PROOF OF INSURANCE (2009) CLOSEDCORD., CERTIFICATE OF LIABILITY INSURANCE 01/27/ o09) '
PRODUCER (760)79S-2002 FAX (760)754-61S4
Hatter, Williams & Purdy Insurance, Inc.
2230 Faraday Ave
Carlsbad, CA 92008
CISR, Nickie Einertson
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NAIC #
INSURED Ace Electric, Inc.
P.O. Box 601071
San Diego, CA 92160
INSURER Landmark American Ins Co
33138
INSURER Peerless Insurance Company
24198
INSURER RSUI Indemnity Company
22314
INSURER D
GENERAL LIABILITY
INSURER E
03/25/2008
COVERAGES
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
POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
DD'
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE IMMID13NYi
POLICY EXPIRATION
DATE IMMIDDJXYI
LIMITS
GENERAL LIABILITY
LHA132891
03/25/2008
03/25/2009
EACH OCCURRENCE
$ 1,000,00
X I COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
$ SO, OO
CLAIMS MADE I OCCUR
MED EXP (Any one person)
$ Exclude
A
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER
PRODUCTS - COMP/OP AGG
$ 2,000,000
POLICY PRO LOC
JECT
AUTOMOBILE
LIABILITY
ANY AUTO
BA8133142
04/15/2008
04/15/2009
COMBINED SINGLE LIMIT
(Ea accident)
$
1,000,00
BODILY INJURY
(Per person)
$
B
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
X
X
BODILY INJURY
(Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
5
AUTO ONLY AGG
EXCESSIUMBRELLA LIABILITY
NHA221057
03/25/2008
03/25/2009
EACH OCCURRENCE
$ 2,000,00
_X1 OCCUR E] CLAIMS MADE
AGGREGATE
$ 2,000,000
C
$
$
DEDUCTIBLE
$
RETENTION $
WORXERS COMPENSATION AND
I WC STATU- 0.R Y "MIT,
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
E L EACH ACCIDENT
$
E L. DISEASE - EA EMPLOYEE
$
OFFICERIMEMBER EXCLUDED)
K yes describe under
SPECIAL PROVISIONS below
E L DISEASE - POLICY LIMIT
$
OTHER
E
F
DESCRIPTION OF QPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
he City of E1 Segundo, its officers, officials, employees, agents and volunteers arenamed Additional
nsured as respects: liability arising out of activities performed by or on behalf of the Contractor as
er attached endorsements
e: Recreation Park Baseball Field Lighting and Scoreboard Replacement
Except 10 days notice for nonpayment of premium
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL 10=0 o MAIL
City of El Segundo ='30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Dana Greenwood, Public Works Dir. l(i()rAl�fd�i6lfIXIXX XXa(lfi(IXck161(iXUK1(0(►1(i(XX
Attn: Dan Garcia, Assist. City Eng.
3SO Main Street dfK**XcX1W(Aii(i %)0(NA ()iXXil(KtkK1K XXXXXXXX
El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE �%�
Nickie Einertson. CISR Q%t AS LAA0/�il/K1Y
ACORD 25 (2001/08) I CACORD CORPORATION 1988
3896•,.;
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 (2001108)
38 c� G
Forming a Part of
Policy Number: BA8133142
Coverage Is Provided In Peerless Ins Co
Named Insured:
Agent:
Ace Electric, Inc.
Hatter, Williams & Purdy Ins., Inc.
P.O. Box 601071
2230 Faraday Avenue
San Diego, CA 92160
Carlsbad, CA 92008
Agent Code: 4292779 Agent Phone: (760)795 -2002
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
GARAGE COVERAGE FORM
TRUCKERS COVERAGE FORM
The person or organization shown in the Schedule is an insured to the extent of their liability for the conduct of an insured under
Section II- Liability Coverage of this policy.
