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PROOF OF INSURANCE (2010) CLOSED407 ACORD��# L,Ik81LTY DATE IMM /DD /YYI :1N(11i 07/09/10 PRODUCER FEDERATED MUTUAL INSURANCE COMPANY Home Office: P.O. BOX 328 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, Owatonna, MN 55060 One: 1- 888 -333 -4949 COMPANIES AFFORDING COVERAGE COMPANY FEDERATED MUTUAL INSURANCE COMPANY OR A FEDERATED SERVICE INSURANCE COMPANY INSURED RUSSELL WARNER INC 311 -322 -2 ROTO ROOTER PLUMBERS COMPANY B - -.- ADVANCED SEWER TECHNOLOGIES 24971 AVENUE STANFORD COMPANY C VALENCIA CA 91355 -1278 COMPANY D 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 POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR DATE IMMJDONY) DATE IMM /DD /YYI LIMITS A GENEAAL UABILIT Y COMMERCIAL GENERAL LIABILITY . j CLAIMS MADE u OCCUR 9339794 09/01/09 09/01/10 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG S 2,000,000 ,. PERSONAL & ADV INJURY S 1 090.090 OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE. S 1 000.000 FIRE DAMAGE (Any one fire) $ 1000W S MED EXP (Any one perwn) AUTOMOBILE LIABILITY X ANY AUTO COMBINED SINGLE LIM1T $ 1,000,000 ALL OWNED AUTOS - - -�- A SCHEDULED AUTOS 9339794 09/01/09 09/01/10 BODILY INJURY (Per personl $ X HIRED AUTOS X NON -OWNED AUTOS BODILY INJURY (Per xcident) S PROPERTY DAMAGE S GARAGE LIABILITY AUTO ONLY -_EA ACCIDENT S ANY AUTO OTHER THAN AUTO ONLY; EACH ACCIDENT 8 - - -- AGGREGATE $ EXCESS X UABILTY UMBRELLA FORM 9339795 09/01/09 09/01/10 EACH OCCURRENCE S 5,000 000 AGGREGATE _ _ 9 5�000,WO OTHER THAN UMBRELLA FORM S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WC STATU- 0TH - EL EACH ACCIDENT .._... S _ _. S THE PROPRIETOR) PARTNERStEXECUTIVE INCL OFFICERS ARE: EXCL _.._. -..._- EL DISEASE - POLICY LIMIT EL DISEASE - EA EMPLOYEE S OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESISPECIAL ITEMS SEE ATTACHED PAGE >CT�FSi14ELD &t... 3113222 ', ,....�:......: :. ..:.....:.. .. .. ....... PUBLIC WORKS DEPARTMENT 1538 CITY OF EL SEGUNDO 350 MAIN ST EL SEGUNDO CA 90245 :. ,. �SNL"Ft l,AiTIQi SHOULD ANY OF THE ABOVE. DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL -J-Q_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE PRESIAEr{7 . 4U CERTIFICATE OF INSURANCE INSURED 311 -322 -2 RUSSELL WARNER INC ROTO ROOTER PLUMBERS ADVANCED SEWER TECHNOLOGIES 24971 AVENUE STANFORD DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES /SPECIAL ITEMS CERTIFICATEHOLDER IS AN ADDITIONAL INSURED FOR GENERAL LIABILITY. THE CITY OF EL SEGUNDO, ITS OFFICERS, EMPLOYEES AND VOLUNTEERS ARE INCLUDED AS ADDITIONAL INSURED WITH REGARD TO LIABILITY AND DEFENSE OF SUITS ARISING FROM 'YOUR WORK' PERFORMED BY OR ON BEHALF OF THE NAMED INSURED FOR LIABILITY ATTRIBUTABLE TO THE NAMED INSURED OR A COMBINATION OF THE NAMED AND THE ADDITIONAL INSURED. 10 DAY NOTICE OF CANCELLATION FOR NON - PAYMENT OF PREMIUM BY REGISTERED OR CERTIFIED MAIL. PROJECT: CLEANING AND CLOSED CIRCUIT TELEVISION INSPECTION OF SEWER LINES CERTIFICATE HOLDER PUBLIC WORKS DEPARTMENT 1538 CITY OF EL SEGUNDO 350 MAIN ST EL SEGUNDO CA 90245 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: PUBLIC WORKS DEPT CITY OF EL SEGUNDO 350 MAIN ST EL SEGUNDO CA 90245 4077.,. - (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) 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. Job or Project: RE: CLEANING AND CLOSED CIRCUIT TELEVISION INSPECTION OF SEWER LINES. ADDITIONAL INSURED INCLUDES CITY OF EL SEGUNDO ITS OFFICERS OFFICIALS EMPLOYEES AND VOLUNTEERS Insured: RUSSELL WARNER INC 24971 AVENUE