PROOF OF INSURANCE (2020) CLOSEDI DATE (M M/DD/YYYY)
AC"RV CERTIFICATE OF LIABILITY INSURANCE
ll`-� . 6/1412019
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 pol'lcy(les) 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($).
CONTACT
PRODUCER Risk Shaine ies Suite 450 PH t Risk St2 tegI � Com any _....�
ieS Company rtA.. E _�_
AODREs ; syoungCrisk-strategles.com FAX
It,: 949 24 �,trC,Nd)
Irvine, CA 92514MAIL
www.risk-strategies.com CA DOI License No. OF06675
INSURED
MIS Engineers, Inc.
2.01 N. Calle Cesar Chavez, Suite 300
Santa Barbara CA 93103
IN URERfSIAFEQnNGCOV'E'RAGE
NAIC'Y
INSURERA ; Travelers in erll'Ie�it'hr C(»»m, rlY of CT ..............
25682
INSURER 8: Travelers lndemnlha!gpmDanY
25658
INSUR(R C � AXIS Insuranc .,..COmoalny . ...........
37273
INSURER 0: ._............ ............
........_
PERSON_ALBADV INJURY
$$1,000,000,,,,,,,,,,,_,
IN§§ ffER E:
INSURER F:
$2,000,000
COVERAGES CERTIFICATE NUMBER: 49305054 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANMNG ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR A156CM00k POLICY' TEFF I POLICY EXP
TYPE OF INSURANCE
LTR lUp WVn POLICYNUMBER /MMIDDfYYY'Y'1 IMM/DDIYYYY1 LIMITS
A V COMMERCIAL GENERAL LIABILITY ✓ 6802JO51458 6/14/2019 6/14/2020 EACH OCCURRENCE $$1,000,000
CLAIMS -MADE ❑✓ OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY f • I PRO- 7 LOC
OT'HE'R JECT
A AUTOMOBILE LIABILITY
✓ ANY AUTO
..w. OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
✓,,,,,, AUTOS ONLY I ✓✓ AUTOS ONLY
B ,/ UMBRELLA LIAB:J�CLAIMS-,MADE R
EXCESS LIAB_
DED R ✓ RETENTION$0__-.
B WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y 1 N
AOFFICER/MEMBER EXCLUDED? NYPROPRIETOR/PARTNER/EXECUTIVE r N 1 A
(Mandatory In NH)
If yes, doacn be under
DESCRIPTION OF OPERATIONS below
C Professional Liability
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Projects as on file with the 'Insured including but not limited to PW 17.40 Wafter Yard Chlorination Facility, Feasibility Study.
The City of EI Segundo, its officials and employees are named as additional insureds and primary'lnon-contributory clause applies to the
general liability Ipolicy-see attached endorsement,
CERTIFICATE HOLDER CANCELLATION
ANY OFBEFORE
The City of El Se undo a THE SHOULD EXPIRATIIONH DATE DESCRIBED
NOTICE I WILL ES CBE CDELIVERED IN
Attn: Orlando Rodriguez, Sr. Civil Engineer ACCORDANCE WITH THE POLICY PROVISIONS.
350 Main St.
EI Segundo CA 90245 AUTHORIZED REPRESENTATIVE
Michael Christian
C 1988.2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
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_PREWfSE;SCRaN�cTEOn aJ,.
$$1.000,000
MED EXP (Any one person)
s$10000
PERSON_ALBADV INJURY
$$1,000,000,,,,,,,,,,,_,
GENERAL AGGREGATE
$2,000,000
PRODUC S-COMP/OP
�—si—ii6p..0010
BA2220L967
6/14/2019 6/14/2020
I�Oa�BINEOSINGLEI.IM�AGGa�mm.._
) T
$$1 00000 .............
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
I
PROP_.,.,
RTY
$
amu, Y'µ^OAMAGE
P' r accudsnl,),
.......... ............. �.
$
CUP8E545094
6/14/2019 6/14/2020
EACH OCCURRENCE
$$10000,000
, AGGREGATE ........ ....
$$10 OOO 000 �,
.....
UB6K139301
6114/2019 6114/2020
,/ STATUTE ERH
_E.L EACH ACCIDENT
$$1,000,000
I E.L. DISEASE - EA EMPLOYEE, aticion 000
E.L,DISEASE- POLICY LIMIT
$$1,000,000 _
DP002553032019
6/1412019 6114/2020
Per Claim: $5,000,000
Aggregate: $5,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Projects as on file with the 'Insured including but not limited to PW 17.40 Wafter Yard Chlorination Facility, Feasibility Study.
The City of EI Segundo, its officials and employees are named as additional insureds and primary'lnon-contributory clause applies to the
general liability Ipolicy-see attached endorsement,
CERTIFICATE HOLDER CANCELLATION
ANY OFBEFORE
The City of El Se undo a THE SHOULD EXPIRATIIONH DATE DESCRIBED
NOTICE I WILL ES CBE CDELIVERED IN
Attn: Orlando Rodriguez, Sr. Civil Engineer ACCORDANCE WITH THE POLICY PROVISIONS.
350 Main St.
EI Segundo CA 90245 AUTHORIZED REPRESENTATIVE
Michael Christian
C 1988.2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
49305054 1 19-20 GL -AL -UL -WC -PL I Sherry Young 1 6/14/2019 1:41:33 PM (PDT) I Page 1 of 3
Insured: MNS Engineers, Inc.
