PROOF OF INSURANCE (2009) CLOSEDCSR GF DATE (MM /OD
ACORD IYYYY) CERTIFICATE OF LIABILITY INSURANCE ALLCI-1 01/06/09
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ISU Curry Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Lic #0588757 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
489 E Colorado ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Pasadena CA 91101
Phone:626- 449 -3870 Fax:626- 449_5268
All City Management, Inc.
1749 South La Ciene3a Blvd.
Los Angeles CA 90035
COVERAGES
INSURERS AFFORDING COVERAGE I NAIC #
INSURER A: Admiral insurance Company
j INSURER B: —
f
INSURER ER C -. -- .�t. - - - - -- l
INSURER D
INSURER E:
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.
y{D
`POLICY F"ECTi
EXMRATZW
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
LTR INSR
TYPE OF INSURANCE POLICY NUMBER DATE MMIDD/YY
DATE MM /DD/YY
LIMITS
GENERAL LIABILITY EACH OCCURRENCE ,5 1,000,000
A X COMMERCIAL GENERAL LIABILITY CA00000365308 04/01/08 I 04/01/09 PREMISES(Eaoccurence) $50,000 _
�X
JCLAIMS MADE OCCUR I MED EXP (Any one person) I S— excluded
—
I PERSONAL 6 ADV INJURY 1$1,000,000
GENERAL AGGREGATE 1$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER . I PRODUCTS - COMP /OP AGG $1,000,000
L�.
-- - - - - -- —
POLICY I
7 JECT LOC I I
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT 5
I
j ANY AUTO I (Ea accident)
i
ALL OWNED AUTOS r --
BODILY INJURY 5
I (Per person)
SCHEDULED AUTOS I
I I
HIRED AUTOS BODILY INJURY f
r I NON -OWNED AUTOS I I (Per accident) i
PROPERTY DAMAGE 15
+ I (Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
5
OTHER THAN EA ACC
$ —
ANY AUTO
�� I
$ — — —
I
AUTO ONLY AGG
EXCESS /UMBRELLA LIABILITY I
EACH OCCURRENCE 5
�$
OCCUR L J CLAIMS MADE I I
AGGREGATE
DEDUCTIBLE
C —I RETENTION S �
, S
WORKERS COMPENSATION AND
TORY LIMITS I ER
EMPLOYERS' LIABILITY
--
ANY PROPRIETOR/PARTNEWEXECUTIVE
E.L. EACH ACCIDENT S
E L DISEASE - EA EMPLOYEE. S
OFFICER/MEMBER EXCLUDED? I
I
If yes, describe under
SPECIAL PROVISIONS below I
- -- --
E L DISEASE - POLICY LIMIT : S
OTHER
I
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
*10 days notice of cancellation in the event of non - payment of premium.
City of E1 Segundo and its officials, officers, agents, employees and
volunteers are additional insured asrespects operations to the named insured
per forms attached.
CFRTIFICATF H01_DFR CANCELLATION
ELSEGUN
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL *30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
City of El Segundo
Attn: City Clerk
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
350 Main Street
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
1 44 -1al: r-452"" io A
El Segundo CA 90245-0989
ACORD 25 (2001108) / y -- - of - T /— -v Ally u wrcrUMAIIvN ISao
Policy tvumoer: CA000003653 -08
Effective Date: 04/01/08 M 20 10 07 04
THIS ENDORSEMENT CHANG" THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED -- OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
This entliwcment modifies insurance prop itit;d under the fullim ing:
COMMERCIAL GENFRAL I.IMIR.17Y ('OWRA61: PART
SC11E1)ltl.)',
.
Name Of Additional Insured Persons) I I
Or Organization(s): Locatiouls) Of Covered Onerations
A \1' I \ f1 FY FOR WHOM YOV ARI PI'.RVOR� INN ALL COVF.RI:1) PROIIT I'S
0\GOI \G OPER-MO\S, in "r om 1' IF RLQUIRED 1311•
Wit] TTEN CONTRAC T' PRIOR 10 :t\ `•( VC11ME NCT"' "k
Lt )SS. `
to
A. Section 1I— Who Is An Insured ie amended to
include as an additional insured dtc person(s1 or
oTyanization(s) sho«n in the Schedule, but onl) m ith
rcr,pcct io liability for "bodily injury". "propcm
d,twAge" or "personal and advertising injury" caused.
in whole or in part, by:
1, Your acts or omissions; tir
2. The a:r or omissions of those: acthtg au your
behalf;
in the perfommnce of your ongoing operations for the
additional iusured(s) at the locatitnt(s) designated
above.
