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PROOF OF INSURANCE (2019 - 2019) CLOSEDMCECORP-01 KOCKERT CERTIFICATE OF LIABILITY INSURANCE DATE (MMDDIYYYY) 5/20/I2019 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 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 endomement(s). ... .......................� PRODUCER License # OH66758 CONTACT M Arc Nrr 925 482-1001 Leb6ggacy Risk 8 Insurance Services, LLC FAX 1890 t. Diablo Blvd., Suite 400 �-MAIC certNfl teS".� ��g........_..._._......................................................�...L..........m.........N?�............� gAHrccineE reek, 3........-9.2.5......4.8.....!.......... +cyrisk.net .................................. INSURERISN.AFFO,R_,DING CQVERAGE ........NAIC # ....... INsuRER A :Hartford Underwriters Ins Co 30104 INSURED INSURER, B,:,.Hartford ....Pas ..u.a.�.t(..Ins...Co.............................................. 29424 I MCE Corporation INSURERINSURERc: Hartford ....F.�.lgnsurance Co. 19682 �.. .........................._...._....m......- 4000 Industrial Way INSURER D: Concord, CA 94520 INSURERE: 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 POLIC ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY 'AID CLAIMS. ........................................................................ /NSR TYPE OF INSURANCE AOOL SU00 POLICY NUMBER IMMIODNYYY1 IMMIDDNYYYI LIMITS LTR NN'L, _ .,.• A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DESCRIPTION OF OPERATIONS d LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule maybe attached if more space is requiredl Re: Brett Field Renovation, Brett Field at Recreation Park, EI Segundo, CA. The G�ity of El Segundo, Its officers, officials, employees, agents, and volunteers are named additional insured as respects general liability and this insurance is primary and noncontributory with any other insurance of the additional insured. 30 day NOC applies to GL. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ci of EI Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City 9 ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main St EI Segundo, CA 90245 ..... .......... - AUTHORIZED REPRESENTATIVE V ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CLAIMS -MADE X OCCUR .............. 57UEAFN3735 8/1/2018 8/1/2019 _NREM S t6kEW n , 1............� __.__ 300,0000 0' XP.(Any ..one .person) ._...•.,.,,5 .............. 10,000 PERSMqD ONA mV INJ R 1,000,000 _ �.�...XXXX.�..� _�Er"L AGGREGATE LIMIT APPLIES PER S; --PRCO- POLICY T OC ENERALGGREAT PRO.O,OM tOPAGG .. ..„ ...$ 2,000,000 $ 2,000,000 II u OTHER ........ $ B OMOBILE ABILITY 0 BINEDANGLIMIT S LE .... 1,000,000 X^ ANY AUTO 57UEAFN3857 8/1/2018 8/1/2019 DI INJURY(Per person) 1'$ SCHEDULED AUTOS ONLY AUTOS BODII,m,m,,,,l,,,•„mU,,,,,,,V _.._ $ X R .,,pp Dp HI ED X...ry N AUTOS ONLY AOSY R'Y DAM G EacGdentl (Pa�cEcrnt.........................................$ $ B .......... X UMBRELLA LIAB V X V OCCUR ......... EACH OCCURRENCE $ 5,000,000 CLAIMS -MADE 57RHAFN3763 8/1/2018 8/1/2019 AGGREGATE $ 5,000,00 ...........�...DEDES.S..LJAl3,•... ION$ X RETENT 10,000 $ WORKERS COMPENSATION D EMPLOYERS' LIABILITY ❑ YIN FY P,ERWRIETO R EXCLUDED? C��FICER,IMEMBER EXCLUDED N / A (Y9tndato In NH ,57ATI ITF ORH E -L EACH NT ...................`..........���,• E.L, DISEASEC ..EMPLOYEE. $ ___...................____...... ___. If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT 8 ........•.. C Rented/Leased Eqp ,•,......•••• 57UUMFN3829 8/1/2018 8/1/2019 Limit 300,000 DESCRIPTION OF OPERATIONS d LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule maybe attached if more space is requiredl Re: Brett Field Renovation, Brett Field at Recreation Park, EI Segundo, CA. The G�ity of El Segundo, Its officers, officials, employees, agents, and volunteers are named additional insured as respects general liability and this insurance is primary and noncontributory with any other insurance of the additional insured. 30 day NOC applies to GL. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ci of EI Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City 9 ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main St EI Segundo, CA 90245 ..... .......... - AUTHORIZED REPRESENTATIVE V ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: MCECORP-01 KOCKERT " LOC #: 1 AC40R0 1111la..� ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY License, # OH66758 NAMED INSURED MCE Corporation Legacy RiskBER & Insurance Services, LLC ............... 4000 Industrial W2 Concord, CA 9dfe2tl PEE PAGE 1 CARRIER mm NAIC CODE E.E PAGE 1.......... SEE P 1 EFFECTIVE DATE SEE Q ........ �__ . AGE 1 ._._. ADDITIONAL (REMARKS �....._.................. .......... 1 THIS ADDITIONALNAL REMARKS FORM IS A SCHEDULE TO ACO RD FORM, FORM NUMBER: ACORD 25 FORM TITLE: eof Lebi'ty. Insurance _ Certificate of Liability Remarks * 10 Day notice of cancellation for non-payment of premium. Certificate of Liability Remarks ***THE FOLLOWING FORMS APPLY ONLY AS INDICATED IN THE DESCRIPTION OF OPERATIONS OR SUBSEQUENT SUPPLEMENTAL PAGES.*** GENERAL LIABILITY: * Additional Insured if required by written contract per form HG00010916 * Coverage is primary & non-contributory if required by written contract perform HG00010916 * Waiver of Subrogation if required by written contract perform HG00010916 AUTOMOBILE LIABILITY * Additional Insured if required by written contract per form HA 99 16 0312 * Primary and non-contributory wording if required by written contract per form HA 99 16 03 12. * Waiver of Subrogation if required by written contract per form HA 99 16 03 12 " Blanket Loss Payee if required by written contract per form HA 9916 0312. