded graph 2., Exclusions, of SECTION 1 —COV- only: ERAGES—COVERAGE A BODILY INJURY (1) Until the 180th day after you acquire or AND PROPERTY DAMAGE LIABILITY: form the organization or the end of the Sale Of Pharmaceuticals policy period, whichever is earlier, if you "Bodily injury" or "property damage" arising do not report such organization in writing out of the willful violation of a penal statute or to us within 180 days after you acquire or ordinance relating to the sale of pharmaceuti- form it; or cals committed by, or with the knowledge or (2) Until the end of the policy period, when consent of,the insured. that date is later than 180 days after you S. The following is added to the DEFINITIONS acquire or form such organization, if you Section: report such organization in writing to us "Incidental medical services"means: within 180 days after you acquire or form a. Medical, surgical,dental, laboratory,x-ray it, and we agree in writing that it will Con- or nursing service or treatment, advice or tinue to be a Named Insured until the end instruction, or the related furnishing of of the policy period; food or beverages;or b. Coverage A does not apply to "bodily injury" b. The furnishing or dispensing of drugs or or "property damage" that occurred before medical, dental, or surgical supplies or you acquired or formed the organization;and appliances. c. Coverage B does not apply to "personal in- "Good Samaritan services" means any emer- jury" or "advertising injury" arising out of an gency medical services for which no compen- offense committed before you acquired or sation is demanded or received. formed the organization. 6. The following is added to Paragraph 4.b., Ex- F. WHO IS AN INSURED— BROADENED NAMED cess Insurance, of SECTION IV — COM- INSURED—UNNAMED SUBSIDIARIES MERCIAL GENERAL LIABILITY CONDI- The following is added to SECTION II —WHO IS TIONS: AN INSURED: The insurance is excess over any valid and collectible other insurance available to the in- Any of your subsidiarjes,other than a partnership, sured,whether primary, excess, contingent or joint venture or limited liability company, that is on any other basis, that is available to any of not shown as a Named Insured in the Declara- your "employees" or "volunteer workers" for tions is a Named Insured if you maintain an own- "bodily injury" that arises out of providing or ership interest of more than 50% in such subsidi- failing to provide "incidental medical ser- ary on the first day of the policy period. vices", first aid or"Good Samaritan services" No such subsidiary is an insured for"bodily injury" to any person to the extent not subject to or "property damage" that occurred, or"personal Paragraph 2.a.(1) of Section II — Who Is An injury" or "advertising injury" caused by an of- Insured. fense committed after the date, if any, during the E. WHO IS AN INSURED — NEWLY ACQUIRED policy period, that you no longer maintain an OR FORMED ORGANIZATIONS ownership interest of more than 50%in such sub- The following replaces Paragraph 4. of SECTION sidiary. II—WHO IS AN INSURED: CG D3 16 1111 ®2011 The Travelers Indemnity Company.All rights reserved. Page 3 of 8 42517436 1 MORRO-1 1 16/19 OL AD WC VMS W -Msoter TerVlate- I Sandy Staley 1 6/13/2018 3:16:09 PM (PDT) I Page 4 of 11 COMMERCIAL GENERAL LIABILITY G. BLANKET ADDITIONAL INSURED—OWNERS, H. BLANKET ADDITIONAL INSURED— LESSORS MANAGERS OR LESSORS OF PREMISES OF LEASED EQUIPMENT The following is added to SECTION II —WHO IS The following is added to SECTION II —WHO IS AN INSURED: AN INSURED: Any person or organization that is a premises Any person or organization that is an equipment owner, manager or lessor and that you have lessor and that you have agreed in a written con- agreed in a w6tten contract or agreement to in- tract or agreement to include as an insured on clude as an additional insured on this Coverage this Coverage Part is an insured, but only with re- Part is an insured, but only with respect to liability spect to liability for"bodily injury", "property dam- for "bodily injury", "property damage", "personal age", "personal injury"or"advertising injury"that: injury"or"advertising injury"that: a. Is "bodily injury" or "property damage" that a. Is "bodily injury" or "property damage" that occurs, or is "personal injury" or "advertising occurs, or is "personal injury" or "advertising injury" caused by an offense that is commit- injurycaused by an offense that is commit- ted, subsequent to the execution of that con- ted, subsequent to the execution of that con- tract or agreement; and tract or agreement; and b. Arises out of the ownership, maintenance or b. Is caused, in whole or t part, by your acts or use of that part of any premises leased