8. With resp-..;t to the insurance afford.;tl to theic
additional insureds, the following additional
cxcl+lsioos apply:
This insurance does not apply to "brdily injury" of
"property damage" occwTitig aftsa:
I. All work including materials, parts or cquipment
furnished in connection with such work, on the
project (other than senice, maintenance or
repair) to be performed by or on behalf of the
additional iry d(s) at the location ofthe
covered operations has been completed; or
2. 'Clint portion of "your work" out of x•bich the
injury or damage arises has I,crn put to its
intended use by any poicin or organization other
than another contiactot or subcontractor engaged
iu Iwrfornring operations fitr ;i principal as a part
of the ;ame project.
CG 20 10 07 04 f ISO Pioputtia5, hic., !00•1 Page 1 of 1 O
policy Number: CA000003653 -08 CG 24 04 10 93
Effective Date: 04/01/08
THIS E1 UORSEIIENT CHANGES THE, PONCY. PIYASF, 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 CoVI :RAGP PART
St;'IJFDIJLE
Nance of Persnn or organization:
: \ny person or organization, but ortic 4 the fullovh ing conditions are rru:e
u. You have expressly agreed to the waivcr in a written conituct eatemd into by yoti; and
b. The injury or damage occurs subsequent to the execution of the written contract.
(If no entry appears above, infornotion required to complete this endot<errtent will be shown in the DL- clarations as appht•ahle
to this endorsement.)
The TRANSIT OF RIO ITS OF RECOVI?RY AGAINS r 011MRS TO VS Condition (Section IV COMMERCIAL
UYNERAL LIABILI1 Y CONDITIONS) is ahrn-ndvd by the addition of the folloi%ing:
We waive any right of recovery %,u may have against die person or organization shown fit the Schedule above because of
ltayments wu male for injury of dmrtage arising out or vuur ongoing operations ar "your work" doav under a contract with
that person or organization and included In the "products•conyrleted operations hazard ". This w aivcr applies only to dw pet
srm or orgUML31ion Shone in the Schedule above.
CG 24 04 10 93 copyright, Irisutan: :e Service, Oirk, -% Inc., 11tn2 Page 1 of 1 0
Policy Number: CA00003653 -08
Effective Date: 04/01/08 AD 06 57 12 03
THIS ENDORSEMENT CHANGES Ti E POLIC Y. PLEASE READ IT CAREFULLY.
PRIMARY/NON-CONTRIBUTING INSURANCE
ENDORSEINTENT
This endorsement modifies insurance provided tinder the following:
COMMERCIAL. GE NI UAi31L11'Y COVER 01' PART
S('1ILDU I.E
A \ *Y PGRSON OR 0110ANIZATION QUALIFYING AS AN 1\SUHH) UNDER 1JIF 111)UI imAL INSURED -
OWNEitS, LYSSEFS OR (:ON TRA('I'()R.S l:Ni)ORSI: \,11.N I' I'(*)Iti\i t'(1 20 lu 07 04 A I °TACI IED TO MM HIS I)OLICY.
It is a6feed that Commercial Gcncral Liability Coverage
Form CG 00 01 Section TV paragraphs 4.b, and 4.c. do not
apply with respect to other %alid and collectible Conr»rrt
vial General Liability insurmiee, whether printtn or exces-•,
available to the person or organization ,pelts n in the Sched-
ule and:
l) Who is an insured wWer an Additional Instin•d-
Owners. Lessees or Contractors cn(larwrttent at-
tached to this policy: and
2) Who inquires by specific written contract that this
insurance is to be primary and/or non-contributory
to other %alid and coltectiMc: inauritwc available to
the +i pear n or oiganiration.
'(Ilk endorsement does not change the scone of coverage
pmvidcd to tlu pcnson ar organvatitin b) any Additional
lnsutrtl endorsement.
