PROOF OF INSURANCE (2003) CLOSEDr l
02Y'20/2003 16:29 FAX 6196991344 DRIVER ALLIANT INS SVCS
PRODUCER 619 -238 -1828
DRIVER ALLIANT INSURANCE
1620 FIFTH AVENUE
SAN DIEGO, CA 92101
ROBBIE ROBERTS, V.P.
INSURED
Art's Disposal Service, Inc.
127 Van Norman Road
Montebello CA 90640
2002/003
tR, .I I'f j+ j{;: y� :'iY(f >kYF >x > %i59:i1ifiij; DATE (MMNOIYYI i
1 I ':i >s:o:<,:<•k• >:•; a::P .f }:,iiii'ii
.,;... >:..:or,�•r•.s,. ;,vu. v : s�'!hii ?3':iir� ;(s "s'k• >: ;<r > ,,.. 2/20/03
THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION
ONLY AND COWERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANY
A SPECIALTY NATIONAL INS, CO.
COMPANY
B STATE COMPENSATION INS, FUND
COMPANY
C
COMPANY
D
. u ::•,:,e.>r.:o.rp. ;•: rr �i,::>:: r> s,: rrr,: g• s: a:: i::::,,. 5¢ r' rr; ank:/ J:, gif�M` isw: ::.x`�ii::0::�: >f #':q::8::rwnMi >tr4fta:< r ^x ^i;: "a
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE L(5TEDXBELOW HAVE BEE % < >• ; •} • ����)•» • �<•`x s,• r" �;``"''"'"""''`` i'::.•>:„;;( r,; x;,;;�(:;r$� ";;E;�. "xk;:::^�,k,
INnlr.ATFn. NnT1A1IT1-ISTAPIDING ANY REQuinrmCNT, TCnM On 0014DITION or ANN /.SUN EAU) THE ulIVHEM DOCUMENT WITH ERESPECT TO WHICH PER
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
Co P INSURANCE POLICY EFFECTIVEPOLICY NUMBER DATE (MM /OD/YY) DATE (MM /DD/YY) LIMITS
TY 3XZ170178 -00
5/08/02 5/08/03 GENERAL AGGREGATE a 2000000
AL GENERAL LIABILITY PRODUCTS - COMP /OP AGG S 2000000
S MADE X OCCUR PERSONAL & ADV INJURY B 1000000
CONTRACTOfl'S PROT
EACH OCCURRENCE S 000000
A AUTOMOBILE LIABILITY 3XZ170178 -00
5/08/02 5/08/03
X ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTO5
X HIRED AUTOS
X NON -OWNED AUTO$
X POLLUTION
AGE UAELITY
ANY AUTO
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
B WORKERS COMPENSATION AND 1688542 -03 1/01/03 1 /p i /04
EMPLOYERS' LIABILITY
THE PFicpmETOA/ IN"
PARTNERS /EXECUTIVE
OFFICERS ARE: EXCL
A OTHER 3XZ170178 -00
MOTOR TRUCK CARGO 5/08/02 5/08/03
DESCRIPTION OF OPERATIONS /LOCATIONS/VEHICLES /SPECIAL ITEMS
CITY OF EL SEGUNDO IS NAMED AS ADDITIONAL INSURED PER CO2010 ATTACHED.
CITY OF EL SEGUNDO,CITY CLERKS
OFFICE,ATTN: PURCHASING AGENT
350 MAIN STREET, ROOM 5
EL SEGUNDO, CA 90245 -3895
FIRE DAMAGE (Any one fire) 8 30000C
MED EXP (Any one person) $ 15000
COMBINED SINGLE LIMIT
1000000
ROOILY INJURY
(Per person)
BODILY INJURY 6
(Per accluent)
PROPERTY DAMAGE g
AUTO ONLY • EA ACCIDENT 9
OTHER THAN AUTO ONLY:
EgCH RrH_
A $
EACH OCCURRENAGGREGATE
TD O
WCSTATU- :.:•.....:.;:;.. :..: EL E ACH ACCIDEN000000 EL DISEASE - POLIC000000 EL DISEASE - EA EM000000
$10,000 ANY ONE VEHICLE
f 1,000 DEDUCTIBLE
'10 DAYS NOTICE FOR NON -PAY
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES Be CANCELLED BEFORE THE
EXPIRATION DATE THEREOF. THE ISSUINO COMPANY WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPO6E ND OBypATION OR LIABILITY
DF NY KIND ON HE PANY. ITS AGENTS OR REPAE6ENTATIVeR.
'
62u /20/2003 16:30 FAX 6196991344 DRIVER ALLIANT INS SVCS 121003/003
POLICY NUMBER: 3XZ17017 -00 COMMERCIAL GENERAL LIABILITY
NAMED INSURED: ART'S DISPOSAL SERVICE, INC. CG 20 10 10 O1
I
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
I
ADDITIONAL !INSURED - OWNERS, LESSEES OR
OR CONTRACTORS- SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
I
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization;
PER CERTIFICATE ATTACHED
(If no entr y appears above; information required to complete this
endorsement will be shown in the Declarations as applicable to this
endorsement.)
A. Section, II - Who Is An;Insured 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 ongoing
operations performed for that insured.
B. With respect to the insurance afforded to these additional
insureds, the following exclusion is added:
I. Exclusions
This insurance does not apply to "bodily injury" or
"Property damage" occurring after:
(1) All work, including materials, parts or equipment
furnished in connection with such work, on the project,
(other than sdrvice, maintenance or repairs) to be
performed by o,r on behalf of the Additional insured(s)
at the site of the covered operations has been
completed; or
(2) That portion oif "your work" out of which the injury
or damage arises has been put to its intended use by
any person or prganization other than another contractor
or subcontractor engaged in performing operations for a
principal as part of the same project.
CG 20 10 10 O1
ISO Properties, llnc., 2000
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