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PROOF OF INSURANCE (2019) CLOSED4 00 AC CERTIFICATE OF LIABILITY INSURANCE I DATE (M 4/11/ /201 YYY) 2019 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 NAME:t� ONE �..... _..................IFAX PHONE ................. 88) 780 5381..........._...._.LA!J<......886) 828 2424 ate... ' E-MAIL O'HanoVer.com WILLIS OF ILLINOIS, INC. AQ9LR9_SS: Certlific _ .......... . 233 S WACKER DR,SUITE 2000 mIT__ITITm INSURER(S).AFFORDING COVERAGE NAIC # _ CHICAGO IL 60606 INSURER A : Citizens Ins Co of America 3159,4 INSURED INSURER B: Hanover American Ins Co 3606,4 INSURER C BUCKNAM INFRASTRUCTURE INSURER 3548 SEAGATE WAY SUITE 230 INSURER E... ..... _........,,,,, _._ ...... OCEANSIDE CA 92056 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH ''OLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR.. ,. pNSD Swvn .,.POLICYNUMBER.,.,.,.,.,., rAPWDDNYYY I_.._DD. ,.,.,.,.,.. ..... INSFt TYPE OF INSURANCE _ EFF � MbO,Nd'DOIYYNEICY WYY LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F,_/1 OCCUR A Y Y OBC A399956 04 Y Y Y OBC A399956 04 EACH OCCURRENCE GEN'L AGGREGATE LIMIT APPLIES PER: 1,000,000 POLICY [ PRO- LOC JECT $ MED EXP (Any one person) OTHER, 09/16/2018 09/16/2019 PERSONAL 8 ADV INJURY $ 2,000,000 AUTOMOBILE LIABILITY $m 4,000,000 ..........-.._. _GENERAL DUCTS-COMP/OPAGG PRO ^ ANY AUTO A OWNED SCHEDULED AUTOS ONLY AUTOS Y Ee s�NEO �— � ......IwIN r9erpC .......... ,/ HIRED NON -OWNED ^M AUTOS ONLY I/ AUTOS ONLY BODILY INJURY (Per person) $ UMBRELLALIAB OCCUR � $ A EXCESS � CLAIMS -MADE Y .......- ........................�. /LIAB _ DED I V I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I' N B ANYPROPRIETOR/PARTN ER/EXECUTI VE OFFICER/MEMBEREXCLUDED? NIA (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below - Y Y Y OBC A399956 04 EACH OCCURRENCE $ 2,000,000 1,000,000 �REMISE54E�'�ve;uu,rrrsdae��}',....,_ $ MED EXP (Any one person) $ 10,000 09/16/2018 09/16/2019 PERSONAL 8 ADV INJURY $ 2,000,000 AGGREGATE $m 4,000,000 ..........-.._. _GENERAL DUCTS-COMP/OPAGG PRO ^ $ 4,000,000 $ $...........,'00 f LIMIT COMBISINGLE 2 0,000 Ee s�NEO �— � ......IwIN r9erpC .......... BODILY INJURY (Per person) $ 09/16/2018 09/16/2019 BODILY INJURY Per ac .... n���������������������.........� ( accident) $ .RTY DAMAGE ..... �arr F $ a ..PROP'�mmcldanll � .......- ........................�. EACH . ......................... 00,000 �........................... NCE $ OBC A399956 04 09/16/2018 09/1612019 AGGREGATE RE $ 3,000,000 V 1 ERPER H,„-_ 00,00 .......a.... 00,00 . WZC A399946 04 09/16/2018 09/16/2019 EACH ACCIDENT $ „E„L, DISEASE -EA EMPLOYEE ,$ 1,O 0 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) City of EI Segundo are Additional Insured on the General L'iab'ility and Auto Liability pursuant to the terms and conditions by form 391-1586 Excess4Umbrella to follow form. Additional Insured is Primary and Nonconlrlbutory oil General Liability to the extent provided by form, 391-100'3 (page 79 of 81). Waiver of subrogation on Workers Compensation as provided by form. WC040306 (Waiver of Our Right to Recover from Others Endorsement — California), Cancellation notice will be provided to the Certificate Holster pursuant to endorsements: 401-1'235 and 3'31.0342. Such notice is solely for the purpose of informing the Certificate Holder of the effective date of cancellation and does not grant, alter, or extend any rights or obligations under this policy. / u �v CERTIFICATE HOLDER CANCELLATION 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 EL SEGUNDO AUTHORIZED REPRESENTATIVE 350 MAIN STREET " EL SEGUNDO CA 90245 I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GENERAL LIABILITY SUPPLEMENTARY ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM injury and advertising injury". A. Additional Insured by Contract, Agreement or (2) To any person or organization included Permit as an insured by another endorsement The followingis added to SECTION II - issued by us and made part of this LIABILITY, C. Who Is An Insured: Coverage Part. Additional Insured