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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