PROOF OF INSURANCE (2009) CLOSEDMARSH CERTIFICATE OF INSURANCE ISSUE DATE
PRODUCER 10/23/2008
MARSH USA INC. This certificate is issued as a matter of information only and confers no rights
ONE STATE STREET upon the Certificate Holder. This Certificate does not amend, extend or alter the
HARTFORD, CT 06103 -3187 coverage afforded by the policies below.
COMPANIES AFFORDING COVERAGE
COVERAGES This certificate supersedes and replaces any previously issued certificate for the policy period noted below.
This is to certify that the policies of insurance described herein have been issued to the Insured named herein for the policy period indicated. Notwithstanding
any requirement, term or condition of 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, conditions and exclusions of such policies. Limits shown may have been reduced by paid claims.
�O TYPE OF INSURANCE POLICY NUMRPR eoecnrn,e-
A I GENERAL LIABILITY
® Commercial General Liability
❑ Claims Made ® Occurrence
❑ Owners' and Contractors- Protection
El
General Aggregate Limit applies per:
® Policy []Project ❑ Location
A AUTOMOBILE LIABILITY
® Any Automobile
❑ All Owned Automobiles
❑ Scheduled Automobiles
❑ Hired Automobiles
❑ Non -owned Automobiles
El
B WORKERS' COMPENSATION
C
D AND EMPLOYERS' LIABILITY
E
EXCESS LIABILITY
❑ Occurrence ❑ Claims Made
02CSET10004
$2,000,000 general aggregate per
location /project
$10,000,000 policy general
aggregate
02CSET10000 (A/O)
02CSET10019 (HI)
Hartford Underwriters Ins
1928748(MA), 1928751(CA)
1928750(FL)
1928752(CT ex-SIR $2,500,000)
1928742 1928744 1928745(MN)
1928746(TX) 1928749(NJ)
(F) American Int'I South Ins Co
1928743 1928747(OR)
0410112008 I 04101/2009 1 EACH OCCURRENCE
FIRE DAMAGE
MEDICAL EXPENSE
04/01/2008 1 04/01/2009
04/0112008 1 04/01/2009
u F
$ 1,000,000
$ 300,000
$ 10,000
$ 1.000,000
S 2,000,000
$ 2,000,000
WC Statutory Limit I Other LJ
EL EACH ACCIDENT $ 1
EL DISEASE (Each employee) $ 1
EL DISEASE (Policy Limit) $ 1
EACH OCCURRENCE
AGGREGATE $
This certificate only applies to DVL- 60341 -NC $
Park Vista Apartments, 615 E. Holly Ave, El Segundo, CA.
The City of El Segundo are additional insured to the extent required by contract. The policies are primary and non contributory and include a waiver of subrogation both to the extent
required by contract.
CERTIFICATE HOLDER
PUBLIC WORKS DEPARTMENT
El Segundo City Hall
350 Main Street
El Segundo, CA 90245
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT A FAILURE TO MAIL
SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
ISSUER, COMPANY, ITS AGENTS OR REPRESENTATIVES.
MARSH USA INC
BY: C�
Page 1 of 1
Certificate ID #
Company
A
Hartford Fire Insurance Co
INSURED
AMTECH ELEVATOR SERVICES
Company
Ins Co of the State of PA
9808 FIRESTONE BLVD.
B
DOWNEY, CA 90241
Company
C
Illinois National Ins Co.
Company
D
National Union Fire Ins Co Pa
Company
E
New Hampshire Insurance Co
COVERAGES This certificate supersedes and replaces any previously issued certificate for the policy period noted below.
This is to certify that the policies of insurance described herein have been issued to the Insured named herein for the policy period indicated. Notwithstanding
any requirement, term or condition of 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, conditions and exclusions of such policies. Limits shown may have been reduced by paid claims.
�O TYPE OF INSURANCE POLICY NUMRPR eoecnrn,e-
A I GENERAL LIABILITY
® Commercial General Liability
❑ Claims Made ® Occurrence
❑ Owners' and Contractors- Protection
El
General Aggregate Limit applies per:
® Policy []Project ❑ Location
A AUTOMOBILE LIABILITY
® Any Automobile
❑ All Owned Automobiles
❑ Scheduled Automobiles
❑ Hired Automobiles
❑ Non -owned Automobiles
El
B WORKERS' COMPENSATION
C
D AND EMPLOYERS' LIABILITY
E
EXCESS LIABILITY
❑ Occurrence ❑ Claims Made
02CSET10004
$2,000,000 general aggregate per
location /project
$10,000,000 policy general
aggregate
02CSET10000 (A/O)
02CSET10019 (HI)
Hartford Underwriters Ins
1928748(MA), 1928751(CA)
1928750(FL)
1928752(CT ex-SIR $2,500,000)
1928742 1928744 1928745(MN)
1928746(TX) 1928749(NJ)
(F) American Int'I South Ins Co
1928743 1928747(OR)
0410112008 I 04101/2009 1 EACH OCCURRENCE
FIRE DAMAGE
MEDICAL EXPENSE
04/01/2008 1 04/01/2009
04/0112008 1 04/01/2009
u F
$ 1,000,000
$ 300,000
$ 10,000
$ 1.000,000
S 2,000,000
$ 2,000,000
WC Statutory Limit I Other LJ
EL EACH ACCIDENT $ 1
EL DISEASE (Each employee) $ 1
EL DISEASE (Policy Limit) $ 1
EACH OCCURRENCE
AGGREGATE $
This certificate only applies to DVL- 60341 -NC $
Park Vista Apartments, 615 E. Holly Ave, El Segundo, CA.
The City of El Segundo are additional insured to the extent required by contract. The policies are primary and non contributory and include a waiver of subrogation both to the extent
required by contract.
CERTIFICATE HOLDER
PUBLIC WORKS DEPARTMENT
El Segundo City Hall
350 Main Street
El Segundo, CA 90245
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT A FAILURE TO MAIL
SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
ISSUER, COMPANY, ITS AGENTS OR REPRESENTATIVES.
MARSH USA INC
BY: C�
Page 1 of 1
Certificate ID #
359 .
9
10-30 -2008 01:45PM FROM - AMTECH +5626586060 T -124 P.001 /001 F -088
Policy Number: 02 CSE T10004 Effective Date: 04101/8008
Named Insured and Address: UNITED TECHNOLOGIES CORPORATION
ONE FINANCIAL PLAZA
HARTFORD, CT 06101
Endt. No,
THIS ENDORSEMENT CHANCES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL, INSURED m OWNERS, LESSEES OR
CONTRACTORS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY INSURANCE POLICY
SCHEDULE
Name of Person or Organization: CONTRACT NO; DVL- 60341 -NC
THE CITY OF EL SEGUNDO
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.
For the purposes of this endorsement, "you" shall refer to Otis Elevator Company d /b /a Amtech Elevator Services,
and "your work" shall mean work performed by or for Otis Elevator Company d/b /a Amtech Elevator Services.
Form GT 53 2413 (Ed 01103)
m 2003, The Hartford
(includes copyrighted material of Insurance Services Office
with Its permission. Copyright, Insurance Services office, Inc., 2003 )
Page 1 of 1