PROOF OF INSURANCE (2009) CLOSEDA_C 60. CERTIFICATE OF LIABILITY INSURANC I 5/28/2009
PRODUCER (818)547 -1975 FAX: (818)242 -5288 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
JOHN SARGEANT INSURANCE AGENCY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
750 FAIRMONT AVENUE, SUITE 100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P. 0. BOX 831
GLENDALE CA 91209 -0831 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURERNFIRST NAT'L. INS. CO /AMER
BARTEL- ASSOCIATES, LLC INSURERB.INDIAN HARBOR INS. CO.
411 BOREL AVE STE 445 INSURERC:AMERICAN STATES INS. CO.
INSURER D:
SAN MATEO CA 94402 INSURER E:
OVERAGES 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.
AY HAVE BEEN REDUCED BY PAID LAIM POLICY EFFECTIVE POLICY EXPIRATION
VSR ADD'L LIMITS
TYPE OF INSURANCE POLICY NUMBER DATE MMlDD/YY DATE MM1DD/YY
A H RE E $ 1,000,000
GENERAL LIABILITY DAMAGE TO RENTED 1,000,000
X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrenceil $
25CC12442930 9/1/2008 9/1/2009 MEDEXP An one person) 3 10,000
A CLAIMS MADE OCCUR
P S 1,000,000
GENERALAGGREGATE $ 2,000,000
_.f. nr_c s 2,000,000
GENT AGGREGATE LIMIT APPLIES PER
X POLICY 0 PR T O-
LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
(Ea accident)
ANY AUTO
A 9/1/2008 9/1/2009 BODILY INJURY
ALL OWNED AUTOS 25CC12442930 $
(Per person)
SCHEDULED AUTOS
BODILY INJURY $
X HIRED AUTOS (Per accident)
X NON- OWNEDAUTOS
PROPERTY DAMAGE S
(Per accident)
GARAGE LIABILITY I I I AUTO ONLYN
ANY AUTO
EXCESSIUMBRELLA LIABILITY
7 OCCUR 0 CLAIMS MADE
DEDUCTIBLE
C WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY E.L. EACH ACCIDENT _ $ 1,000,000
ANY PROPRIETORIPARTNERIEXECUTIVE 1 , 000 , 000
OFFICER/MEMBEREXCLUDED? O1WC14518330 11/17/2008 11/17/2009 E.L. DISEASE - EA EMPLOYEES
If yes, describe under E.L. DISEASE - POLICY LIMIT $ 1,000,000
SPECIAL PROVISIONS e w
B OTHER MISC. PROFESSIONAL MPPOO1715204 9/1/2008 9/1/2009 $1,000,000 /PER CLAIM
$z, Doo, o0o /aNN. AaGR.
LIABILITY
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES !EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
CERTIFICATE HOLDER IS HEREBY NAMED AS ADDITIONAL INSURED ON POLICY #: 25CC12442930 AS RESPECTS OPERATIONS OF THE NAMED
INSURED ONLY. SEE ATTACHED FORM #: CG76350207.
COVERAGE UNDER POLICY #: 25CC12442930 IS PRIMARY 6 NON - CONTRIBUTORY ABOVE ANY OTHER INSURANCE THE CERTIFICATE
HOLDER(S) MAY CARRY.
10 DAY NOTICE FOR NONPAYMENT OF PREMIUM.
City of E1 Segundo
ATTN: Admin. Svcs. Director
350 Main Street, Room 5
E1 Segundo, CA 90245 -3813
ACORD 25 (2001106)
INS025 (o1os) o8a
UANULLLA "' —
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL XAJQWYO( MAIL
[
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, XX
XnX �14d�J (.��i1�r.Y+iG�14J�L�/F,�4.
AUTHORIZED REPRESENTATIVE„
Joanne: Sar.geant /0116
,P, Arnnn r(1RPnRATION 19RA
Page 1 of 2
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.