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD MCE Corporation Policy #: 57UEAFN3735 SECTION II - WHO IS AN INSURED "volunteer worker' as a consequence 1. If you are designated in the Declarations as: of Paragraph (1)(a) above; a. An individual, you and your spouse are (c) For which there is any obligation to insureds, but only with respect to the conduct share damages with or repay someone of a business of which you are the sole else who must pay damages because owner. of the injury described in Paragraphs b. A partnership or joint venture, you are an (1)(a) or (1)(b) above; or insured. Your members, your partners, and (d) Arising out of his or her providing or their spouses are also insureds, but only with failing to provide professional health respect to the conduct of your business. care services. c. A limited liability company, you are an If you are not in the business of providing insured. Your members are also insureds, but professional health care services: only with respect to the conduct of your (a) Subparagraphs (1)(a), (1)(b) and (1)(c) business. Your managers are insureds, but above do not apply to any "employee" only with respect to their duties as your or "volunteer worker' providing first aid managers. services; and d. An organization other than a partnership, joint (b) Subparagraph (1)(d) above does not venture or limited liability company, you are apply to any nurse, emergency medical an insured. Your "executive officers" and technician or paramedic employed by directors are insureds, but only with respect to you to provide such services. their duties as your officers or directors. Your (2) "Property damage" to property: stockholders are also insureds, but only with respect to their liability as stockholders. (a) Owned, occupied or used by, e. A trust, you are an insured. Your trustees are (b) Rented to, in the care, custody or also insureds, but only with respect to their control of, or over which physical duties as trustees. control is being exercised for any 2. Each of the following is also an insured: purpose by a. Employees And Volunteer Workers you, any of your "employees", "volunteer workers", any partner or member (if you Your "volunteer workers" only while are a partnership or joint venture), or any performing duties related to the conduct of member (if you are a limited liability your business, or your "employees", other company). than either your "executive officers" (if you are b. Real Estate Manager an organization other than a partnership, joint venture or limited liability company) or your Any person (other than your "employee" or managers (if you are a limited liability "volunteer worker', or any organization while company), but only for acts within the scope acting as your real estate manager. of their employment by you or while c. Temporary Custodians Of Your Property performing duties related to the conduct of Any person or organization having proper your business. temporary custody of your property if you die, However, none of these "employees" or but only: "volunteer workers" are insureds for. (1) With respect to liability arising out of the (1) "Bodily injury" or "personal and advertising maintenance or use of that property; and injury": (2) Until your legal representative has been (a) To you, to your partners or members (if appointed. you are a partnership or joint venture), d. Legal Representative If You Die to your members (if you are a limited liability company), to a co -"employee Your legal representative if you die, but only while in the course of his or her with respect to duties as such. That employment or performing duties representative will have all your rights and related to the conduct of your duties under this Coverage Part. business, or to your other "volunteer e. Unnamed Subsidiary workers" while performing duties Any subsidiary, and subsidiary thereof, of related to the conduct of your yours which is a legally incorporated entity of business; which you own a financial interest of more (b) To the spouse, child, parent, brother or than 50% of the voting stock on the effective sister of that co -"employee" or that date of the Coverage Part. HG 00 0109 16 Page 11 of 21 MCE Corporation Policy #: 57UEAFN3735 The insurance afforded herein for any A person or organization is an additional insured subsidiary not named in this Coverage Part under this provision only for that period of time as a named insured does not apply to injury required by the contract or agreement. or damage with respect to which such insured However, no such person or organization is an is also a named insured under another policy insured under this provision if such person or or would be a named insured under such organization is included as an insured by an policy but for its termination or the exhaustion endorsement issued by us and made a part of of its limits of insurance. this Coverage Part. 3. Newly Acquired Or Formed Organization a. Vendors Any organization you newly acquire or form, Any person(s) or organization(s) (referred to other than a partnership, joint venture or limited below as vendor), but only with respect to liability company, and over which you maintain "bodily injury" or "property damage" arising financial interest of more than 50% of the voting out of "your products" which are distributed or stock, will qualify as a Named Insured if there is sold in the regular course of the vendor's no other similar insurance available to