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PROOF OF INSURANCE (2020) CLOSED0 DATE (MMIDD/YYYY) �- CERTIFICATE OF LIABILITY INSURANCE I 6/24/2019 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(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER g NAME: 'P Roxanne C,ampi'n0 19000 MacArthurr Blvd. PH Floor PHONE EPIC PaHarMartEae�^�? FA%..—."-" rAlo, Nle Er0. 4 t7 1 FAX dAro. Nol..................... 949-809-2375 Irvine, CA 92612 E-MACE AhD089ss�............. rogrrlptn ft edgewood'ins.com INSURERS) AFFORDING COVERAGE NAIC # www.edgewoodins.com INSURER A : Travelers Property Casualty Company of America 25674 ............................W_ ..�....._ �_..._........._.....n_..... _.._ INSURED INSURER 8: Travelers Casualty and Surety Cc America31194 JM Diaz Inc. DBA: Ji\%ID INSURER C: Travelers Indemnity Company of CT _ 25682 _. 18645 E. Gale Ave., Ste #212 INSURER D: Cit of Indust CA 91748 _._._ Y Industry INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 49473527 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 POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH DOLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE....................................................................................................LIMITS IIVSrt w(5iS4.�..............._...........m POL4CY EFF POLICY EXP _LTR IN,E VVD POLICY JM,MIDDIYYYYI IMM/DD/YYYY) A ✓" COMMERCIAL GENERAL LIABILITY ✓ 680002J330994 6/27/2019 6/27/2020 EACH OCCURRENCE $1,000,000 iiRE XP (Any o ccurre ce) _...._ CLAIMS-MADE ✓ OCCUR ,PREM„I,SES,{Eaoccurrenc,m ,,,_,,,,,,,,1,000.000 MED E erso $ 5,000 PERSONAL E, ADV INJURY $1,000.0 ” 0 0 GEN°L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 ............... POLICY PRO JECp✓ 1 LOC PRODUCTS - COMPIOP AGG $ 2,OOO.QOQ OTHER Deductible $ None C AUTOMOBILE LIABILITY BA4J373941 6/27/2019 6/27/2020 CO MBINED'1SINGLE LIMITAEa $1,000,000 ...�r ANY AUTO BODILY INJURY (Per person) $ - OWNED SCHEDULED BODILY INJURY (Per accident) $ ✓ AUTOS ONLY AUTOS .................... HIRED NON-WNED✓ PRTY AUTOS ONLY ✓ AUU OS ONLY IPr ssAac tlaoM MAGE $ $ UMBRELLALIAB CLAIMS-MADE EACH OCCURRENCE $ OCCUR EXCESS LIAR AGGREGATE $ DED I RETENTION $ $ A WORKERS COMPENSATION UB006K869402 6/27/2019 6/27/2020 kEL STR I OTH- OFICER/ UT AND OMBEREXCB'LIAILITYUD D7ECUTIVE ❑ NIA CE YIN ACCIDENT $1,000,000 (Mandatory In NH) E L DSEASE- EA EMPLOYEE $ 1.00Q,Qal_ If yes, describe under DESCRIPTION, OF OPERATIONS below E.L DISEASE -POLICY LIMIT $ 1,000,000 B Professional Liability 105263164 6/27/2019 6/27/2020 $2,000,000 per Claim Claims Made Form $2,000,000 Aggregate Knowledge Date: 4/8/2005 $10,000 Per Claim Deductible DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) RE: PW 19-05 On-Call Traffic Engineering Services The City of EI Segundo, its officials, and employees are included as Additional Insureds as respects General Liability per the attached endorsement. General Liability policy is primary and non-contribU'tcry per the attached endorsement. CERTIFICATE HOLDER CANCELLATION Clt of EV Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 35 Main St. ACCORDANCE WITH THE POLICY PROVISIONS. EI Segundo CA 90245 AUTHORIZED REPRESENTATIVE Todd Holliday ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 49473527 1 19-20 GL, AU, w/AI, WC, Umb, Prof. I Roxanne Camping 1 6/24/2019 1:29:12 PM (PDT) I Page 1 of 4 This certificate cancels and supersedes ALL previously issued certificates. JIVIoiaz Inc.' COMMERCIAL GENERAL LIABILITY 680002J330994 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (ARCHITECTS9 ENGINEERS AND SURVEYOR4 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1' The following is added to SECTION Q —WHO IS ANYNSURED: Any person or organization that you agree in a "written contract requiring insurance" bzinclude as anadditional insured onthis Coverage Part, but: a. Only with respect to liability for "bodily injury". "property damage" or"personal injuD"; 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 byurrented toyou. The person ororganization does not qualify asan additional insured: m' With respect to the independent ads or omissions ofsuch person ororganization; or d. For "bodily injury", "property