ACORD 25 (2001!08) Page 2 of 2
INS025 (ofoe) oea
BARTEL— ASSOCIATES, LLC
POLICY NO: 25CC12442930
COMMERCIAL GENERAL LIABILITY
CG 76 35 02 07
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE A IT CAREFULLY.
LIABILITY PLUS ENDORSEMENT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
THE CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS, EMPLOYEES, AGENTS
AND VOLUNTEERS.
ADDITIONAL INSURED — BY WRITTEN
CONTRACT, AGREEMENT OR PERMIT, OR
SCHEDULE
The following paragraph is added to WHO IS AN
INSURED (Section II):
4. Any person or organization shown in the Sched-
ule or for whom you are required by written con-
tract, agreement or permit to provide insurance
is an insured, subject to the following additional
provisions:
a. The contract, agreement or permit must be
in effect during the policy period shown in
the Declarations, and must have been exe-
cuted prior to the "bodily injury", "property
damage ", or "personal and advertising
injury".
b. The person or organization added as an in-
sured by this endorsement is an insured only
to the extent you are field liable due to:
(1) The ownership, maintenance or use of
that part of premises you own, rent,
lease or occupy, subject to the following
additional provisions:
(a) This insurance does not apply to
any "occurrence" which takes place
after you cease to be a tenant in
any premises leased to or rented to
you;
(b) This insurance does not apply to
any structural alterations, new con-
struction or demolition operations
performed by or on behalf of the
person or organization added as an
insured;
(2) Your ongoing operations for that in-
sured, whether the work is performed
by you or for you;
(3) The maintenance, operation or use by
you of equipment leased to you by such
person or organization, subject to the
following additional provisions:
(a) This insurance does not apply to
any "occurrence" which takes place
after the equipment lease expires;
Includes Copyrighted Material of Insurance Services Office, Inc., with its permission.
Copyright, Insurance Services, 2001
CG 76 35 02 07 Page I of 4
(b) This insurance does not apply to
"bodily injury" or "property dam-
age" arising out of the sole negli-
gence of such person or
organization;
(4) Permits issued by any state or political
subdivision with respect to operations
performed by you or on your behalf,
subject to the following additional pro-
vision:
This insurance does not apply to "bodily
injury ", "property damage ", or
"personal and advertising injury" arising
out of operations performed for the state
or municipality.
c. The insurance with respect to any architect,
engineer, or surveyor added as an insured
by this endorsement does not apply to
"bodily injury", "property damage ", or "per-
sonal and advertising injury" arising out of
the rendering of or the failure to render any
professional services by or for you, includ-
ing:
(1) The preparing, approving, or failing to
prepare or approve maps, drawings,
opinions, reports, surveys, change or-
ders, designs or specifications; and
(2) Supervisory, inspection or engineering
services.
d. This insurance does not apply to "bodily
injury" or "property damage" included within
the "products - completed operations haz-
ard".
A person's or organization's status as an insured un-
der this endorsement ends when your operations for
that insured are completed.
No coverage will be provided if, in the absence of this
endorsement, no liability would be imposed by law on
you. Coverage shall be limited to the extent of your
negligence or fault according to the applicable princi-
ples of comparative fault.
NON -OWNED WATERCRAFT AND NON -OWNED
AIRCRAFT LIABILITY
Exclusion g. of COVERAGE A (Section 1) is replaced
by the following:
This exclusion applies even if the claims
against any insured allege negligence or
other wrongdoing in the supervision, hiring,
employment, training or monitoring of others
by that insured, if the "occurrence" which
caused the "bodily injury" or "property
damage" involved the ownership, mainte-
nance, use or entrustment to others of any
aircraft, "auto" or watercraft that is owned
or operated by or rented or loaned to any in-
sured.
