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PROOF OF INSURANCE (2009) CLOSEDPRODUCER
NHC Insurance Services Inc
796 W. 9th Street
San Pedro CA 90731
Phone:310- 221 -0917 Fax:310 -221 -0966
AMERICAN INTER
�p�TIONAL
INSPECTIONS LP
118 PATRIC!" WAY
PASADENA CA 91105
COVERAGES
THIS CERTIFICATE IS ISSUED AS A M4160©INFORMATIC
ONLY AND CONFERS NO RIGHTS UPON THE CEERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOV
INSURERS AFFORDING COVERAGE NAIC #
INSURER A: CNA INSURANCE COMPANIES
INSURER B:
INSURER C:
INSURER D:
INSURER E:
Wv u.OUMMM r ua I cu ntLUVV I1AVE 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.
R NSR TYPE OF INSURANCE POLICY NUMBER I ?OLICY EFFECTIVE I WL17dV_9XVj_RA_Tf0—N
GENERAL LIABILITY
A I A X COMMERCIALGENERALLIABILITY 2077172931
CLAIMS MADE ® OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO-
JECT LOC
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
A R HIRED AUTOS 2077172931
x NON -OWNED AUTOS
GARAGE LIABILITY
7 ANY AUTO
EXCESS /UMBRELLA LIABILITY
HOCCUR 0 CLAIMS MADE
HDEDUCTIBLE
RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR /PARTNER/EXECUTIVE
OFFICER /MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
OTHER
1TE MWOO DATE MM /DD/YY LIMITS
EAC H OCCURRENCE $1,000,000
05/01/08) 05/01/09 PREMISES(Eaoccurence) $300,000
MED EXP (Any one person) $10,000
PERSONAL BADV INJURY $1,000,000
GENERAL AGGREGATE $2,000,000
PRODUCTS - COMP /OP AGG $2,000,000
05/01/08
05/01/09
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
BODILY INJURY
(Per person)
—INJURY
$
BODILY
(Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
AUTO ONLY: AGG
$
$
EACH OCCURRENCE
$
AGGREGATE
$
$
$
TORY LIMITS ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYE
$
E.L. DISEASE - POLICY LIMIT
$
oESCRIPTION OF OPERATIONS 7 LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
*10 DAY NOTICE OF CANCELLATION APPLIES FOR NON - PAYMENT OF PREMIUM. THOSE
USUAL TO THE INSUREDS OPERATIONS. THE CITY OF EL SEGUNDO, ITS OFFICERS,
AGENTS AND EMPLOYEES ARE NAMED AS ADDITIONAL INSURED PER NON - CONTRACTORS
BLANKET FORM SB- 146932 -B. PLEASE SEE ATTACHED FORMS.
TE H(]II nro
PUBLIC3
PUBLIC WORKS DEPARTMENT
EL SEGUNDO CITY HALL
350 MAIN STREET
EL SEGUNDO, CA 90245
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SMALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
1
3860 • ,
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.
CNA 38 6 0 * (F-a.'b s)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
NON - CONTRACTORS BLANKET ADDITIONAL INSURED
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS LIABILITY COVERAGE FORM
Coverage afforded under this extension of coverage endorsement does not apply to any person or organization covered
as an additional insured on any other endorsement now or hereafter attached to this Coverage Part.
1. ADDITIONAL INSURED — BLANKET VENDORS
WHO IS AN INSURED is amended to include as an
additional insured any person or organization (referred
to below as vendor) with whom you agreed, because
of a written contract or agreement to provide
insurance, but only with respect to "bodily injury" or
"property damage" arising out of "your products" which
are distributed or sold in the regular course of the
vendor's business, subject to the following additional
exclusions:
1. The insurance afforded the vendor does not
apply to:
a. "Bodily injury" or "property damage" for
which the vendor is obligated to pay
damages by reason of the assumption of
liability in a contract or agreement. This
exclusion does not apply to liability for
damages that the vendor would have in
the absence of the contract or agreement;
b. Any express warranty unauthorized by
you;
c. Any physical or chemical change in the
product made intentionally by the vendor;
d. Repackaging, except when unpacked
solely for the purpose of inspection,
demonstration, testing, or the substitution
of parts under instructions from the
manufacturer, and then repackaged in the
original container;
e. Any failure to make such inspections,
adjustments, tests or servicing as the
vendor has agreed to make or normally
undertakes to make in the usual course of
business, in connection with the
distribution or sale of the products;
f. Demonstration, installation, servicing or
repair operations, except such operations
performed at the vendor's premises in
connection with the sale of the product;
g. Products which, after distribution or sale
by you, have been labeled or relabeled or
used as a container, part or ingredient of
any other thing or substance by or for the
vendor; or
SB- 146932 -B
(Ed. 03106)
h. "Bodily injury" or "property damage"
arising out of the sole negligence of the
vendor for its own acts or omission or
those of its employees or anyone else
acting on its behalf. However, this
exclusion does not apply to:
(1) The exceptions contained in
Subparagraphs d. or f.; or
(2) Such inspections, adjustments, tests
or servicing as the vendor has
agreed to make or normally
undertakes to make in the usual
course of business, in connection
with the distribution or sale of the
products.
2. This insurance does not apply to any insured
person or organization, from whom you have
acquired such products, or any ingredient,
part or container, entering into, accompanying
or containing such products.
3. This provision 2. does not apply to any vendor
included as an insured by an endorsement
issued by us and made a part of this
Coverage Part.
4. This provision 2. does not apply if "bodily
injury" or "property damage" included within
the "products- completed operations hazard" is
excluded either by the provisions of the
Coverage Part or by endorsement.