that business and only if this Coverage Part organization. However: provides coverage for "bodily injury" or a. Coverage underthis provision is afforded only "property damage" included within the until the 180th day after you acquire or form "products -completed operations hazard". the organization or the end of the policy (1) The insurance afforded the vendor is period, whichever is earlier; subject to the following additional b. Coverage A does not apply to "bodily injury" exclusions: or "property damage" that occurred before This insurance does not apply to; you acquired or formed the organization; and (a) "Bodily injury" or "property damage" for c. Coverage B does not apply to "personal and which the vendor is obligated to pay advertising injury" arising out of an offense damages by reason of the assumption committed before you acquired or formed the of liability in a contract or agreement. organization. This exclusion does not apply to 4. Nonowned Watercraft liability for damages that the vendor With respect to watercraft you do not own that is would have in the absence of the less than 51 feet long and is not being used to contract or agreement; carry persons for a charge, any person is an (b) Any express warranty unauthorized by insured while operating such watercraft with your you; permission. Any other person or organization (c) Any physical or chemical change in the responsible for the conduct of such person is product made intentionally by the also an insured, but only with respect to liability vendor, arising out of the operation of the watercraft, and (d) Repackaging, except when unpacked only if no other insurance of any kind is available solely for the purpose of inspection, to that person or organization for this liability. demonstration, testing, or the However, no person or organization is an insured substitution of parts under instructions with respect to: from the manufacturer, and then a. "Bodily injury" to a co -"employee" of the repackaged in the original container; person operating the watercraft; or (e) Any failure to make such inspections, b. "Property damage" to property owned by, adjustments, tests or servicing as the rented to, in the charge of or occupied by you vendor has agreed to make or normally or the employer of any person who is an undertakes to make in the usual insured under this provision. course of business, in connection with 5. Additional Insureds When Required By the distribution or sale of the products; Written Contract, Written Agreement Or (f) Demonstration, installation, servicing Permit or repair operations, except such The following person(s) or organization(s) are an operations performed at the vendor's additional insured when you have agreed, in a premises in connection with the sale of written contract, written agreement or because of the product; a permit issued by a state or political subdivision, (g) Products which, after distribution or that such person or organization be added as an sale by you, have been labeled or additional insured on your policy, provided the relabeled or used as a container, part injury or damage occurs subsequent to the or ingredient of any other thing or execution of the contract or agreement. substance by or for the vendor; or Page 12 of 21 HG 00 0109 16 MCE Corporation Policy #: 57UEAFN3735 (h) "Bodily injury" or "property damage" omissions of those acting on your behalf: arising out of the sole negligence of the (1) In connection with your premises; or vendor for its own acts or omissions or (2) In the performance of your ongoing t hose of its employees or anyone else operations performed by you or on your acting on its behalf. However, this behalf, exclusion does not apply to: exceptions (i) The exceptions contained in Sub- With respect to the insurance afforded these paragraphs () (f7; or d or additional insureds, the following additional exclusion applies: (ii) Such inspections, adjustments, This insurance does not apply to "bodily tests or servicing as the vendor has„ injury', "property damage or personal and agreed to make or normally undertakes to make in the usual advertising injury” arising out of the rendering course of business, in connection of or the failure to render any professional with the distribution or sale of the services by or for you, including: products. 1. The preparing, approving, or failing to (2) This insurance does not apply to any prepare or approve, maps, shop drawings, insured person or organization, from opinions, reports, surveys, field orders, whom you have acquired such products, change orders or drawings and or any ingredient, part or container, specifications; or entering into, accompanying or containing 2. Supervisory, inspection, architectural or such products. engineering activities. b. Lessors Of Equipment This exclusion applies even if the claims (1) Any person(s) or organization(s) from against any insured allege negligence or whom you lease equipment; but only with other wrongdoing in the supervision, hiring, respect to their liability for "bodily injury", employment, training or monitoring of others "property damage" or "personal and by that insured, if the occurrence which advertising injury" caused, in whole or in caused, the bodily injuryor property part, by your maintenance, operation or damage , or the offense which caused the 'Personal use of equipment leased to you by such and advertising injury", involved the person(s) or organization(s). rendering of or the failure to render any professional services by or for you. (2) With respect