PROOF OF INSURANCE (2006) CLOSEDAC -ORQ, CERTIFICATE OF LIABILITY INSURANCE 7
DAM
06/28/20061
PRODUCER (714) 731 -7700 FAX (714) 731 -7750
Cornerstone Specialty Insurance Services, Inc.
14252 Culver Drive, A299
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.
INSURERS AFFORDING COVERAGE
NAIC #
Irvine, CA 92604
-- - - — -
INSURED
BOA ARCHITECTURE
279 West Seventh Street
INSURERA: Fidelit y & Guaranty Insurance
INSURERS St. Paul Protectiv Co.
-
INSURERC Everest National I e
San Pedro, CA 90731 -3321
INSURER D.
INSURER E:
11/20/2005
11/20/2006
EACH OCCURRENCE
OVtKAUL -
OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
THE POLICIES
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE TE MAY BE ISSUED NS OF SUCH
EXCLUSIO
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
DD'
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
POLICY EXPIRATION
LIMITS
GENERAL LIABILITY
BKO1950347
11/20/2005
11/20/2006
EACH OCCURRENCE
$ 1, 000, 00
DAMAGE RENTED
$ 300 000
X COMMERCIAL GENERAL LIABILITY
MED EXP (Any one person)
$ 10,000
CLAIMS MADE I '� OCCUR
A
-- -
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP /OP AGG
$ 2,000,000
POLICY X jECOT LOC
AUTOMOBILE
LIABILITY
BKO1950347
11/20/2005
11/20/2006
COMBINED SINGLE LIMIT
$
(Ea accident)
1,000,000
ANY AUTO
—
BODILY INJURY
ALL OWNED AUTOS
$
(Per person)
A
SCHEDULED AUTOS
- ____ --
X
HIRED AUTOS
BODILY INJURY
$
NON -OWNED AUTOS
(Per accident)
X
PROPERTY DAMAGE
$
- —
(Per accident)
GARAGE LIABILITY
AUTO ONLY- EA ACCIDENT
$
OTHER THAN - EA ACC
- - --
ANY AUTO
$ - --
-
- - - -- ----- - -
$
-
AUTO ONLY: AGG
EXCESSIUMBRELLA LIABILITY
BKO1950347
11/20/2005
11/20/2006
EACH OCCURRENCE
$ 2,000,000
_
AGGREGATE
$
OCCUR D CLAIMS MADE
___2,000,000
- --
A
-- —
—
$ —-
DEDUCTIBLE
— -
-
$
RETENTION $
BW02182119
05/01/2006
05/01/2007
X WC srnru-
�__
WORKERS COMPENSATION AND
EMPLOYERS' LIABI LITY
E.L. EACH ACCIDE
000 , 000B
ANY PROPRIETOR /PARTNER/EXECUTIVE
OFFiCEiVMLMoER EXCLUDLD?
-
E.L. DISEASE - EA EMPLOYE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT $ 1,000,000
If yes, describe under
SPECIAL PROVISIONS below
OTHF�t
48AE000462 -051
11/20/2005
11/20/2006
$1,000,000 Each Claim
ProYessional Liability
$2,000,000 Annual Aggregate
C
$5,000 Deductible per Claim
D €SCRIPTI N O OPERATIONS /LOCATIONS 1 V HICLES / EXCLUSIONS ADDED Y END RSEMENT I SPECIAL P YISIQNS
qty ofi 0T Segundo, its officers, agents and employees are Additional Insured for General Liability but
m y if required by written contract with the Named Insured prior to an occurrence and as per coverage
form CL/BF26090903. Coverage is subject to all policy terms and conditions. *Except 10 days Notice of
ancellation for non - payment of premium. For Professional Liability coverage, the aggregate limit is
he total insurance available for all covered claims reported within the policy period.
Public Works Department
E1 Segundo City Hall
Attn: Paul Bowen
350 Main Street
E1 Egundo, CA 90245
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL *)INIXON01 MAIL
*30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT:
AUTHORIZED REPRES
Aimee La Rue
0 l C -Icw
1981
The ST. PAUL COMPANIES ENDORSEMENT FOR
ARCHITECTURE AND ENGINEERING FIRMS
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the following:
1. THE FOLLOWING IS ADDED TO THE BUSINESS OWNERS LIABILITY COVERAGE FORM:
ADDITIONAL INSURED -- BY CONTRACT, AGREEMENT OR PERMIT
City of El Segundo, its officers, agents and employees
350 Main Street
El Segundo, CA 90245 -3895
Item 5. of Section C. WHO IS AN INSURED, is deleted and replaced by the following:
Any person or organization (named shove) to whom or to which you are obligated by virtue of a written
contract, agreement or permit to provide such insurance as afforded by this policy is an insured, but only
with respect to liability arising out of:
a. "Your work" for that insured by you, including work or operations performed on your behalf for that
insured;
b. Permits issued by state or political subdivision for operations performed by you; or
c. Premises you own, rent, occupy or use.
This provision does not apply unless the written contract or agreement has been executed, or the permit
has been issued, prior to the "bodily injury," " property damage," "personal injury" or "advertising injury."
This provision does not apply to any person or organization included as an insured under Additional
Insured — Vendors.
This insurance is primary and is not additional to or contributing with any other insurance carried by or
for the benefit of Additional Insureds.
2. Separation of Insureds:
Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this policy to the
first Named Insured, this insurance applies:
a. As if each Named Insured were the only Named Insured; and
b. Separately to each insured against whom claim is made or "suit" is brought.
Nothing herein contained shall vary, alter or extend any provision or condition of the Policy other than as above stated.
NAMED INSURED: BOA ARCHITECTURE L1.��""�,, ""n�,, POLICY NO: BKO1950347
The ST. PAWLl l MEWS
Authorized Signature: ' Aimee LaRue
ISSUED: June 28, 2006
Notice of Cancellation
1. If we cancel this policy for any reason other than non - payment of premium, we will mail written notice at
least 30 days before the effective date of cancellation to the Additional Insured on file with the Company.
2. If we cancel this policy for non - payment of premium, we will mail written notice at least 10 days before the
effective date of cancellation to the Additional Insureds on file with the Company.