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PROOF OF INSURANCE (2019 - 2020) CLOSEDDATE (M MYY) CERTIFICATE OF LIABILITY INSURANCE lul /12/2019/2019 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 Sue LUSIC NAME: AX Cornerstone Specialty Insurance Services, Inc PHDNE (714) 731-7700 V'fC ('714) 731.7750 IA", No. E,,) (AJC, No).: 14252 Culver Drive, A299 E'MA4a A'ODRESS: sue@cornerstonespecialty.com INSURER(S) AFFORDING COVERAGE NAIC # Irvine CA 92604 INSURERA: Travelers Property Casualty Co 25674 INSURED I INSURER B: Travelers Casualty & Surety Co. ofAmerica 31194 HAYER CONSULTANTS, INC. I INSURER C: 4067 Hardwick St. V INSURER D: PNB 250 INSURER E: I Lakewood CA 90712 I INSURER F: COVERAGES CERTIFICATE NUMBER: 18/19/20 COVERAGES REVISION NUMBER: THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABO "I 11 E FO11 R THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRFWUL'bUtW POLICY EFF I POLICY EXP TYPE OF INSURANCE LTR INSD WVD POLICY NUMBER (MMIDDIYYYY) (MMIDD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE Fx_] OCCUR UAMAU;E 5UftNIbU PREMISES IEa ocaarrencul 1,000,000 II $ 5,000 X ADD'T1 INSURED/ PRIMARY MED EXP (Any one person) $ A X BLNKT WVR OF SUBRO Y Y 680-2JO09914-19 06/13/2019 06/13/2020 PERSONAL &ADV INJURY $ 1,000,000 GEN'LAGGREGATELIMITAPPLIESPER: GENERALAGGREGATE I $ 2,000,000 POLICY [g PRO 0 LOC JECT PRODUCTS-COMP/OPAGG M I $ 2,000,000 I $ OTHER: Y AUTOMOBILE LIABILITY I COMBINED' SINGLE LIMIT RFa acodenll $ INCLUDED ANYAUTO I BODILY INJURY (Per person) I, $ A OWNED SCHEDULED Y Y 680-2JO09914-19 06/13/2019 06/13/2020 I BODILY INJURY (Per accident) $ AUTOS ONLY HIRED+w� AUTOS ONLY X AUTOS AUTOS ONNON-OWNLY I I PROPLRTY DAMAGE Par accdd'enO $ $ X UMBRELLA LIAB X OCCUR Ili EACH OCCURRENCE $ 2,000,000 A EXCESS LIABCUP-6536Y635-19 GLAIMS-MADE 06/13/2019 06/13/2020 AGGREGATE $ 2,000,000 II DED I XI RETENTsON $ 0 $ WORKERS COMPENSATION PER I AND EMPLOYERS' LIABILITY Y / N STATUTE, °RH ANY PROPRIETOR/PARTNERIEXECUTIVEE] N /A F L EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) I E L DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT $ PROFESSIONAL LIABILITY EACH CLAIM B Claims Made 106639088 12/01/2018 12/01/2019 ANNUALAGGREGATE DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of EI Segundo is Additional Insured for General Liability but only if required by written contract with the Named Insured prior to an occurrence and as per attached endorsement. Coverage is subject to all policy terms and conditions. *30 days notice of cancellation, except for 10 days notice for non-payment of premium. For Professional Liability coverage, the aggregate limit is the total insurance available for all covered claims reported within the policy period. CERTIFICATE HOLDER CANCELLATION $2,000,000 $2,000,000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of EI Segundo -Attn: Building & Safety Department ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street AUTHORIZED REPRESENTATIVE EI Segundo CA 90245 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 6Q0-2/U099l4-l9 NAMED INSURED: Hu;ecConsultants, blc. COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ Ul[CAREFULLY. (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART t The following is added to SECTION U —VVHO IS AN|NSURED: Any person or organization that you agree in a .Pwritten contract requiring insurance" to include as an additional insured on this Coverage Part, but: a. Only with respect to liability for injury", "property dmnnage"or"personal injury"; and b~ If, and only to the extent that, the injury or damage is caused by acts or omissions of you uryour subcontractor inthe performance of "your work" to which the "written contract requiring insurance" app|ies, orinconnection with premises owned byorrented k»you. The person ororganization does not qualify asan additional insured: c. With respect to the independent acts or omissions ofsuch person ororganization; or d. For "bodily injury". 