to the insurance afforded to e. Permits Issued By State Or Political these additional insureds this insurance Subdivisions does not apply to any "occurrence" which takes place after the equipment lease Any state or political subdivision, but only with expires. respect to operations performed by you or on c. Lessors Of Land Or Premises your behalf for which the state or political subdivision has issued a permit. Any person or organization from whom you With respect to the insurance afforded these lease land or premises, but only with respect additional insureds, this insurance does not to liability arising out of the ownership, apply to: maintenance or use of that part of the land or premises leased to you. (1) "Bodily injury", "property damage" or With respect to the insurance afforded these "personal and advertising injury" arising additional insureds the following additional out of operations performed for the state exclusions apply: or municipality; or This insurance does not apply to: (2) "Bodily injury" or "property damage" included within the products -completed 1. Any "occurrence" which takes place after operations hazard". you cease to lease that land; or f. Any Other Party 2. Structural alterations, new construction or Any other person or organization who is not demolition operations performed by or on an additional insured under Paragraphs a. behalf of such person or organization. through e. above, but only with respect to d. Architects, Engineers Or Surveyors liability for "bodily injury", "property damage" Any architect, engineer, or surveyor, but only or "personal and advertising injury" caused, in with respect to liability for "bodily injury", whole or in part, by your acts or omissions or "property damage" or "personal and the acts or omissions of those acting on your advertising injury" caused, in whole or in part, behalf: by your acts or omissions or the acts or (1) In the performance of your ongoing operations; HG 00 0109 16 Page 13 of 21 (2) In connection with your premises owned by or rented to you; or (3) In connection with "your work" and included within the "products -completed operations hazard", but only if (a) The written contract or agreement requires you to provide such coverage to such additional insured; and (b) This Coverage Part provides coverage for "bodily injury" or "property damage" included within the "products - completed operations hazard". However: (1) The insurance afforded to such additional insured only applies to the extent permitted by law; and (2) If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. With respect to the insurance afforded to these additional insureds, this insurance does not apply to: "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: (1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (2) Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional services by or for you. The limits of insurance that apply to additional insureds is described in Section III - Limits Of Insurance. How this insurance applies when other insurance is available to the additional insured is described in the Other Insurance Condition in Section IV - Commercial General Liability Conditions. MCE Corporation Policy #: 57UEAFN3735 No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations. SECTION III - LIMITS OF INSURANCE 1. The Most We Will Pay The Limits of Insurance shown in the Declarations and the rules below fix the most we will pay regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". 2. General Aggregate Limit The General Aggregate Limit is the most we will pay for the sum of: a. Medical expenses under Coverage C; b. Damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "products - completed operations hazard"; and c. Damages under Coverage B. 3. Products -Completed Operations Aggregate Limit The Products -Completed Operations Aggregate Limit is the most we will pay under Coverage A for damages because of "bodily injury" and "property damage" included in the "products - completed operations hazard". 4. Personal And Advertising Injury Limit Subject to 2. above, the Personal and Advertising Injury Limit is the most we will pay under Coverage B for the sum of all damages because of all "personal and advertising injury" sustained by any one person or organization. 5. Each Occurrence Limit Subject to 2. or 3. above, whichever applies, the Each Occurrence Limit is the most we will pay for the sum of: a. Damages under Coverage A; and b. Medical expenses under Coverage C because of all "bodily injury" and "property damage" arising out of any one "occurrence". 6. Damage To Premises Rented To You Limit Subject to 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of "property damage" to any one premises, while rented to you, or in the case of damage by fire, lightning or explosion, while rented to you or temporarily occupied by you with permission of the owner. Page 14 of 21 HG 00 01 09 16 K4CECorporation Policy #: 57UEAFN3735 (3) Any manager, if you or the additional insured is alimited liability company; (4)Any "executive officer' or insurance manager, if you or the additional insured is auorpomdVn; (5)Any tmstee, if you or the additional insured isatmue1� or (6) Any elected or appointed officim/, if you or the additional insured is a political subdivision nrpublic entity. This duty applies nepanobs|y to you and any additional insured. 