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PROOF OF INSURANCE (2019 - 2020) CLOSED-.... �... DATE (M MIDm YY)A CERTIFICATE OF LIABILITY INSURANCE 11/14/2018 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(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 g dorsement(s). PRODUCER certificate does not confer rights to the certificate holder in lieu of such CONTACT oDUCER NAME: Cora Lim .._1111.... SelectSolutions Insurance Services PHONE (866) 500-6359 rA (925;) '9151.0077 WC No Ertl, (AIC, Nko): -E•MAdt. .�......, 1107 Investment Blvd ADDRESS' coral@selectsolutionsins com Suite 100 INSURER(S) AFFORDING COVERAGE NAIC # EI Dorado Hills CA 95762 l INSURERA : Travelers Property Casualty Company ofAmerica 25674 INSURED 9$ INSURER B: Continental Casualty Company 20443 ................................................... Denn Engineers INSURER C: 3914 Del Amo Boulevard INSURER D; Suite 921 INSURER E; Torrance CA 90503 INSURER F COVERAGES CERTIFICATE NUMBER: REVISION N CY POLER THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT NTH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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, YNSR AUUL SUbrr POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSO f M POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s 1,000,000 CLAIMS -MADE ❑OCCUR S V'�, 7URINT0 MRIS.EiE3 occsrrenr. 1 000 000 5 � ' I.. 10,000 MED EXP (Anv one person) �, 5 A _ Y 6801HB819461847 09/01/2018 09/01/2019 PERSONAL&ADV INJURY is 1,000,000 CvEN'LAGGREGATEGENERALAGGREGATE ' LIMIT APPLIES PER ffi 2,000,000 POLICY PEC'TO LOC ,..-,�. JE PRODUCTS - COMPIOPAGG 15 2,000,000 S OTHER' CO'MBINFO "GLI LIMIT $ AUTOMOBILE LIABILITY dEa'a�,C+de r1p'V ANYAUTO BODILYINJURY(Per person) 5 OWNED SCHEDULED BODILY INJURY (Per accident) 5 �. AUTOS ONLY AUTOS HIRED NON -OWNED PROP'ERT'v''DAMACE 5 AUTOS ONLY AUTOS ONLY dP`wr aacoderrlt' s _...... _............... _. UMBRELLA LAB OCCUR EXCESS LIAB HCLAIMS-MADE I EACH OCCURRENCE AGGREGATE $ ..... S ,. DED I RETENTION5 s .............. WORKERS COMPENSATION pp W STArUTE I NORTH MM AND EMPLOYERS' LIABILITY YIN ,ANY PRO'PRIE,TORIT°AR'INER*XECUTIVE pELEACH ACCIDENT 1111... 5 - 'OEFtlCERIMEMBER EXCLUDED? NIA tMandatory in NH) If describe under '', V E L DISEASE - EA EMPLOYEE $ yes, DESCRIPTION OF OPERATIONS below _ E L DISEASE -POLICY LIMIT 5 PROFESSIONAL LIABILITY g AEH113984368 11/07/2018 11/07/2019 II PER CLAIM $1,000,000 AGGREGATE $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: As Per Contract or Agreement on File with the Insured City of EI Segundo Public Works Department, its officers elected and appointed officials employees and volunteers are included as additional insured on General Liability policy per the attached endorsement. CERTIFICATE HOLDER City of EI Segundo Public Works Department Attn: Floriza Rivera 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 350 Main St, 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: 680-1 H881946-18-47 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 insurance 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 under 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 09 15 0 2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 2 Includes the copyrighted material of Insurance Services Office, Inc., 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 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 ® 2015 The Travelers Indemnity Company. All rights reserved. CG D3 8109 15 Includes the copyrighted material of Insurance Services Office, Inc., with its permission ° `IFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) CERT 07/23/2019 THIS CERTIFICATE IS ISSUED ASA 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 certlficate holder Is an ADDITIONAL INSURED, the pollcy(les) must have ADDITIONAL INSURED prWslons or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certaln policlesmay require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endarsement(s). PRODUCER CONTACT NAME: Michael P. Delaney Michael Delaney(2958C5T) 2340 Plaza Del Amo Ste 200 Torrance CA 90501-3453 INSURED DENN ENGINEER INC 3914 DEL AMO BLVD STE 921 TORRANCE COVERAGES CA 90503 PHONE FAX (A/C, NO, ExT): 310-782-8586 (A/c, No) 310-787 0039 E-MAIL ADDRESS: mdelaney@farmersagent.com INSURER(S) AFFORDING COVERAGE NAIC4 FNSURERA: .......... Truck Insurance Exchange 21709 INSURERB: Farmers Insurance Exchange 21652 INSURERC: Mid Century Insurance Company ................... 