2. MISCELLANEOUS ADDITIONAL INSUREDS
WHO IS AN INSURED is amended to include as an
insured any person or organization (called additional
insured) described in paragraphs 3.a, through 3.h.
below whom you are required to add as an additional
insured on this policy under a written contract or
agreement but the written contract or agreement must
be:
1. Currently in effect or becoming effective
during the term of this policy; and
2. Executed prior to the "bodily injury," "property
damage" or "personal and advertising injury,"
but
Only the following persons or organizations are
additional insureds under this endorsement and
Page 1 of 3
(Version 1.0)
vv- i-rv.ac -u
3 8 6 Q , , (Ed. /06)
coverage provided to such additional insureds is
entrances, coal holes, driveways,
limited as provided herein:
manholes, marquees, hoistaway
openings, sidewalk vaults, street
a. Additional Insured — Your Work
banners, or decorations and
That person or organization for whom you
similar exposures; or
do work is an additional insured solely for
(b) The construction, erection, or
liability due to your negligence specifically
removal of elevators; or
resulting from your work for the additional
insured which is the subject of the written
(2) This insurance applies only with
contract or written agreement. No
respect to operations performed by
coverage applies to liability resulting from
you or on your behalf for which the
the sole negligence of the additional
state or political subdivision has
insured.
issued a permit.
The insurance provided to the additional
This insurance does not apply to "bodily
insured is limited as follows:
injury," "property damage" or "personal
and advertising injury" arising out of
(1) The Limits of Insurance applicable to
operations performed for the state or
the additional insured are those
municipality.
specified in the written contract or
written agreement or in the
c. Controlling Interest
Declarations of this policy, whichever
Any persons or organizations with a
is less. These Limits of Insurance are
controlling interest in you but only with
inclusive of, and not in addition to,
respect to their liability arising out of:
the Limits of Insurance shown in the
Declarations.
(1) Their financial control of you; or
(2) The coverage provided to the
(2) Premises they own, maintain or
additional insured by this
control while you lease or occupy
endorsement and paragraph F.9. of
these premises.
the definition of "insured contract"
under Liability and Medical
This insurance does not apply to
Expenses Definitions do not apply
"property
structural alterations, new construction
and demolition operations performed by
to "bodily injury" or
or for such additional insured.
damage" arising out of the "products-
completed operations hazard" unless
d. Managers or Lessors of Premises
required by the written contract or
A manager or lessor of premises but only
o written agreement.
o
with respect to liability arising out of the
(3) The insurance provided to the
ownership, maintenance or use of that
additional insured does not apply to
specific part of the premises leased to
N "bodily injury," "property damage," or
you and subject to the following additional
o "personal and advertising injury"
exclusions:
o arising out of the rendering or failure
This insurance does not apply to:
N
to render any professional services.
(1) Any "occurrence" which takes place
b. State or Political Subdivisions
after you cease to be a tenant in that
A state or political subdivision subject to
premises; or
the following provisions:
(2) Structural alterations, new
(1) This insurance applies only with
construction or demolition operations
respect to the following hazards for
performed by or on behalf of such
which the state or political
additional insured.
subdivision has issued a permit in
e. Mortgagee, Assignee or Receiver
connection with premises you own,
rent, or control and to which this
A mortgagee, assignee or receiver but
insurance applies:
only with respect to their liability as
(a) The existence, maintenance,
mortgagee, assignee, or receiver and
out of the ownership,
o repair, construction, erection, or
arising
maintenance, or use of a premises by
removal of advertising signs,
awnings, canopies, cellar
you.
Page 2 of 3
SB- 146932 -B
(Ed. 03/06)
This insurance does not apply to
structural alterations, new construction or
demolition operations performed by or for
such additional insured.
f. Owners /Other Interests — Land is
Leased
An owner or other interest from whom
land has been leased by you but only
with respect to liability arising out of the
ownership, maintenance or use of that
specific part of the land leased to you and
subject to the following additional
exclusions:
This insurance does not apply to:
(1) Any "occurrence" which takes place
after you cease to lease that land; or
(2) Structural alterations, new
construction or demolition operations
performed by or on behalf of such
additional insured.
g. Co -owner of Insured Premises
A co -owner of a premises co -owned by
you and covered under this insurance but
only with respect to the co- owners liability
as co -owner of such premises.
h. Lessor of Equipment
Any person or organization from whom
you lease equipment. Such person or
organization are insureds only with
respect to their liability arising out of the
maintenance, operation or use by you of
equipment leased to you by such person
SB- 146932 -B
lFrl WAMRI
SB- 146932 -B
(Ed. 03/06)
3860. ; 7
or organization. A person's or
organization's status as an insured under
this endorsement ends when their written
contract or agreement with you for such
leased equipment ends.
With respect to the insurance afforded
these additional insureds, the following
additional exclusions apply:
This insurance does not apply:
(1) To any "occurrence" which takes
place after the equipment lease
expires; or
(2) To "bodily injury," "property damage"
or "personal and advertising injury"
arising out of the sole negligence of
such additional insured.
Any insurance provided to an additional insured
designated under paragraphs a. through h. above
does not apply to "bodily injury" or "property
damage" included within the "products- completed
operations hazard."
3. The following is added to Paragraph H. of the
BUSINESSOWNERS COMMON POLICY
CONDITIONS:
H. Other Insurance
4. This insurance is excess over any other
insurance naming the additional insured as an
insured whether primary, excess, contingent or
on any other basis unless a written contract or
written agreement specifically requires that this
insurance be either primary or primary and
noncontributing.
Page 3 of 3