3. Legal Action Against 0w No person or organization has m right under this Coverage Part: a. To join us as a party orotherwise bring me into e "suit" asking for damages from an insured; or b. Tosue usunthis Coverage Part unless all of its terms have been fully complied with. Apemsmn or organization may sue ms to recover on an agreed settlement or on a final judgment against an imsonmd� but we will not be liable for damages that are not payable under the terms of this Comm/age Part or that are in excess of the applicable fimM of Insurance, An agreed settlement memns a settlement and release of liability signed by ua, the insured and the oka/monim��hed�imrepresentative. r~— -- 4. Other Insurance If other valid and collectible insurance is available hmthe insured for ploss wmcover under Coverages A or B of this Coverage Part, our obligations are limited as follows: m. Primary Insurance This insurance is primary except when b. below applies. If other insurance is also pMmary, we will share with all that other |naunonom by the method described in c. below. b. Excess Insurance This insurance isexcess over any ofthe other |noumnce, whether phmmry, excess, contingent oronany other basis: (1) Your Work That isFire, Extended Coverage, Builders Risk, Installation Risk o/similar coverage for "your work"; (2) Premises Rented To You That is fim, lightning or explosion insurance for premises rented to you or temporarily occupied by you with permission ofthe owner; (3) Tenant Liability That isinsurance purchased by you to cover your liability as a tenant for .property damage" to premises rented to you or temporarily occupied by you with permission ofthe owner; (4) Aircraft, Auto Or Watercraft |fthe loss arises out ofthe maintenance nr use ofaircraft, "eutns"orwatercraft to the extent not subject to Exclusion g. of Section X - CovmnageA- Bodily Injury And Property Damage Liability; (6) Property Damage To Borrowed Equipment Or Use Of Elevators )fthe loss arises out of"property damage" to borrowed equipment or the use of elevators to the extent not subject to Exclusion j. of Section | ' Coverage A ' Bodily Injury And Property Damage Liability; (6) When You Are Added As An Additional Insured To Other Insurance Any other insurance available to you covering liability for damages ehminQ out ofthe premises nroperations, or products and completed operations, for which you have been added msmnadditional insured bythat insurance; or (7) When You Add Others As An Additional Insured TmThis Insurance Any other insurance available to an additional insured. However, the following provisions apply to other insurance available toany person or organization who isenadditional insured under this coverage part. (a) Primary Immwmmnca When Required By Contract This insurance is primary if you have agreed in o written contract or written wgnopmmnd that this insurance be primary. U other insurance is also phmery, we will share with all that other insurance by the method described inc.below. (b) Primary And Non -Contributory To Other Insurance When Required By Contract If you have mgnaod in a written cnnbad, written ogneoment, or pmmnh that this insurance is primary and non- contributory with the additional inmurnd'sown insurance, this insurance is primary and we will not seek contribution from that other insurance. Page 16 of 21 HG 00 0109 16 MCE Corporation Policy #: 57UEAFN3735 Paragraphs (a) and (b) do not apply to other insurance to which the additional insured has been added as an additional insured. When this insurance is excess, we will have no duty under Coverages A or B to defend the insured against any "suit" if any other insurer has a duty to defend the insured against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the insured's rights against all those other insurers. When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (1) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (2) The total of all deductible and self-insured amounts under all that other insurance. We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part, c. Method Of Sharing If all of the other insurance permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. Premium Audit a. We will compute all premiums for this Coverage Part in accordance with our rules and rates. b. Premium shown in this Coverage Part as advance premium is a deposit premium only. At the close of each audit period we will compute the earned premium for that period and send notice to the first Named Insured. The due date for audit and retrospective premiums is the date shown as the due date on the bill. If the sum of the advance and audit premiums paid for the policy period is greater than the earned premium, we will return the excess to the first Named Insured. c. The first Named Insured must keep records of the information we need for premium computation, and send us copies at such times as we may request. 6. Representations a. When You Accept This Policy By accepting this policy, you agree: (1) The statements in the Declarations are accurate and complete; (2) Those statements are based upon representations you made to us; and (3) We have issued this policy in reliance upon your representations. b. Unintentional Failure To Disclose Hazards If unintentionally you should fail to disclose all hazards relating to the conduct of your business that exist at the inception date of this Coverage Part, we shall not deny coverage under this Coverage Part because of such failure. 7. Separation Of Insureds Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this Coverage Part to the first Named Insured, this insurance applies: a. As if each Named Insured were the only Named Insured; and b. Separately to each insured against whom claim is made or "suit" is brought. 