21687 INSURER D: _-- ... ............. _....... INSURER E: ,INSURER F: ............................... CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFYTHATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEABOVE FORTHE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANYCONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAYPERTAIN, THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHETERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _._._. , ....----- INSR TYPEOFINSURANCE ADDTL SUBR POLICYNUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DD/YYYY) (MM/DD/YYYY) .... ...._ .............................................__....... . ........................ EACH OCCURRENCE COMMERCIAL GENERAL LIABILITY �$ CLAIMS-MADE[I OCCUR PREMISES (EDAMAGE (Ea $ a Occurrence) GENT AGGREGATE LIMIT APPLIES PER: POLICY ❑ PROJECT ❑ LOC OTHER: AUTOMOBILE LIABILITY ANY AUTO . .......... ., OWNEDAUTOS v SCHEDULED C ONLY ^ AUTOS Y X HIREDAUTOS X NON -OWNED ONLY AUTOSONLY UMBRELLA LIAR OCCUR EXCESS LIAB CLAIMS -MADE DED RETENTION $ WORKERS COMPENSATION AN................................... . ...... D EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/ YIN EXECUTIVE OFFICER/MEMBERN/A EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below MED EXP (Any one person) $ PERSONAL& ADV INJURY $ GENERAL AGGREGATE ;$ PRODUCTS - COMP/OP AG�$ $ COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) BODILY INJURY (Per person) Is BODILY INJURY (Per accident) $ Y 606665017 09/13/2018 09/13/2019 PROPERTY DAMAGE $ L (Per accldent) ......................... $ FEACH OCCURRENCE $ ._.. ...- w .-_. .......... 1... ... AGGREGATE $ $ PER I OTHER $ STATUTE E.L. EACH ACCIDENT _ $ �E.L.DISEASE -EA EMPLOYEE Y1� E.L.DISEASE- POLICYLIMIT $ .............................. ...,... DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) The City of EI Segundo, Its officers, elected and appointed offals, employees and volunteers named as Addillonal Insured with respect to liability arising out of automobiles owned, leased, hired or borrowed by or on behalf of the consultant Denn Engineers, Inc. See allached Additional Insured Endorsement CA20480299 CERTIFICATE HOLDER CANCELLATION City of f Segund'D Plubic VG+OrkS ar1ment SHOULD ANY 0 350 Main Street DATE THE EI Segundo, CA 90245 AUTH'15 IZEDR� ACORD 25 (2016/03) 31-1769 11-15 The ACORD name and logo are reglstere�t ................ ESB ANCE�L}LEDBEFORETHEEXPIRATION 1C ANCtIWITHTHEPOLICYPROVISIONS. 4c)1988-2015 ACORD CORPORATION. All Rights Reserved of ACORD POLICY NUMBER: 60666-50-17 Policy Period 9113/18 to 9/13/19 CO►9 ►►iERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement, This endorsement Identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provi- sion of the Coverage Form. This endorsement does not alter coverage provided in the coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date Is indi- cated below. Encdd �r2rt Effective: Countersigned By: Named Insured: DENN ENGINEER INC (Authorized Representative), SCHEDULE Name of Person(s) or Organization(s): City of EI Segundo Publlic-Works Department, 350 Main Street, EI Segundo, CA 90245 (If no entry appears above, Information required to complete this endorsement will be shown In the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule Is an "Insured" for Liability Coverage, but only to the extent that person or organization qualifles as an "insured" under the Who Is An Insured Provision contained In Section II of the Coverage Form. CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 DATE IMMIDDIYYYYI � CER�'I'�FICATE OF LIABILITY INSURANCE 07!2312019 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 ce'rtiflcate 60ider is an DD1116 +�'AL INSURED, the poli i(lesj must hiVo AbbitioNA L INSURE provisions r and A D p o ersad. 