by Contract, Agreement or (3) To any lessor of equipment: Permit (a) After the equipment lease expires; a. Any person or organization with whom you or agreed In a written contract" written agreement or permit that such person or (b) If the "bodily injury", "property Y "personal organization to add as an additional insured damage", or and advertising injury" arises out of sole on your policy is an additional Insured only "bodily negligence of the lessor with respect to liability for injury", ""property damage"' or "personal and (4) To any: advertising injury" caused, In whole or In (a) Owners or other interests from part, by your acts or omissions" or the acts whom land has been leased if the or omissions of those acting on your behalf„ "occurrence" or offense takes place but only with respect to: or the offense is committed after (1) "Your work" for the additional insured(s) the lease for the land expires; or designated in the contract, agreement (b) Managers or lessors of premises if: or permit including "bodily injury or property damage included in the :,:property I The "occurrence" takes place or (1) _completed operations hazard" the offense is committed after only if this Coverage Part provides such you cease to be a tenant in that coverage. premises; or (2) Premises you own, rent, lease or occupy; (ii) The ""bodily injury", ""property or damage", "personal injury or (3) Your maintenance, operation or use of "advertising Injury" arises out of structural alterations, new equipment leased to you. construction or demolition b. The insurance afforded to such additional operations performed by or on insured described above: behalf of the manager or lessor. (1) Only applies to the extent permitted by (5) To "bodily injury"" ""property damage" or law; and "personal and advertising injury"" arising (2) Will not be 'broader than the insurance out of the rendering of or the failure to render any professional services. which you are requiired by thecontract, agreement or permit to provide for such This exclusion applies even if the claims additional insured. against any insured allege negligence (3) Applies on a primary basis if that is required bythe written contract, written or other wrongdoing in the supervision, hiring, em loyment, training or otpothers by that insured, if agreement or permit. monitoring the "occurrence" which caused the (4) Will not be broader than coverage "bodily injury" or "property damage" or provided to any other insured. the offense which caused the "personal (5) Does not apply if the "bodily injury"", and advertising injury" involved the "propertydamage" or ""personal and rendering of or failure to render any advertising injury" is otherwise professional services by or for you. excluded from coverage under this d„ With respect to the insurance afforded to Coverage Part, including any these additional Insureds, the following is endorsements thereto. added to SECTION II - LIABILITY, D. Liability c. This provision does not apply: and Medical Expense Limits of Insurance: (1) Unless the written contract or written The most we will pay on behalf of the agreement was executed or permit was additional insured for a covered claim is the issued prior to the "bodily injury", lesser of the amount of insurance: '°property damage", or "personal 391-1586 08 16 Includes copyrighted material of Insurance Services Offices, Inc., with its permission. Page 1 of 2 1. Required by the contract, agreement or permit described in Paragraph a.; or 2. Available under the applicable Limits of Insurance shown in the Declarations. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations B. Aggregate Limits of Insurance per Project or per Location The following changes are made to SECTION 11 - LIABILITY: 1. The following is added to SECTION 11 - LIABILITY, D. Liability and Medical Expenses Limits of Insurance, paragraph 4: The Aggregate Limits of Insurance apply separately to each of "your projects°" or each "location" listed in the Declarations. 