8. Transfer Of Rights Of Recovery Against Others To Us a. Transfer Of Rights Of Recovery If the insured has rights to recover all or part of any payment, including Supplementary Payments, we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. b. Waiver Of Rights Of Recovery (Waiver Of Subrogation) If the insured has waived any rights of recovery against any person or organization for all or part of any payment, including Supplementary Payments, we have made under this Coverage Part, we also waive that right, provided the insured waived their rights of recovery against such person or organization in a contract, agreement or permit that was executed prior to the injury or damage. 9. When We Do Not Renew If we decide not to renew this Coverage Part, we will mail or deliver to the first Named Insured shown in the Declarations written notice of the HG 00 0109 16 Page 17 of 21 Policy#: 57UEAFN3735 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS BROAD FORK ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART INDEX 1. Alienated Premises Coverage........_._,. .................................. ......... ................. 1 2. Damage To Your Work.............................................................................................................................. 1 3 Contractors Limited Professional Liability...................................................................................................1 4. Per Project and Per Location General Aggregate Limits Of Insurance........................................................ 2 5. Medical Payments Coverage — Including Products - Completed Operations ............................................... 3 6. Injury To Employee's Reputation With Respect To Incidental Medical Malpractice .................................... 3 7. Bodily Injury Employee Suits.................................................................................................................... 3 8. Consolidated Insurance (Wrap -Up) Program.............................................................................................. 3 9. Access Or Disclosure Of Confidential Or Personal Information And Data -Related Liability ........................ 4 10. Supplementary Payments.......................................................................................................................... 5 11. Two Or More Coverage Parts Or Policies Issued By Us............................................................................. 5 d12. N oti qg of: grlc Nation to Certificate Hpders............. r..._;.:.....:.;...:...:......:..;...:.:: .............. .,.,......,..,....,.....,.....,...,, ..,........... 51 13. Contractual Liability Coverage For Personal And Advertising Injury ............................................................ 5 14. Insured Contract Definition......................................................................................................................... 6 1. 2. ALIENATED PREMISES COVERAGE Exclusion j. Damage To Property of Section I — Coverage A is amended as follows: a. The following exception to the exclusion is deleted: Paragraph (2) of this exclusion does not apply if the premises are "your work" and were never occupied, rented or held for rental by you. b. This exception is replaced by the following: Paragraph (2) of this exclusion does not apply if the premises are "your work". DAMAGE TO YOUR WORK Exclusion I. Damage To Your Work of Section - Coverage A is replaced by the following: I. Damage to Your Work "Property damage" to that particular part of "your work" that must be restored, repaired or replaced because "your work" was incorrectly performed and included in the "products - completed operations hazard". This exclusion does not apply if the damaged work or the work performed incorrectly was performed on your behalf by a subcontractor. Form HS 24 50 03 17 This provision does not apply if exclusion I. Damage To Your Work has been otherwise modified by endorsement. 3. CONTRACTORS LIMITED PROFESSIONAL LIABILITY The following exclusion is added to Paragraph 2., Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liability, and to Paragraph 2., Exclusions of Section I - Coverage B - Personal And Advertising Injury Liability: This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of or failure to render any professional services by you with respect to your providing engineering, architectural or surveying services in your capacity as an engineer, architect or surveyor. Professional services include: (1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders, or drawings and specifications; and © 2017, The Hartford Page 1 of 6 B. The following is added to Paragraph 2. Exclusions of Section I — Coverage B — Personal and Advertising Injury : 2. Exclusion This insurance does not apply to: Access Or Disclosure Of Confidential Or Personal Information "Personal and advertising injury" arising out of any access to or disclosure of any person's or organization's confidential or personal information, including patents, trade secrets, processing methods, customer lists, financial information, credit card information, health information or any other type of nonpublic information. This exclusion applies even if damages are claimed for notification costs, credit monitoring expenses, forensic expenses, public relations expenses or any other loss, cost or expense incurred by you or others arising out of any access to or disclosure of any person's or organization's confidential