damage" or "personal injury" for which such person or organization hos assumed liability in a contract oragreement. The insurance provided tosuch additional insured islimited asfollows: e. This insurance does not apply nnany basis to any person or organization for which coverage as anadditional 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 ofInsurance ofthe 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 Mnnited to the limits of liability required by that "written contract requiring insunsnoe". This endorsement does not increase the limits of insurance described in Section III — Limits OfInsurance. y. This insurance does not apply to "bodily injury" or "property damage" causediy 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 tnthe additional insured is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basiu, that is available to the additional insured for loss we cover. Hoxoever, if you specifically agree in the "written contract requiring insurance" that this insurance provided 10the additional insured under this, Coverage Pail must apply mn a primary basis or a primary d non-contributory bes\s, this insurance is primary to other insurance available to the additional insured which covers that person nrorganizations as a named insured for such |uss, and we will not share with the other insurance, provided that: (1) The "bodily injury" ur"property damage" for which coverage \ssought occurs; and (2) The "personal injury" for which coverage is sought arises out ofanoffense cnrnnoftted� after you have signed that "written contract requiring insurance". But this insurance provided tothe additional insured still is excess over valid and collectible other insuramce, whether primary, encess, contingent or on any other basio, that is available to the additional insured when that person or organization is an additional insured under any other insurance. CG D3 8109 15 C 2015 The Travelers Indemnity Company. All eights reserved. Includes the copyrighted material of Insurance Services Office, Inc., with its permission 4S4.173527 / /+«os� �' WAY,, WC, �b. Prof!.nv�pop 1.�.�zm, tax) I �p 2u:" Page 1of 2 COMMERCIAL GENERAL LIABILITY 3. The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: We waive any right of recovery we may have against any person or organization because of payments we make for "bodily injury" ""'property damage" or "personal injury" arising out of "''your work" performed by you, or on your behalf, done under a "written contract requiring insurance" with that person or organization. We waive this right only where you have agreed to do so as part of the "written contract requiring insurance" with such person or organization signed by you before, and in effect when, the "bodily injury" or "property damage"' occurs, or the "personal injury" offense is committed. 4. The following definition is added to the DEFINITIONS Section: "Written contract requiring insurance" means that part of any written contract under which you are required to include a person or organization as an additional insured on this Coverage Part, provided that the "bodily injury" and "property damage" occurs and the "personal injury" is caused by an offense committed: a. After you have signed that written contract; b. While that part of the written contract is in effect; and c. Before the end of the policy period. "611age 2 of Includes.ir . u material of Office,permission 014149 99973527 19-20 GL, AU, WAI, WC, Umb, Prof. I Roxanne Camping 1 6/29/2019 1:29:12 PM (PDT) I Page 3 of 9 This certificate cancels and supersedes ALL previously issued certificates. CG D3 81 09 15 JM Diaz, Inc. 680002J330994 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT - OTHER INSURANCE CONDITION - ENGINEERS, ARCHITECTS OR SURVEYORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS 1. The following replaces the part of the first paragraph of Paragraph 4., Other Insurance, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS that precedes Paragraph a.: If valid and collectible other insurance is available to the insured for a loss we cover under Coverages A or B of this Coverage Part, our obligations are limited as described in Paragraphs a. and b. below. As used anywhere in this Coverage Part, other insurance means insurance, or the funding of losses, that is provided by, through or on behalf of: Insurance shown in the Declarations of this Coverage Part. As used anywhere in this Coverage Part, other insurer means a provider of other insurance. As used in Paragraph c. below, insurer means a provider of insurance. 