2. For the purpose of coverage provided by this endorsement only, the following is 4 11w Hanover Inmr.incc (;roitp OBCA399956 1309570 added to SECTION 11 -LIABILITY, F. Liability And Medical Expenses Definitions: 1. "Your project" means: a. Any premises, site or "location" at, on, or in which "your work" is not yet completed; and b. Does not include any "location" listed in the Declarations. 2. "Location" means premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway, waterway or right-of-way of a railroad. ALL OTHER TERMS, CONDITIONS, AND EXCLUSIONS REMAIN UNCHANGED. $914586 0816 Includes copyrighted material of Insurance Services Offices, Inc., with its permission. Page 2 of 2 Page 1 of 1 �► CERTIFICATE OF LIABILITY INSURANCE I DATE(M04/111/201/201 Y) 9 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 ii this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NPHONE _NAME: N E .,., ...._ Willis of Illinois, Inc. � -7378 1-686-967-2378 c/o 26 Century Blvd Nga ExP: 1-877-945........, ....,.. .,L FAX .xITNrct1: .,....... P.O. Box 305191 ADDRESS: certificates@willss.com Nashville, TN 372305191 USA -,# INSURER(S) AFFORDING COVERAGE NAIC _._ . Con..... ..... ........ .... .,,,,-,......... .......... INSURERA: : y ........_ .......................... ....................., ,,,,,, ..-ti...... Casualty Company 20443 ........................... ? 4.--------..... INSURED INSURER B : Bucknam Infrastructure Group, Inc. ...... 3548 Seagate Way, Suite 230 Oceanside, CA 92056 INSURER C: INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: W10873555 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. .. ........_......._.._......... ADOL'SUBR....................................... POLIC�YFF.. POLICY EXP LIMITS LTRTYPE OF INSURANCE INSD yyVO POLICY NUMBER WWOWYY'YY+ IMWOWYYYY'Y COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ .., "'Tti;�W,9GE TO RENTED............................................................ „mITITITIT.,mm,IT,� CLAIMS -MADE OCCUR PREpvtIS,,,,,,,,. occurrence) $ ......,.E..Fa...,._.._....._ ............................... GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- LOC PRO, OTHER: AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBREL EXCESS LIALIABB CLAIMS -MADE OCCUR DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE r" --i N I A OFFICER/MEMBER EXCLUDED? _y (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below A Professional Liability MED EXP (Any one person) $ .... PERSONAL 8 ADV INJURY $ ^YY m ................... . .............. GENERAL AGGREGATE $ .. PRODUCTS-COMP/OPAGG $ �.........................._..,m $ COMBINEDSINGLE LIMIT $ .,-.............................. BODILY INJURY (Per person) $ _1 . ........ .......__.............. .,.,..................__.... BODILY INJURY(C accident) $ PROPERTY DAMA,"„�..m...- ........................_.,., EACH OCCURRENCE $ AGGREGATE $,,,,,,,,, �STATUTE....I........... LER -__.................._.,.....�.,..�. E.L. EACH ACCIDENT $ El, DISEASE - EA EMPLOYEE $ , E.L, DISEASE - POLICY LIMIT $ MCH288359767 09/16/2018 09/16/2019 Per Claim: $2,000,000 Aggregate: $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: PMP Consulting Services fL_ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE City of E1 Segundo 350 Main Street E1 Segundo, CA 90245 ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD SR ID: 17809123 BATCH: 1151653 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS We have the right to recover our payments from anyone liable for injury d by this policy. We will enforce our right st the person o nization named in the Schedule. (This agreement applies only to the extent that you perform work=r a written contrraocTth a t 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 inthe Schedule. The additional premium for this endorsement shall be2% %ofthe California workers' compensation premium otherwise due onsuch remuneration. Schedule Person wrOrganization Job Description BLANKET AS REQUIRED BY CONTRACT 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 Insured Ponm'muWnc-Asyy*«a-n« Endorsement No. Insurance Company THE aoNonoo AmEazcAm zmanmAmco coMeoNr Countersigned By