or personal information. C. The following paragraph is added to Section III — Limits Of Insurance: Subject to Paragraph 5. Each Occurrence Limit, the most we will pay under Coverage A for "property damage" because of all loss of "electronic data" arising out of any one "occurrence" is $100,000, unless modified by endorsement. D. The following definition is added to Section V - Definitions: "Electronic data" means information, facts or programs: a. Stored as or on; b. Created or used on; or c. Transmitted to or from; computer software, (including systems and applications software) hard or floppy disks, CD-ROMS, tapes, drives, cells, data processing devices or any other media which are used with electronically controlled equipment. E. For the purposes of the coverage provided by this provision, the definition of "property damage" in Section V - Definitions is replaced by the following: "Property damage" means: a. Physical injury to tangible property, including all resulting loss of use of that property. All such loss of use shall be deemed to occur at the time of the physical injury that caused it; b. Loss of use of tangible property that is not physically injured. All such loss of use shall be deemed to occur at the time of the "occurrence" that caused it; or c. Loss of, loss of use of, damage to, corruption of, inability to access, or inability to properly manipulate "electronic data", resulting from physical injury to tangible property. All such loss of "electronic data" shall be deemed to occur at the time of the "occurrence" that caused it. For the purposes of this insurance, "electronic data" is not tangible property. 10. SUPPLEMENTARY PAYMENTS In the Supplementary Payments — Coverages A and B provision: The limit for the cost of bail bonds is increased to $2,500. 11. TWO OR MORE COVERAGE PARTS OR POLICIES ISSUED BY US If this policy and any other policy issued to an insured by us or any affiliated company provides coverage that applies to the same claim or damages, the maximum applicable limit(s) of liability or limit of insurance under all the policies will not exceed the highest applicable limit of liability or limit of insurance under any one policy. This condition does not apply to any policy issued by us or an affiliated company specifically written to apply as excess insurance over this policy. 12. NOTICE OF CANCELLATION TO CERTIFICATE HOLDER(S) This policy is subject to the following additional Conditions: A. If this policy is cancelled by the Company, other than for nonpayment of premium, notice of such cancellation will be provided at least thirty (30) days in advance of the cancellation effective date to the certificate holder(s) with mailing addresses on file with the agent of record or the Company. B. If this policy is cancelled by the Company for nonpayment of premium, or by the insured, notice of such cancellation will be provided within (10) days of the cancellation effective date to the certificate holder(s) with mailing addresses on file with the agent of record or the Company. If notice is mailed, proof of mailing to the last known mailing address of the certificate holder(s) on file with the agent of record or the Company will be sufficient proof of notice. Any notification rights provided by this endorsement apply only to active certificate Form HS 24 50 03 17 Page 5 of 6 holder(s) who were issued a certificate of An obligation, as required by ordinance, insurance applicable to this policy's term. to indemnify a municipality. Failure to provide such notice to the certificate b. CONTRACTUAL LIABILITY holder(s) will not amend or extend the date the Paragraph f. of the definition of "insured cancellation becomes effective, nor will it negate contract" is deleted and replaced by the cancellation of the policy. Failure to send notice following: shall impose no liability of any kind upon the That part of any other contract or Company or its agents or representatives. agreement pertaining your business 13. CONTRACTUAL LIABILITY COVERAGE FOR (including an indemnification of a PERSONAL AND ADVERTISING INJURY municipality in connection with work Exclusion e. of SECTION I — COVERAGE B performed for a municipality) under which PERSONAL AND ADVERTISING INJURY you assume the tort liability of another party to pay for "bodily injury", "property LIABILITY is replaced by the following: damage", or "personal and advertising This insurance does not apply to: injury" to a third person or organization. e. Contractual Liability Tort liability means a liability that would be imposed by law in the absence of any "Personal and advertising injury" for which the contract or agreement. insured has assumed liability in a contract or agreement. This exclusion does not apply to Paragraph f. includes that part of any liability for damages: contract or agreement that indemnifies a railroad for "bodily injury", "property (1) That the insured would have in the damage", or "personal and advertising absence of the contract or agreement; or injury" arising out of construction or (2) Assumed in a contract or agreement that demolition operations, within 50 feet of is an "insured contract", provided the any railroad property and affecting any "personal and advertising injury" occurs railroad bridge or trestle, tracks, road - subsequent to the execution of the beds, tunnel, underpass or crossing. contract or agreement. Solely for the However, Paragraph f. does not include purposes of liability assumed in an that part of any contract or agreement: "insured contract", reasonable attorney