STANFORD VALENCIA CA 91355 Copyright, Insurance Services Office, Inc., 1992 CG -F -64 (05 -97) Policy Number: 9339794 Transaction Effective Date: 07 -16 -2010 (CG 2010 11 -85) 4077 . AGORDM CERTIFICATE OF LIABILITY INSURANCE DATEIMMIDDIYYYY) 07/15/2a10 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 CERTIF=ICATE HOLDER. IMPORTANT: H the certificate holder is an ADDITIONAL. INSURED, the polley(ie9) must 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 endorsements), PRODUCER GQNITACT NAME: Colonial western Insurance Agency HEkr- OS.388.7130 ; Nd :805.388.7138 License Number OES0896 EA-MAI 751 Daily Drive, Suite 230 cs,sRESSRiDr: _ Camarillo, CA 93010 INSURERIG) AFFORDING COVEWE _ NMCx INSURED INSURER A: SeaBright Insurance Co Russell Warner Inc. _INSURER B: _ USA: Roto- Rooter Plumbers INSURER 0: ORA: Advanced Sewer Technologies INSURER D: _ 24971 Avenue Stanford INSURERS: Valencia, CA 91355 IYOGQ. L,Ir. 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 POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR I TYPE OF INSURANCE AD —DL UBR ` POLICY POUCY*PXP LTR INSR WVD POLICY NUMBER MID M IYYYY LIMITS THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN GENERAL LIABILITY ACCORDANCE WITH THE POLICY PROVISIONS. City of El Segundo AUTHORIZED REPRESENTATIVE Public Works Depart n 3S0 Main Street E1 Segundo, CA 9024S EACH OCCURRENCE S COIM %RCIAL GENERAL LIAB ILITY S CLAIMS MApE OCCUR PREMI0 e owwwrm MED EXP (Any ena person) S PERSONAL BADVINJURY _. S GENERAL AGGREGATC $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGO S POLICY JOT LOC s AUTOMOSILE LIABILITY COMPINED SINGLE LIMIT ANY AUTO (re etcident) 3 EOOILY INJURY (Per person) S ALL OWNED AUTO$ BODILY INJURY (Per edndenl) S SCHEDULED AUT08 PROPERTY DAMAGE _ HIRED AUTOS (Peracddent) S NON -OWNED AUTOS s ' UMUCLIAI.IAe OCCUR EACH OCCURRENCE $ AGGREGATE EXCESS LIAR CLAIMS-MADE S DEDUCTIBLE" RETENTION S S im— WERS COMPIlNSATION AND EIIPLOYERW LIABILITY YIN BBII0337 07/01/2010 OT10112011 X WC STATU- 1 10 _, TORY IMI A ANY FICEO RRmEmSEMEXCLUDED? ECUTNE NIA E.L. EACH ACCIDENT S 1 s 000 r QQ E.L. DISEASE . EA EMPLOYEES 1 000, 00 (ManOatory M NH) II es udder E,L. DISEASE - POLICY LIMIT S 1 000 00 DtYIPTI SCRIPTI ON OF OPERATIONS Oe1ow D TION CPRRATION 1 I- OCATIO I vr;gICLES (Alleeh ACORD 101 Addidonal Remarks heduU it more speea It requlred) a ay tice of Cancellation except 10 [lays Notice Tor Non Payment Premium by of registered or ertifled mail. E: Project No.: PWOS -10 vcn , rrrvn r c nvwcn fLA NCG. , ATi"w W I000 -AVUU AWRY %4%JRrW13M I%JN. All rlarnin rgeervep. ACORD 26 (2009109) The ACORD name and logo ar eglstered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of El Segundo AUTHORIZED REPRESENTATIVE Public Works Depart n 3S0 Main Street E1 Segundo, CA 9024S W I000 -AVUU AWRY %4%JRrW13M I%JN. All rlarnin rgeervep. ACORD 26 (2009109) The ACORD name and logo ar eglstered marks of ACORD Dear Policyholder, 121 Bast Park .Square P.O. Box 328 - Owatonna, MN 55060 Phone: (888).333-4949 - Fax., (507) 446 -4664 40 77 . r • . Thank you for choosing Federated Insurance to handle your insurance and risk management needs. The attached certificate(s) of insurance has been issued or updated per your request. Please feel free to contact us with any additional changes, additions or deletions that may be needed by calling the Federated Client Contact Center at 1- 888 - 333 -4949. Thank you again for your business! Enclosed. Certificate(s) of Insurance 1V, i r)o�+��rE. jrrl,r`„ dlixt4rr'�trtr= r,�r,r MISC -0829 (01 -09)