%I1 tither leimi anti conditions rcnuin unchanged
AD 06 57 12 03 pure i of 1
INCERTIFICATE OF INSURANCE
SUCH INSURANCE AS RESPECTS THE INTEREST OF THE CERTIFICATE HOLDER NAMED BELOW WILL NOT BE
CANCELED OR OTHERWISE TERMINATED WITHOUT GIVING 10 DAYS PRIOR WRITTEN NOTICE TO THE
CERTIFICATE HOLDER, BUT IN NO EVENT SHALL THIS CERTIFICATE BE VALID MORE THAN 30 DAYS FROM
THE DATE WRITTEN. THIS CERTIFICATE OF INSURANCE DOES NOT CHANGE THE COVERAGE PROVIDED BY
ANY POLICY DESCRIBED BELOW.
This certifies that: ® STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY of Bloomington, Illinois
❑ STATE FARM FIRE AND CASUALTY COMPANY of Bloomington, Illinois
❑ STATE FARM COUNTY MUTUAL INSURANCE COMPANY OF TEXAS of Dallas, Texas
❑ STATE FARM INDEMNITY COMPANY of Bloomington, Illinois, or
❑ STATE FARM GUARANTY INSURANCE COMPANY of Bloomington, Illinois
has coverage in force for the following Named Insured as shown below:
NAMED INSURED: r:LL CITY MANAGFUMIT
ADDRESS OF NAMED INSURED: 1149 S. LA CISNGA LOS A11G--LIS, CA 90015 -9601
POLICY NUMBER
0155-0693-A16-75
EFFECTIVE DATE
OF POLICY
2/8/08 - 2/8/09
DESCRIPTION OF
VEHICLE (Including VIN)
Ei\OL
LIABILITY COVERAGE
® YES
❑ NO
❑ YES
❑ NO
❑ YES
❑ NO
❑ YES
❑ NO
LIMITS OF LIABILITY
a. Bodily Injury
1,000,000
Each Person
Each Accident
b. Property Damage
Each Accident
c. Bodily Injury &
Property Damage
Single Limit
Each Accident
1 MILLION
PHYSICAL DAMAGE
COVERAGES
❑ YES
® NO
[]YES
❑ NO
❑ YES
❑ NO
❑ YES
❑ NO
a. Comprehensive
$
Deductible
$
Deductible
$
Deductible
$
Deduct-bte
❑ YES
® NO
❑ YES
❑ NO
❑ YES
❑ NO
❑ YES
❑ NO
b. Collision
$
Deductible
$
Deductible
$
Deductible
$
Deductible
EMPLOYERS NON -OWNED
CAR LIABILITY COVERAGE
® YES
❑ NO
❑YES
❑ NO
❑ YES
❑ NO
❑ YES
❑ NO
CIOVERAGE BILm I
❑ YES
® NO
❑ YES
❑ NO
❑ YES
❑ NO ❑ YES
❑ NO i
FLEET - COVERAGE FOR
1
MMOOT0WNEDNCLgs LICENSED
❑ Y "
(3 NO
❑ YES
❑ NO
❑ YES
❑ NO
❑ YES
[]NO
Name and Address of Certificate Hold
CITY DF EL SEGUNDO
350 MAIN STREET
E! SESUNDO CA 90245
ADDITIONAL IFSCRED
O.FICER,AGENT AND VOLUNTEERS
INTERNAL STATE FARM USE ONLY:
122429.3 Rev. 07.26 -2005
Zd
AGEN? 75 -1289 01 /C8r 2C09
rifle Agent's Code Nt
Name and Address of Agent
"?ILLIAM RAMMONDS,AGENT
STATE FARM INSJRANCE COMPANIES
11040 SA14TA MONICA BLVC. STE.
LOS ANGELES, CA 90025 -1515
Request pennanenl Certificate of Insurarce for Iiablity coverage.
Request Certificate Holder to be added as an Additional Insured.
420
CERTHOLDER COPY
SC
STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142 -0807
COMPENSATION
INSURANCE
FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 12 -12 -2008 GROUP: 000780
POLICY NUMBER: 0000497-2008
CERTIFICATE ID: 1
CERTIFICATE EXPIRES: 06 -01 -2009
10 -01- 2008/08 -01 -2009
CITY OF EL SEGUNDO SC
CITY CLERK
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.
tTIORI�ZeD REPVRESENTATAIJ PRESIDENT
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE.
ENDORSEMENT #2085 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10 -01 -2008 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY.
EMPLOYER
ALL CITY MANAGEMENT INC SC
1749 S LA CIENEGA BLVD
LOS ANGELES CA 90035
[B14,SC)
tREV.2 -05t PRINTED : 12 -12 -2008