This exclusion does not apply to:
(1) A watercraft while ashore on premises
you own or rent;
(2) A watercraft you do not own that is:
(a) Less than 52 feet long; and
(b) Not being used to carry persons or
property for a charge;
(3) Parking an "auto" on, or on the ways
next to, premises you own or rent, pro-
vided the "auto" is not owned by or
rented or loaned to you or the insured;
(4) Liability assumed under any "insured
contract" for the ownership, mainte-
nance or use of aircraft or watercraft; or
(5) "Bodily injury" or "property damage"
arising out of:
(a) the operation of machinery or
equipment that is attached to, or
part of, a land vehicle that would
qualify under the definition of
"mobile equipment" if it were not
subject to a compulsory or financial
responsibility law or other motor ve-
hicle insurance law in the state
where it is licensed or principally
garaged; or
(b) the operation of any of the machin-
ery or equipment listed in Paragraph
Q2) or f.(3) of the definition of
"mobile equipment ".
(6) An aircraft you do not own provided it is
not operated by any insured.
TENANTS' PROPERTY DAMAGE LIABILITY
When a Damage To Premises Rented To You Limit is
shown in the Declarations, Exclusion j. of Coverage
A, Section I is replaced by the following:
g, "Bodily injury" or "property damage" arising
out of the ownership, maintenance, use or j. Damage To Property
entrustment to others of any aircraft, "auto" "Property damage" to:
or watercraft owned or operated by or rented
or loaned to any insured, Use includes oper- (1) Property you own, rent, or occupy, including
ation and "loading or unloading ". any costs or expenses incurred by you, br
Page 2 of 4
any other person, organization or entity, for
repair, replacement, enhancement, restora-
tion or maintenance of such property for any
reason, including prevention of injury to a
person or damage to another's property;
(2) Premises you sell, give away or abandon, if
the "property damage" arises out of any part
of those premises;
(3) Property loaned to you;
(4) Personal property in the care, custody or
control of the insured;
(5) That particular part of real property on which
you or any contractors or subcontractors
working directly or indirectly on your behalf
are performing operations, if the "property
damage" arises out of those operations, or
(6) That particular part of any property that must
be restored, repaired or replaced because
"your work" was incorrectly performed on it.
Paragraphs (1), (3) and (4) of this exclusion do
not apply to "property damage" (other than
damage by fire) to premises, including the con-
tents of such premises, rented to you. A separate
limit of insurance applies to Damage To Prem-
ises Rented To You as described in Section III
— Limits Of Insurance.
Paragraph (2) of this exclusion does not apply if
the premises are "your work" and were never
occupied, rented or held for rental by you.
Paragraphs (3), (4), (5) and (6) of this exclusion
do not apply to liability assumed under a side-
track agreement.
Paragraph (6) of this exclusion does not apply to
"property damage" included in the "products -
completed operations hazard".
Paragraph 6. of LIMITS OF INSURANCE (Section 111)
is replaced by the following:
6. Subject to 5. above, the Damage To Premises
Rented To You Limit is the most we will pay un-
der Coverage A for damages because of
"property damage" to any one premises, while
rented to you, or in the case of damage by fire,
while rented to you or temporarily occupied by
you with permission of the owner.
The Damage To Premises Rented To You limit is the
higher of the Each Occurrence Limit shown in the
Declarations or the amount shown in the Declarations
as Damage To Premises Rented To You Limit.
WHO IS AN INSURED — MANAGERS
The following is added to Paragraph 2.a. of WHO 1S
AN INSURED (Section 11):
Paragraph (1) does not apply to executive officers, or
to managers at the supervisory level or above.
SUPPLEMENTARY PAYMENTS — COVERAGES A
AND B — BAIL BONDS — TIME OFF FROM
WORK
Paragraph 1.b. of SUPPLEMENTARY PAYMENTS —
COVERAGES A AND B is replaced by the following;
b. Up to $3,000 for cost of bail bonds required
because of accidents or traffic law violations
arising out of the use of any vehicle to which
the Bodily Injury Liability Coverage applies.
We do not have to furnish these bonds.