SCHEDULE
City of El Segundo, its officers, officials, employees, agents and volunteers are
named Additional Insured as respects: Liability arising out of activities
performed by or on behalf of the Contractor as per attached endorsements
350 Main Street
El Segundo, CA 90245
GECA 812 (10/96)
Landmark American InSJ 9 6
This Endorsement Changes This Policy. Please Read It Carefully.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST
OTHERS TO US
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE FORM
SCHEDULE
Name of the Person or Organization:
Any Person or Organization As Required By Written Contract or
City of El Segundo, its officers, officials, employees, agents and volunteers are named Additional
Insured as respects: Liability arising out of activities performed by or on behalf
of the Contractor as per attached endorsements
350 Main Street
El Segundo, CA 90245
The following is added to Section IV — Conditions, 8. TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHER TO US:
We waive any right of recovery we may have against the person or organization shown in the SCHEDULE
above because of payment we make for injury or damage arising out of "your product' or "your work" done
under a written contract with that person or organization and included in the "product- completed
operations hazard ". This waiver applies only to the person or organization shown in the SCHEDULE
above.
This endorsement effective: 03/25/2008
forms part of Policy Number: LHA132881
Issued to Ace Electric, Inc.
by Landmark American Ins Co
Endorsement No.:
RSG 14048 0903 Includes copyrighted material of Insurance Services Office, Inc. 1992
with is permission.
Landmark ArigAns Cp
This Endorsement Changes The Policy. Please Read It Carefully.
ADDITIONAL INSURED
BLANKET - PRIMARY
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
SCHEDULE
Name of Person or Organization:
Any person or organization to whom or to which you are obligated by virtue of a written contract or by the
issuance or existence of a written permit, to provide insurance such as is afforded by this policy or
City of El Segundo, its officers, officials, employees, agents and volunteers are named
Additional Insured as respects: liability arising out of activities performed by or on behalf
of the Contractor as per attached endorsements
350 Main Street
El Segundo, CA 90245
Re: Recreation Park Baseball Field Lighting and Scoreboard Replacement
(If no entry appears above, information required to complete this endorsement will be shown in the
Declarations as applicable to this endorsement.)
SECTION II - WHO IS AN INSURED is amended to include as an insured the person or organization shown in
the SCHEDULE, but only with respect to liability arising out of "your work" for that insured by or for you.
If you are required by a written contract to provide primary insurance, this policy shall be primary as respects
your negligence and SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, 4. Other Insurance does
not apply, but only with respect to coverage provided by this policy.
This endorsement effective: 03/25/2008
forms part of Policy Number: LHA132881
issued to: Ace Electric, Inc.
by Landmark American Ins Co
Endorsement No: 01
RSG 15001 0306 Includes copyrighted material of Insurance Services Office, Inc. 1984
(CG 2010 1 185) with its permission
3896 .
POLICYHOLDER COPY
SD
STATE P.O. BOX 420807, SAN FRANCISCO,GA 94142 -0807
COMPENSATION
INSURANCE
FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 01 -27 -2009 GROUP: 000238
POLICY NUMBER: 0008452 -2008
CERTIFICATE ID: 187
CERTIFICATE EXPIRES: 01 -01 -2010
01 -01- 2009/01 -01 -2010
CITY OF EL SEGUNDO SD JOB:RECREATION CENTER
PUBLIC WORKS
350 MAIN ST
EL SEGUNDO CA 90245-3813
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 30 days advance written notice to the employer.
We will also give you 30 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.
THORIZED REPRESENTATI PRESIDENT
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE.
ENDORSEMENT #1800 - HINDS, JEFFREY PR SEC TR - EXCLUDED.
ENDORSEMENT #1800 - ENSMINGER, DAVID J. VP - EXCLUDED.
ENDORSEMENT #2086 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 01- 01-2009 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY.
ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2009 -01 -27 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME:
CITY OF EL SEGUNDO
EMPLOYER
ACE ELECTRIC INC SD
PO BOX 801071
SAN DIEGO CA 92180
IB10,SD]
IREV.2-06I PRINTED : 01 -27 -2009