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 t(s), „dlhl to the certificate holder in lieu of such endorse'men „„„ PRODUCERNATd Blanca De La Hoz pp�,p( . ,. Dammer Insurance Services Inc. O1094515 Nw License # OD36873 DDS(951) 509-0509 (951) 5 1' 9899 Indiana Avenue, Ste 1 D1 INSURER(S) AFFORDING COVERAGE NAIC 9 Riverside CA 92503 INSURER Preferred Employers Insurance Company II 10900 INSURED INSURERS: p�p Dann Engineers, Inc. INSURER P c: 3914 Dal Amo Bl., Ste 921 INSURER D ., INSTorrance CA 90503 ( INSURER F FICATE 0 THISi OECERTIFY THAT THE POLICIES OF IIN URANCE LISTED BELOW CL1972307 UMBER: IS ELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. iLTRR TYPE OF INSURANCE„ „ TSO iWV[1 POLICY NUMBER „P mmor�MMUDMIJCP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS -MADE D OCCUR �' MSE' (FA Nt4:Lr 1 S MED EXP (Anr one Pelson) $ _ PERSONAL&ADVINJURY S LAGGASGATE,UMITAPPUESPER: .............. II'GENERAL AGGREGATE $ POLICY[DjE LOC PRODUCTS -COMPIOPAGG $ GNR $ AUTOMOBILE LUBILITY rMBWE�1WGLE LIMIT S ANYAUrO BODILY INJURY (Par penon) S AUTOS BODILY INJURY (Per axrdent S OWNED lT�OS ONLY I HIRED NON -OWNED PROPERTY DAMAGE S AUTOS ONLY ALTOS ONLY (Per aoddemlI ... S UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS -MADE AGGREGATE $ DEO I RETENTION S S W ERSCOMPENSATION YIN - PER J �,T- INO � � ”' AN'D EMPLOYERS' UAB((.(TY ' 1,000.000 ANY A ���EMBEREXCLUDED7 In NH) ) NIA WKN1853622 02!0112019 02!01/2020 E.LDISEASE -FJIEMPLOYEE S 1,000,000 yyeeaa OR/PARTNERIEJ(ECUTIVE L.. oMRIPTCONOFOPERATIONSw. I E.L.DISEASE-POLICY, IT S 1,ODO,00O If d� under I LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I EHICLES (AGGRO 1011,Additional Remarks Schedule, maybe aMaehad If mora epaca la required) Waiver of subrDgadon applies in favor of the certificate holder In respects to the Workers Compensation policy per PEI 104 endorsement attached. ' CERTIFICATE HOLIDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of EI Segundo Public Works Department Alin: Floriza Rivera ACCORDANCE WITH THE POLICY PROVISIONS. I _ 350 Mein St aumoD REPRESENTATIVE EI Segundo CA 90245 I'O ( ®1988-2015 ACORD CORPORATION. All rig hts reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Workers Compensation and Employers Liability Pr&rred EMployys Insurance Policy I N 3 U R A N C B CdMPANY Waiver of Our Right to Recover from Others Endorsement — California 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. (This agreement applies only to the extent that you perform work under a written contract that 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 in the Schedule. The additional premium for this endorsement shall be determined by multiplying the California workers' compensation premium due on such remuneration by the factor 0.050 Schedule Person or Orrlanization City of EI Segundo Public Works Department 360 Main Street EI Segundo, CA 90246 Job Deacriatlon RE: Engineering work This endorsement is subject to a minimum premium charge of $ 200 Nothing In this endorsement shall vary, alter, waive or extend any of the terms, conditions or limitations of this policy other than as slated above. Nothing elsewhere In this policy shall be held to vary, alter, waive or limit the terms, conditions, agreements or limitations of this endorsement. This Endorsement when attached to Policy Number. WKN 165382-2 Issued to DENN ENGINEERS. INC. shall be valid and shall form part of referenced policy. The effective date of this endorsement Is 02101/19 at 12:01 A.M. Endorsement No.: 19 Producer Number. 12886 Agency Name: DANMAR INSURANCE SERVICES PE1104 05/01/98 Date Issued: 01/09/19 Refer To Signature Page Authorized Representative