to omissions in the maintenance, operation or use of equipment leased to you by such you. equipment lessor. The insurance provided to such premises owner, The insurance provided to such equipment lessor manager or lessor is subject to the following pro- is subject to the following provisions: visions: a. The limits of insurance provided to such a. The limits of insurance provided to such remises owner, or lessor will be equipment lessor will be the minimum limits p manager g which you agreed to provide in the written the minimum limits which you agreed to pro- contract or agreement, or the limits shown on vide in the written contract or agreement, or the Declarations,whichever are less. the limits shown on the Declarations, which- ever are less. b. The insurance provided to such equipment lessor does not apply to any"bodily injury"or b. The insurance provided to such premises "property damage" that occurs, or "personal owner, manager or lessor does not apply to: injury"or"advertising injury" caused by an of- (1) Any "bodily injury" or "property damage" fense that is committed, after the equipment that occurs,or"personal injury"or"adver- lease expires. tising injury"caused by an offense that is c. The insurance provided to such equipment committed, after you cease to be a tenant lessor is excess over any valid and collectible in that premises; or other insurance available to such equipment (2) Structural alterations, new construction or lessor, whether primary, excess, contingent demolition operations performed by or on or on any other basis, unless you have behalf of such premises owner, lessor or agreed in the written contract or agreement manager. that this insurance must be primary to, or c. The insurance provided to such premises non-contributory with, such other insurance, owner, manager or lessor is excess over any in which case this insurance will be primary valid and collectible other insurance available to, and non-contributory with, such other in- to such premises owner, manager or lessor, surance. whether primary, excess, contingent or on I. BLANKET ADDITIONAL INSURED — STATES any other basis, unless you have agreed in OR POLITICAL SUBDIVISIONS—PERMITS the written contract or agreement that this in- The following is added to SECTION II —WHO IS surance must be primary to, or non- AN INSURED: contributory with, such other insurance, in which case this insurance will be primary to, Any state or political subdivision that has issued a and non-contributory with, such other insur- permit in connection with operations performed by ance. you or on your behalf and that you are required Page 4 of 6 ®2011 The Travelers Indemnity Company.All rights reserved. CG D3 16 11 11 42517436 MORRO-1 16/19 OL AV NC VMS $SM -Master Te�late• I Sandy Staley 1 6/13/2018 3:16:09 PM (PDT) I Page 5 of 11 COMMERCIAL GENERAL LIABILITY 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 Il- 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 However, if this Coverage Part includes an en- you or any insured listed in Paragraph 1.or 2. of 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" l g p The following is added to Paragraph 6., Re or directors (if you are an organiza- re- 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 B.,Transfer (1) 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 1111 ®2011 The Travelers Indemnity Company.All rights reserved. Page 5 of 6 42517436 MORRO-1 l 16/19 OL AU WC UMB $5M 'Master TePplateO i Sandy Staley 1 6/13/2016 3:16:09 PM (POT) i Page 6 of 11 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 f.(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: City of EI Segundo,its officials and employees Page 6 of 6 O 2011 The Travelers indemnity Company.All rights reserved. CG D3 16 11 11 09517436 1 MORRO.1 1 18/19 OL AU RC VMD $5M -Mester Teffolate- l Sandy Staley i 6/13/7018 3:16:09 PM (POTI l Page 7 of 11 TRAVELER S,11111h, WORKERS COMPENSATION ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD, CT 06153 ENDORSEMENT WC 99 03 76( A)— 001 POLICY NUMBER: VTC2J-UB-9494A622-18 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 02.000 % 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. Berson or Organization: City of El'Segundo Attn: PW inept 350 Main St EI Segundo, CA 90245 ,lob Descri tion, City of�l egundo, its officials, officers,agents and employees re: Engineering Man Check Svcs, City of EI Segundo 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 7/1/2018 Policy No.VTC2J-UB-9494A622-18 Endorsemen o. Insured Morrow-Meadows Corporation lir lu'm Insurance Company Countersigned by r' Page 1 of 1 /7517436 I MORRO-1 1 18/19 OL AV WC UMB 05M 'Master Template" i Sandy Staley 1 6/13/7016 3:16:09 PM (PDT) I Page 11 of 11