11property " or "personal injury" for which such person or organization has assumed liability in m contract wragreement. The insurance provided hosuch additional insured islimited asfollows: e. This insurance does not apply on any basis bz any person or organization for which coverage asanadditional 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 ^w/kten contract requiring insurance", the insurance provided to the additional insured shall belimited Uuthe limits ufliability required by that "written contract requiring insurance". This endorsement does not increase the limits of insurance described in Section III — Limits (3fInsurance. h. This insurance duos not apply to "bodily injury" o/"property d 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 tosuch "bodily injury" or "p^opertydamage" 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 isearlier, 2. The following is added to Paragraph 4.a. of SECTION K/ ~ COMMERCIAL GENERAL LIABILITY CONDITIONS: The insurance provided Uothe additional insured is excess over any valid and collectible other insurance, whether primary, excess, contingent ur on any other basis' that is available to the additional insured for aloss wecover. However, if you specifically agree in the ^'wmMen contract requiring insurance" that this insurance provided tmthe additional insured Linder this Coverage Part must apply on a primary basis or primary and non-contributory boeiy, this insurance is primary to other insurance available to the additional insured which covers that person wrorganizations as a named insured for such |oss, and wewill not share with the other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage /ssought occurs; and (2) The "personal injury" for which coverage is sought arises out ofanoffense committed; after you have signed that "written mmmtnoc\ requiring insurance". But this insurance provided to the additional insured still Is excess, over valid and collectible other insurance, whether primary, excess, contingent oronany other basis, that is available to the additional insured when that person or organization is on additional insured under any other insurance. CG D3 81@B15 V»2015The Travelers Indemnity Company. All f ights reserved, Page 1of2 Includes the copyrighted material v/Insurance Services offloo^/nc..with its permission 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 requi0ng 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, CG D3 81 09 15 Includes the copyrighted material of Insurance Services Offlce, Inc., with its permission CERTHOLDER COPY Sc P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 06-20-2019 CITY OF EL SEGUNDO SC 350 MAIN ST EL SEGUNDO CA 90245-3813 GROUP: POLICY NUMBER: 9100543-2019 CERTIFICATE ID: 19 CERTIFICATE EXPIRES: 05-24-2020 05-24-2019/05-24-2020 THIS CERTIFICATE SUPERSEDES AND CORRECTS CERTIFICATE # 18 DATED 05-24-2019 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer. We will also give you 10 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2019-05-24 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF EL SEGUNDO ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2019-06-20 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF EL SEGUNDO ENDORSEMENT #1651 - JASVINDER KAUR PRESIDENT - EXCLUDED. ENDORSEMENT #1651 - NAVDEEP KAUR SEC,TRES - EXCLUDED. EMPLOYER HAYER CONSULTANTS, INC. SC 4067 HARDWICK ST PMB 250 LAKEWOOD CA 90712 [JRC,CN] (REv.7-2014) PRINTED : OB -20-2019 STATE ENDORSEMENT AGREEMENT COMPENSATION WAIVER OF SUBROGATION 9100543-19 FUND RENEWAL SC HOME OFFICE SAN FRANCISCO PAGE 1 OF 1 ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC EFFECTIVE JUNE 20, 2019 AT 12.01 A.M. STANDARD TIME OR THE TIME INDICATED AT AND EXPIRING MAY 24, 2020 AT 12.01 A.M. PACIFIC STANDARD TIME HAYER CONSULTANTS, INC. 4067 HARDWICK ST PMB 250 LAKEWOOD, CA 90712 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, CITY OF EL SEGUNDO WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, HAYER CONSULTANTS, INC. IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER. IT IS FURTHER AGREED THAT PREMIUM ON THE-ZZARNINGS OF SUCH EMPLOYEES SHALL BE INCREASED BY 03%. NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: JUNE 24, 2019 2570 AY�TIiORtl QED REPRESENT IVE PRESIDENT AND CEO SCIF FORM 10217 (REV.4-2016) OLD DP 217