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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