PROOF OF INSURANCE (2009) CLOSEDACORDTM CERTIFICATE OF LIABILITY INSURANCE
DATE,MMI °°"YYY,
11/19/2008
IPRODUCER
Marsh Risk & Insurance Services
License No. 0437153
777 South Figueroa Street
Los Angeles, CA 90017
-
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Attn: LosAngeles.certrequest@marsh.com
02720 -TACT -CAS -08/09 GL_AL Al x-out
INSURERS AFFORDING COVERAGE
NAIC 8
INSURED
The Aerospace Corporation
P.O. Box 92957, M1/379
Los Angeles, CA 90009 - 2957
INSURER A: Zurich American Insurance Co 16535
_ ---- ___ - -- ---- ____. -- -- -- -__ _- - _ - -_ -- - - -____
INSURER B: N/A N/A
- -- -- - -- - - - - - - -- - - -- __ - - - - -+
INSURER C: N/A N/A
INSURER D: N/A N/A
INSURER E:
COVERAGES - -
- - -- - - -- - - -- - -- - - - 1i -
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.
INSR
LTR
ADD
INSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MMIDDIYY)
POLICY EXPIRATION
DATE (MMIDDIYY)
LIMITS
A
X—
GENERAL
X
LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE a OCCUR
GLO 5085562 -04
07/01/08
07/01/09
H u N E
2 000 00(
TO RENTED AGE
PREM SES Ea occurence
$ 1,000,00
MED EXP (Any one person)
$ 5,00
PERSONAL & ADV INJURY
$ 2,000,00
GENERAL AGGREGATE
$ 2,000,00
GENERAL AGGREGATE LIMIT APPLIES PER
X POLICY PRO- LOC
JECT
PRODUCTS - COMP/OP A-
2 000 00
A
AUTOMOBILE
X
LIABILITY
ANY AUTO
BAP 5085560 -04
07/01/08
07/01/09
COMBINED SINGLE LIMIT
(Ea accident)
$ 2,000,00
ALL OWNED AUTOS
BODILY INJURY
$
SCHEDULED AUTOS
(Per person)
BODILY INJURY
$
HIRED AUTOS
NON -OWNED AUTOS
(Per accident)
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
ANY AUTO
OTHER THAN EA ACC
AUTO ONLY: AGG
$
$
EXCESSNMBRELLA LIABILITY
EACH OCCURRENCE
$
AGGREGATE
$
OCCUR (- CLAIMS MADE
DEDUCTIBLE
- - - -_—
RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
WC STATU- OTH-
IUITq FR
E.L. EACH ACCIDENT
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
E.L. DISEASE - EA EMPLOYE
$
It yes, describe under
SPECIAL PROVISIONS below
L. DISEASE - POLICY LIMIT
$
OTHER
DESCRIPTION OF OPERATIONSA .00ATIONSNEMICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
REF: Aerospace/Air Force Pedestrian Bridge, El Segundo, California.
The City of El Segundo, its officers, officials, employees, agents and volunteers are included as additional insureds, but only as respects operations of the
insured under written contract With the insured. Coverage is primary and non - contributory.
This certificate cancels and supercedes the certificate dated 11/5/08.
CERTIFICATE HOLDER LOS - 000706066 -23
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City of El Segundo
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL NNOVOO ' M MAIL
Attn: Louis Morales, Project Consultant
Planning & Building Safety
350 Main Street
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
El Segundo, CA 90245
A oaMVfflJT11 a. LM..
Larry Mosier
A{:UKU ZS (ZUUT /U8) O ACORD CORPORATION 1988
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.
RPvar-gp of Pane 1
Reproduction of Insurance Services Office, Inc. Form
INSURER: ISO FORM CG 20 10 11 85: (MODIFIED)
POLICY NUMBER: COMMERCIAL GENERAL LIABILITY
ENDORSEMENT NUMBER: EXHIBIT I -A
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED — OWNERS, LESSEES OR
CONTRACTORS (FORM B)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
The City, its officers, officials, employees, agents, and volunteers
(If no entry appears above, the information required to complete this endorsement
will be shown in the Declarations as applicable to this endorsement.)
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.
Modifications to ISO form CG 20 10 1185:
1. The insured scheduled above includes the Insured's officers, officials, employees and
volunteers.
2. This insurance shall be primary as respects the insured shown in the schedule above,
or if excess, shall stand in an unbroken chain of coverage excess of the Named
Insured's scheduled underlying primary coverage. In either event, any other insurance
maintained by the Insured scheduled above shall be in excess of this insurance and
shall not be called upon to contribute with it.
3. The insurance afforded by this policy shall not be canceled except after thirty days
prior written notice by certified mail return receipt requested has been given to the
Entity.
4. Coverage shall not extend to any indemnity coverage for the active negligence of the
additional insured in any case where an agreement to indemnify the additional insured
would be invalid under Subdivision b of section 2782 of the Civil Code.
Signature- Authorized Representative
Address
CG 20 10 1185 Insurance Services Office, Inc. Form (Modified)