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PROOF OF INSURANCE (2010) CLOSED1 ACD - CERTIFICATE OF LIABILITY INSURANCE 9/2 09"r' PRODUCER CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Business &Health Insurance Services, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1206 E Yorba Linda Blvd ALTER THE COVERAGE CAFFORDED BY THE OLICIES BNELOK Placentia, CA 92870 INSURERS AFFORDING COVERAGE memo wsurm+A: Nationwide Insurance 2.3787 A-1 :Fence Company 2831 E. La Cresta Ave Anaheim, CA 92806 D: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTOTHE 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 SUWECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AISGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. PoUCYTANER 17Cr ro [%P U, TY OF MURANCE NU PE fiIDNLD AMYOF7NEAlOYE DESCRIdEO PDUCN NE CAl1al11iD pE1011E111i EN►iU17NIN aE1N?w L"Lnv COMMERCIAL GENERALLWBILITY : D DA7E7NER�F .7NEN6IiNOwaNERSNNrsr'NOwaNto>r - DAR" ' c/o City Hall NDRCEToym TEIRILOERNA�M070moLET. EACH OCCURRENCE i FfiEDAM1IGE anatka f I»�) si RD CORPOiIATION 1988 PERSONAL A 9w PERSONAL 6 ADV INJURY i I CLAM MADE OCCUR GENERALAGGiE-GATE is PRODUCTS • COWJOP AGO i /AML AGGREGATE LM11f APPLIES PER: 7 . POLICY PRD• U7C ADfOMWILE LIABMITY X MY AM 1 CCIAMINED SINGLE WIT �a.aciMali i 1,000,000 A ALL OWNED AUTOS X SCIIEDULEDAVMS ACP 2512860196 8/29109 08129/10 BODILY IMAM is r X MIRED AUTOS BODILY'"My i {Par acddwRl f X NON.OWNED AUrO5 PROPERTY-DAMAGE IPar aedderd) _ I AUTO ONLY • EA ACCIDENT Is OTHERTHAN EA ACC- AUTOONLY: AGO S GARAGE I,Amny ANVAVM i Elio) LIABBITY X OCCUR F-1 OLAIMS MADE EACH OCCURRENCE f AGGREGATE i f f DEDUCT1BUi I TTETER" s S1 100MA s VWMfR COMWBATM AN EMPLOYIW UANIUTY EL EACH ACCIDENT i EA-DIWASE- FJIEMPLOYE E.L. DISEASE • POLICY UW I S fl &" r IMMOFommnomLI=AUMVMCLMUCUMOMAMMBYFMDMM END6PEM PROVOM 10 Day Notice for non - payment of .Premium. City of El Segundo, Its officer, officials, employees, agents and volunteers are hereby named as additional insured. CERTIFICATE HOLDER I fiIDNLD AMYOF7NEAlOYE DESCRIdEO PDUCN NE CAl1al11iD pE1011E111i EN►iU17NIN City of Ell Segundo DA7E7NER�F .7NEN6IiNOwaNERSNNrsr'NOwaNto>r - DAR" ' c/o City Hall NDRCEToym TEIRILOERNA�M070moLET. 350 Main Street El Segundo, CA 90245 si RD CORPOiIATION 1988 ACOAD 25-S (7197) IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statment on this certificate does not confer rights to the certifcate holder in lieu of such endorsement(s). H SUBROGATION IS WAIVED, subject to the terms and conditions of the policy. certain policies may require an endorsement. A statement on Oft certificate does not confer rights to the certifrcate holder In lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the Issuing tnsurer(s), authorized representative or producer, and the certificate holder, nor does it effinnalhrely or negatively amend. extend or alter the coverage afforded by the policies listed thereon. Client #: 1255108 ACORD. CERTIFICATE OF 305A1 ENT DATE (MMIDDIYYYY) LIABILITY INSURANCE 512212009 NAMED ABOVE WITH RESPECT IS SUBJECT TO POLICY EFFECTIVE DATE MMIDDIYY THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1313&T Insurance Services of CA, Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 680 Langsdorf Drive Suite 100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Fullerton, CA 92831 INSURERS AFFORDING COVERAGE NAIC # A INSURERA: James River Ins Co(Lemac) 12203 INSURED 000202722 12/01/08 INSURER B: 2831 E. La Cresta Ave. INSURER C: Anaheim, CA 92806 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW ANY REQUIREMENT, TERM OR CONDITION OF MAY PERTAIN, THE INSURANCE AFFORDED POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN ISSUED TO THE INSURED ANY CONTRACT OR OTHER DOCUMENT BY THE POLICIES DESCRIBED HEREIN HAVE BEEN REDUCED BY PAID CLAIMS. POLICY NUMBER NAMED ABOVE WITH RESPECT IS SUBJECT TO POLICY EFFECTIVE DATE MMIDDIYY FOR THE POLICY TO WHICH THIS ALL THE TERMS, EXCLUSIONS POLICY EXPIRATION DATE MMIDDIYY PERIOD INDICATED. NOTWITHSTANDING CERTIFICATE MAY BE ISSUED AND CONDITIONS LIMITS OR OF SUCH LTR NSR TYPE OF INSURANCE 12101/09 EACH OCCURRENCE $11,000,000 A GENERAL LIABILITY 000202722 12/01/08 DAMAGE TO RENTED PREMI,9ES (Ea occurrence) $5O OOO X COMMERCIAL GENERAL LIABILITY