Policy No. : 6802JO51458
Effective Date:6/14/2019
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BLANKET ADDITIONAL INSURED
(ARCHITECTS, ENGINEERS AND SURVEYORS)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
1. The following is added to SECTION II — WHO IS
AN INSURED:
Any person or organization that you agree in a
"written contract requiring insurance" to include as
an additional insured on this Coverage Part, but:
a. Only with respect to liability for "bodily injury",
"property damage" or "personal injury'; and
b. If, and only to the extent that, the injury or
damage is caused by acts or omissions of
you or your subcontractor in the performance
Of "your work" to which the "written contract
requiring insurance" applies, or in connection
with premises owned by or rented to you.
The person or organization does not qualify as an
additional insured:
c. With respect to the independent acts or
omissions of such person or organization; or
d. For "bodily injury", "property damage" or
"personal injury" for which such person or
organization has assumed liability in a
contract or agreement.
The insurance provided to such additional insured
is limited as follows:
e. This insurance does not apply on any basis to
any person or organization for which
coverage as an additional insured specifically
is added by another endorsement to this
Coverage Part.
f. This insurance does not apply to the
rendering of or failure to render any
"professional services".
g. In the event that the Limits of Insurance of the
Coverage Part shown in the Declarations
exceed the limits of liability required by the
"written contract requiring insurance", the
insurance provided to the additional insured
shall be limited to the limits of liability required
by that "written contract requiring insurance".
This endorsement does not increase the
limits of insurance described in Section III —
Limits Of Insurance.
h. This insurance does not apply to "bodily
injury" or "property damage" caused by "your
work" and included in the "products -
completed operations hazard" unless the
"written contract requiring insurance"
specifically requires you to provide such
coverage for that additional insured, and then
the insurance provided to the additional
insured applies only to such "bodily injury" or
"property damage" that occurs before the end
of the period of time for which the "written
contract requiring insurance' requires you to
provide such coverage or the end of the
policy period, whichever is earlier.
2. The following is added to Paragraph 4.a. of
SECTION IV — COMMERCIAL_ GENERAL
LIABILITY CONDITIONS:
The inst:irance provided to the additional insured
is excess over any valid and collectible other
insurance, whether primary, excess, contingent or
on any other basis, that is available to the
additional insured for a loss we cover. However, if
you specifically agree in the "written contract
requiring insurance" that this insurance provided
to the additional insured tinder this Coverage Part
must apply on a primary basis or a primary and
non-contributory basis, this insurance is primary
to other insurance available to the additional
insured which covers that person or organizations
as a named insured for such loss, and we will not
share with the other insurance, provided that:
(1) The "bodily injury" or "property damage" for
which coverage is sought occurs; and
(2) The "personal injury" for which coverage is
sought arises out of an offense committed;
after you have signed that "written contract
requiring insurance". But this insurance provided
to the additional insured still is excess over valid
and collectible other insurance, whether primary.
excess, contingent or on any other basis, that is
available to the additional insured when that
person or organization is an additional insured
under any other insurance.
CG D3 81 0915 0 2015 The Travelers Indemnity Company. All rights reserved.
Includes the copyrighted material of Insurance Services Office, Inc., with its permission
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Page 1 of 2
COMMERCIAL GENERAL LIABILITY
3. The following is added to Paragraph 8., Transfer
Of Rights Of Recovery Against Others To Us,
of SECTION IV — COMMERCIAL GENERAL
LIABILITY CONDITIONS:
We waive any right of recovery we may have
against any person or organization because of
payments we make for "bodily injury", "property
damage" or "personal injury" arising out of "your
work" performed by you, or on your behalf, done
under a "written contract requiring insurance" with
that person or organization. We waive this right
only where you have agreed to do so as part of
the "written contract requiring insurance" with
such person or organization signed by you
before, and in effect when, the "bodily injury" or
"property damage" occurs, or the "personal injury'
offense is committed.
4. The following definition is added to the
DEFINITIONS Section:
"Written contract requiring insurance" means that
part of any written contract under which you are
required to include a person or organization as an
additional insured on this Coverage Part,
provided that the "bodily injury" and "property
damage" occurs and the "personal injury" is
caused by an offense committed:
a. After you have signed that written contract;
b. While that part of the written contract is in
effect; and
c. Before the end of the policy period.
Page 2 of 2 0 2015 The Travelers Indemnity Company. All rights reserved.
Includes the copyrighted material of Insurance Services Office, Inc., with its permission
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CG D3 81 09 15
Insured: MNS Engineers, Inc.
Policy No.: UB6K139301
Effective Date: 6/14/2019
WORKERS COMPENSATION
AND
EMPLOYERS LIABILITY
ENDORSEMENT WC 99 03 76 (00)
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.
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 5.000% of the California workers'
compensation premium otherwise due on such remuneration.
Schedule
Person or Organization
ANY PERSON OR ORGANIZATION WITH WHOM YOU AGREE IN WRITING TO WAIVE
YOUR RIGHT TO RECOVER AGAINST THEM. YOU MUST AGREE TO THIS WAIVER
PRIOR TO THE DATE OF LOSS
Job Description:
Projects as on file with the insured.
Authorized Representative
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