fees and necessary litigation expenses (1) That indemnifies an architect, incurred by or for a party other than an engineer or surveyor for injury or insured are deemed to be damages damage arising out of: because of "personal and advertising (a) Preparing, approving, or failing to injury", provided: prepare or approve, maps, shop (a) Liability to such party for, or for the drawings, opinions, reports, cost of, that party's defense has also surveys, field orders, change been assumed in the same "insured orders or drawings and contract'; and specifications; or (b) Such attorney fees and litigation (b) Giving directions or instructions, expenses are for defense of that party or failing to give them, if that is against a civil or alternative dispute the primary cause of the injury or resolution proceeding in which damage; or damages to which this insurance (2) Under which the insured, if an applies are alleged. architect, engineer or surveyor, 14. INSURED CONTRACT DEFINITION assumes liability for an injury or damage arising out of the insured's a. INSURED CONTRACT— rendering or failure to render CONSTRUCTION OPERATIONS AND professional services, including those MUNICIPAL WORK listed in (1) above and supervisory, Paragraph d. of the definition of "insured inspection, architectural or contract" in Section V - Definitions is engineering activities. deleted and replaced by the following: All other terms and conditions in the policy remain unchanged. Page 6 of 6 Form HS 24 50 03 17 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/5/ 0//Y2019 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 SUBROGRATION 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 Willis Towers Watson CONTACT NAME: Concord 12980 Metcalf Ave Suite 500 PHONE (A/C, No Ext): (925) 849-8412 FAX (A/C, NO): (360) 828-0699 Overland Park KS 66213 EMAIL ADDRESS: Carios.Aurellano(d_)bbsihq.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: ACE American Insurance Company 22667 INSURED INSURER B: Barrett Business Services, Inc. L/C/F MCE CORPORATION INSURER C: 4000 INDUSTRIAL WAY INSURER D: CONCORD, CA 94520 INSURER E: 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 ISSUES 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. INS'R TYPE OF INSURANCE ADDL POLICY NUMBER POLICY EFF POLICY EXP y LIMITS LTR NSR yBp (MMIDDIYYYY) (MMIDDrYYYY) GENERAL LIABILITY EACH CCURRENCE O $ COMMERDAMAGE CIAL GENERAL LIABILITY TO PREMISES (Ea CLL AIMS -MADE OCCUR � owurence) � .... MED EXP (Any one person) ----" I PERSONAL & ADV INJURY $,,,, GENERAL AGGREGATE $ i GEN'L AGGREGATE LIMIT APPLIES PER: POLICY J- LOC PRODUCTS - COMP/OP AGG $$ I� 1 1 ECO AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ��� Ea accident ANY AUTO ALL OWNED AUTOS (SCHEDULED AUTOS BODILY INJURY (Per person) $ „ .' HIRED AUTOS r NON -OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB �JOCCUR AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' C65213527 12/01/18 12/01/2019�/ I WC STA'TU. I IOTH- LIABILITY Y/N TORY LIMITS ER ANY PROPRIETORIPARTNER/ EXECUTIVEY E.L. EACH ACCIDENT $2,000,000 OFFICER/MEMBER EXCLUDED? NIA X Covered States: E.L. DISEASE - EA EMPLOYEE $2,000,000 (Mandatory in NH) If yes, describe under CA I DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1$2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) In the event of any payment under this policy for a Loss for which the named insured has waived the right of recovery in a written contract entered into prior to the Loss, insurer hereby agrees to also waive our right of recovery but only with respect to such Loss. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATA THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE City of EI Segundo POLICY PROVISIONS. 350 Main St. AUTHORIZED REPRESENTATIVE EI Segundo CA 90245 Authorized Rep c) 1988-2010 ACORD CORPORATION. All rig es rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD. AGENCY CUSTOMER ID: LOC: M ADDITIONAL REMARKS SCHEDULE Page 2 of 2 'AGENCY NAMED INSURED: Barrett Business Services, Inc. L/C/F �Lockton Affinity MCE CORPORATION POLICY NUMBER 4000 INDUSTRIAL WAY CONCORD, CA 94520 C65213527 CARRIER NAIC CODE ACE American Insurance Company 22667 EFFECTIVE DATE: 12/01/18 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability (01/14) CERTIFICATE HOLDER: City of EI Segundo ADDRESS: 350 Main St. EI Segundo CA 90245 Re: 18-001 Brett Field Renovation 401 Sheldon Street, E1 Segundo, CA 90245 ACORD 101 (2008/01) c) 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD. Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number BARRETT BUSINESS SERVICES, INC, L/C/F ................. MCE CORPORATION Policy Number 8100 NE PARKWAY DRIVE, STE. 200 VANCOUVER WA 98662 Y Symbol: WLR Number: C65213527 Policy Period Effective Date of Endorsement 12-01-2018 TO 12-01-2019 12-01-2018 Issued By (Name of Insurance Company) ACE AMERICAN INSURANCE COMPANY Insert the policy number. The remainder of td; indorrnation is to be compheted only when this endorsement is issued subsequent to the preparation of the policy CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. 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, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Schedule 1. ( ) Specific Waiver Name of person or organization: ( X) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: ALL CALIFORNIA OPERATIONS 3. Premium: The premium charge for this endorsement shall be 2.0 percent of the California premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Minimum Premium: $ 0 Authorized Agent WC 99 03 22