2. The first Subparagraph (2) of Paragraph 4.b., Excess Insurance, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS regarding any other primary insurance available to you is deleted. 3. The following is added to Paragraph 4.b., Excess Insurance, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: (i) Another insurance company; (ii) Us or any of our affiliated insurance companies; (iii) Any risk retention group; (iv) Any self-insurance method or program, including any failure to buy insurance, or 4. decision to not buy insurance, for any reason, in which case the insured will be deemed to be the provider of other insurance; or (v) Any similar risk transfer or risk management method. Other insurance does not include umbrella insurance, or excess insurance, that was bought specifically to apply in excess of the Limits of This insurance is excess over any of the other insurance, whether primary, excess, contingent or on any other basis, that is available to the insured when the insured is added as an additional insured under any other policy, including any umbrella or excess policy. The following is added to Paragraph 4.b. Excess Insurance, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance is excess over any of the other insurance, whether primary, excess, contingent or on any other basis, that is Professional Liability or similar coverage, to the extent the loss is not subject to the professional services exclusion of Coverage A or Coverage B. CG D7 97 01 16 © 2016 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission. 494735271 19-20 6L, " w/A.1, PIC, Umb, Prof. I Roxanne Camp Lnq ( 6(24/2019 ].:'1'7:12 PM (PDT) I Page 4 of 4 'Ph.is cer t.Lfi.cate cancels and sjupersPdes ALL pr -e `J'LOuSly L.ssued cF_L'CLCLCate.S. JM Diaz, Inc. BA4J373941 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM The following is added to Paragraph c. in A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE in the BUSINESS AUTO COVERAGE FORM and Paragraph e. in A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE in the MOTOR CARRIER COVERAGE FORM, whichever Coverage Form is part of your policy: This includes any person or organization who you are required under a written contract or agreement between you and that person or organization, that is signed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to name as an additional insured for Covered Autos Liability Coverage, but only for damages to which this insurance applies and only to the extent of that person's or organization's liability for the conduct of another "insured". CA T4 37 02 16 © 2016 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc, with its permission. 49473525 1 '19-2Q G'(., ACJ, w/Al, WC, timb, Prof.. I Roxanne Camphog 1 6/24/2019 1:24:12 PM (PDT) I Page 4 of 4 This certificate cancels and soPe.edes A.LI, previouai.y isued certificates. Page 1 of 1 T �%��.�SJ WORKERS COMopr=NsATION ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD, CT 06183 ENDORSEMENT WC 99,03 76 ( A) — 001 POLICY NUMBER: UB006K869402 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT -- CALIFORNIA (BLANKET WAIVER) We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. The additional premium for this endorsement shall be p/o of the California workers' compensation pre- mium, Schedule Person or Organization Job Description ANY PERSON OR ORGANIZATION FOR WHICH THE INSUK0 HAS AGREED BY WRITTEN CONTRAC'r EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective6/27/2019 Insured JM Diaz, Inc. DBA: JMD Insurance Company Policy No. UB006K869402 Countersigned by 300602 49473529 1 19-20 GL, AU, W/AI, WC, Umb, Prof. I Roxanne Camping 1 6/24/2019 1:29:12 PM (PDT) I Page 5 of 5 This certificate cancels and supersedes ALL previously issued certificates. Endorsement No. Premium Page 4 of 1