Paragraph 1.d. of SUPPLEMENTARY PAYMENTS
COVERAGES A AND B is replaced by the following
d. All reasonable expenses incurred by the in-
sured at our request to assist us in the in-
vestigation or defense of the claim or "suit ",
including actual loss of earnings up to $500
a day because of time off from work.
EMPLOYEES AS INSUREDS — HEALTH CARE
SERVICES
Provision 2.a.(1)(d) of WHO IS AN INSURED (Section
(I) is deleted, unless excluded by separate endorse-
ment.
EXTENDED COVERAGE FOR NEWLY ACQUIRED
ORGANIZATIONS
Provision 3.a. of WHO IS AN INSURED (Section 11) is
replaced by the following:
a. Coverage under this provision is afforded
only until the end of the policy period.
EXTENDED "PROPERTY DAMAGE"
Exclusion a. of COVERAGE A (Section 1) is replaced
by the following:
a. "Bodily injury" or "property damage" expected
or intended from the standpoint of the insured.
This exclusion does not apply to "bodily injury"
or "property damage" resulting from the use of
reasonable force to protect persons or property.
CG 76 35 02 07 Page 3 of 4 EP
EXTENDED DEFINITION OF BODILY INJURY
Paragraph 3. of DEFINITIONS (Section V) is replaced
by the following:
3. "Bodily injury" means bodily injury, sickness or
disease sustained by a person, including mental
anguish or death resulting from any -of these at
any time.
TRANSFER OF RIGHTS OF RECOVERY
The following is added to Paragraph 8. Transfer Of
Rights Of Recovery Against Others To Us of COM-
MERCIAL GENERAL LIABILITY CONDITIONS (Sec-
tion IV):
We waive any rights of recovery we may have against
any person or organization because of payments we
make for injury or damage arising out of your ongoing
operations or "your work" done under a contract with
that person or organization and included in the
"products - completed operations hazard ". This waiver
applies only to a person or organization for whom you
are required by written contract, agreement or permit
to waive these rights of recovery.
AGGREGATE LIMITS OF INSURANCE — PER
LOCATION
For all sums which the insured becomes legally obli-
gated to pay as damages caused by "occurrences"
under COVERAGE A (Section 0, and for all medical
expenses caused by accidents under COVERAGE C
(Section 1), which can be attributed only to operations
at a single 'location ":
Paragraphs 2.a. and 2.b. of Limits of Insurance (Sec-
tion III) apply separately to each of your "locations"
owned by or rented to you,
"Location" means premises involving the same or
connecting lots, or premises whose connection is
interrupted only by a street, roadway, waterway, or
right -of -way of a railroad.
INCREASED MEDICAL EXPENSE LIMIT
The Medical Expense Limit is amended to $10,000.
KNOWLEDGE OF OCCURRENCE
The following is added to Paragraph 2. Duties In The
Event Of Occurrence, Offense, Claim Or Suit of
COMMERCIAL GENERAL LIABILITY CONDITIONS
(Section IV):
Knowledge of an "occurrence ", claim or "suit" by
your agent, servant or employee shall not in itself
constitute knowledge of the named insured unless an
officer of the named insured has received such notice
from the agent, servant or employee.
UNINTENTIONAL FAILURE TO DISCLOSE ALL
HAZARDS
The following is added to Paragraph 6. Representa-
tions of COMMERCIAL GENERAL LIABILITY CONDI-
TIONS (Section IV):
If you unintentionally fail to disclose any hazards ex-
isting at the inception date of your policy, we will not
deny coverage under this Coverage Form because of
such failure. However, this provision does not affect
our right to collect additional premium or exercise our
right of cancellation or non - renewal.
LIBERALIZATION CLAUSE
The following paragraph is added to COMMERCIAL
GENERAL LIABILITY CONDITIONS (Section IV):
10. If a revision to this Coverage Part, which would
provide more coverage with no additional pre-
mium, becomes effective during the policy period
in the state shown in the Declarations, your pol-
icy will automatically provide this additional cov-
erage on the effective date of the revision.
01 I1 w J 4),4 k 6ijjI
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