CLAIMS MADE 5-1 OCCUR X BI /PD Ded:5,000 MED EXP (Any one person) $Excluded PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2.000=0=0.0— PRODUCTS - COMP /OP AGG $2 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: - LOC POLICY X JECPROT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (Per accident) $ NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ AUTO ONLY - EA ACCIDENT $ GARAGE LIABILITY ANY AUTO OTHER THAN EA ACC AUTO ONLY: AGG $ $ EACH OCCURRENCE $ EXCESSIUMBRELLA LIABILITY OCCUR 0 CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ WC STATU- OTH- 0$— WORKERS COMPENSATION AND EMPLOYERS' LIABILITY E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYE ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under E.L. DISEASE - POLICY LIMIT SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS Re: Recreation Park; Grand & Eucalyptus, El Segundo, CA City of El Segundo, its officers, officials, employees, 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, as required by written contract per endorsements attached. .•A.lf%Cl I ATinu in navt; for Non - Pavment City of El Segundo City Hall 350 Main St. El Segundo, CA 90245 ACORD 25 (2001108) 1 of 2 #S3609689/M3113871 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL Jt Mjt2RMAIL 3_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, jKR AWt16>EJMXA76A71=1dX REPRESENTATIVE GAGAB © ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25-S (2001108) 2 Of 2 #53609669lm;5111501 -1 POLICY NUMBER: 000202722 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -- OWNERS, LESSEES $R CONTRACTORS -- COMPLETED OPERATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Section If — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property dam- age" caused, in whole or in part, by "your work" at the location designated and described in the sched- ule of this endorsement performed for that additional insured and Included in the "products- completed operations hazard ". CG 20 37 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 ❑ POLICY NUMBER: 000202721 COMMERCIAL GENERAL LIABILITY CG 2010 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -- OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Blanket as required by written contract Of Information reouired to complete this Schedule, if not shown above, will be shown in the Declarations. I A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) desig- nated above. B. With respect to the insurance afforded to these additional Insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the Injury or damage arises has been put to Its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 0 Policy No. 000202722 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON CONTRIBUTORY ENDORSEMENT This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS Any coverage provided to an Additional Insured scheduled in endorsement CG 2010 or endorsement CG 2037 (when either is attached to this policy) shall be excess over any other valid and collectible Insurance available to such Additional Insured whether primary, excess, contingent or on any other basis unless: 1) a written contract or written agreement specifically requires that this insurance apply on a primary and noncontributory basis; or 2) prior to a loss, you request in writing and we agree that this insurance shall apply on a primary and non - contributory basis. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. AP5031 US 05 -07 Page 1 of 1 May 22, 2009 City of El Segundo City Hall 350 Main St. El Segundo, CA 90245 Re: A -1 Fence Company To Whom It May Concern: BUT Insurance Services of California, Inc. 680 Langsdorf Drive, Suite 100 P.O. Box 34009 Fullerton, CA 92834 -9409 (714) 578 -7000 (877) 297 -1101 CA License #0619252 Please be advised that our insured, A -1 Fence Company, workers' compensation carrier issued through Pennsylvania Manufacturers Association Ins. Co. will not allow any modification to the cancellation clause. Please accept our certificate issued 05/22/09 on behalf of A -1 Fence Company. Should you have any questions or need anything further please contact me. Sincerely, �v Gloria Gabriel Account Representative 714 -578 -7266 Direct Line 877- 297 -1116 Toll Free Fax ggabriel @bbandt.com