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PROOF OF INSURANCE (2009) CLOSEDACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 5/12/2009 PRODUCER (714) 731 -7700 FAX: (714) 731 -7750 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Cornerstone Specialty Insurance Services, Inc. P Y ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 14252 Culver Drive, A299 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. AUTHORIZED REPRESENTATIVE _ Irvine CA 92604 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA: Travelers Prop. Cas . Co. BLACK O'DOWD & ASSOCIATES, INC., INSURER B: Travelers Casualty Co. INSURER c: Everest National Ins Co. DBA: BOA ARCHITECTURE INSURER D: 279 W. Seventh Street INSURER E: San Pedro CA 90731 -3321 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. kTE LIMITS SHOWN MAY HAVE BEE 4 REDUCED BY PAID CLAIMS, INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDD/YY LIMITS GENERAL LIABILITY EACH RRENC $ 1 r 000 r 000 DAMAGE TO RENTED $ 300 , 000 A X X COMMERCIAL GENERAL LIABILITY CLAIMS MADE ❑X OCCUR 680- 6127L881 -08 11/20/2008 7ATEDD MED EXP An one arson $ 5,000 PERSONAL &ADVINJURY $ 1,000,000 • Addtl Insrd /Primary AS PER FORM MCGD3810907 • Wwr of Subrogation GENERAL AGGREGATE $ 2,000,000 AS REQUIRED BY WRITTEN GEN'L AGGREGATE LIMIT APPLIES PER: $ 2,000,000 CONTRACT POLICY X PRO LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ A ALL OWNED AUTOS SCHEDULED AUTOS 680- 61271,881 -08 11/20/2008 11/20/2009 BODILY INJURY (Per accident) $ X HIREDAUTOS X NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE 2 , 000 , 000 X OCCUR 7 CLAIMS MADE AGGREGATE $ 2,000,000 $ A DEDUCTIBLE CUP- 768SY478 -08 11/20/2008 11/20/2009 RETENTION B WORKERS COMPENSATION AND X I IWC STATUS OTH- EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE " E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE$ 1,000,000 OFFICER/MEMBEREXCLUDED? XSUB- 5840Y53 -1 -09 5/1/2009 5/1/2010 If yes, describe under PROVISIONS SPECIAL low E.L. DISEASE -POLICY LIMIT $ 1,000,000 C OTHER PROFESSIONAL 48AE000462 -081 11/20/2008 11/20/2009 EACH CLAIM $1,000,000 LIABILITY ANNUAL AGGREGATE $2,000,000 Claims Made DESCRIPTION OF OPERATIONS /LOCATIONS/VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS The City of E1 Segundo, its officers, agents and employees are Additional Insured for General Liability but only if required by written contract with the Named Insured prior to an occurrence and as per attached endorsement. Coverage is subject to all policy terms and conditions. *Except 10 days notice of cancellation for non - payment of premium. For Professional Liability coverage, the aggregate limit is the total insurance available for all covered claims reported within the policy period. CFRTIFICOTF Fdnl nFR CANCFI_I_ATIAN ACORD 25 (2001108) INS025 (olos).oaa ; s(o 9 © ACORD CORPORATION 1988 Page 1 of 2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Public Works Department EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL MIX&9?(cAXXX MAIL El Segundo City Hall *30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, XXX 350 Main Street��XiXi4�%�i�XuKi�ol►YsX El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE _ Aimee L ue /AIMEEL -- ACORD 25 (2001108) INS025 (olos).oaa ; s(o 9 © ACORD CORPORATION 1988 Page 1 of 2 GENERAL LIABILITY ADDITIONAL INSURED ENDORSEMENT CITY OF EL SEGUNDO In consideration of the premium charged and notwithstanding any inconsistent statement in the policy4o which this endorsement is attached or any endorsement now or hereafter attached thereto, it is agreed as follows: 1. ADDITIONAL INSURED. The City of El Segundo, its officers, agents and employees are included as additional insured with regard to liability and defense of suits arising from "your work" performed by or on behalf of the named insured regardless of whether liability is attributable to the named insured or a combination of the named and the additional insured. 2. CONTRIBUTION NOT REQUIRED. Any other insurance maintained by the City of El Segundo is excess of this insurance and will not contribute with it. 3. SEVERABILITY OF INTEREST. This insurance applies separately to each insured against whom claim is made or suit is brought except with respect to the company's limits of liability. The inclusion of any person or organization as an insured does not affect any right which such person or organization would have as a claimant if not so included. 4. CANCELLATION NOTICE. With respect to the interests of the City of El Segundo, this insurance may not be canceled, reduced in coverage or limits or non - renewed, except after thirty (30) days prior written notice by REGISTERED OR CERTIFIED MAIL has been given to the Public Works Director of El Segundo addressed as follows: Public Works Department, El Segundo City Hall, 350 Main Street, El Segundo, CA 90245 5. APPLICABILITY. The insurance pertains to the operations and/or tenancy of the named insured under all written agreements in force with the City of El Segundo unless checked here ( ) in which case only the following specific agreements with the City of El Segundo are covered: S. MAILING ADDRESS: Completed endorsements shall be issued to the City of El Segundo as follows: PUBLIC WORKS DEPARTMENT El Segundo City Hall 350 Main Street El Segundo, CA 90245 7. CLAIMS: Underwriter's representative for claims pursuant to this insurance: Except as stated above, nothing herein shall be held to waive, alter or extend any of the limits, conditions, agreements, or exclusions of the policy to which this endorsement is attached. I Aimee La Rue (printltype name), warrant that I have authority to bind the below- listed insurance company and by my signature he o is�o endorsement G }� 8. Signature: Authorized Representative (original signature required on copy fumished to the City Attorney) TITLE: Account Manager 9. ORGANIZATION: Cornerstone Specially Insurallce Services, Inc. ADDRESS: 14252 Culver Drive, #A299 Irvine, CA 92804 TELEPHONE: (714) 731 -7700 (area code) (telephone number) Page I of 2 N TORM&NOTICE SKI (6128100) WP 10. Includes (check as applicable): (x) Broad Form Liability Endorsement (x) Broad Form Property Damage (x) Personal Injury (x) Independent Contractors (x) Premises and Operations (x) Explosion Hazard (x) Collapse /Underground Hazard (x) Products /Completed Operations () Watercraft Liability () Garagekeepees Legal Liability {) Incidental Medical Malpractice (x) Contractual Liability () Owned Automobiles (x) Non -Owned Automobiles (x) Hired Automobiles (x) Fire Legal Liability i) 11. Type Coverage: Commercial General Liability 12. Limits of Liability: $1,000,000 each occurrence 1 $2,000,000 general aggregate 13. Policy Period: From: 1112012008 To: 11120/2009 14. ( ) Deductible () Self- insured Retention (check which) of $ N/A applies to coverage. () Per Claim () Per Occurrence 15. Other provisions: 16. Names Insured and Address: BOA Architecture, 279 W. Seventh Street, San Pedro, CA 90731 17. Insurance Company: Travelers Property Casualty Co 18. Policy Number: 680- 6127L881 -08 19. Endorsement Number: 1 20. Effective Date of Endorsement: May 12, 2009 Page 2 of 2 N TORMSiNOTICE C3K2 (6128M) WP