PROOF OF INSURANCE (2007) CLOSEDW,d
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ACOM. CERTIFICATE OF LIABILITY INSURANCE
DATE (MWUWYY)
6122/2006
PRODUCER ZAMANI INSURANCE AGENCY
23030 LAKE FOREST DR
THIS CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
SUITE 207
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
LAGUNA HILLS CA 92653
(949) 707 -0303
wslTieEO
CARE FOR THE CHILDREN
INSURERA; BANKERS INSU_ RANCE COMPANY
INSURER B: AIG Re - . —
ROBERT GENE HENDERSON
INSURERC; GMAC
INSURER b:
P.O. BOX 3144
WHrrTIgR CA 90605
INSURER E:
r -Cc
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.
L7R
TYM OF INSURANCE
POLICY NUMBER
DAB
DATE MMID
V T`
A
GENERALLIABIIITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE I A] OCCUR
04- 0048006160-7 -00
6/12/2006
6/12/2007
EACH OCCURRENCE
S 1,000,000
FIRE DAMAGE (Arty arm
S 100,000
_fm)�
MED EAP (Any one person)
PERSONAL s ADV INJURY
S 51000
S 1,000,000
�..
GENERAL AGGREGATE
$ 1,000,000
GEWL AGGREGATE LIMIT APPLIES PER;
POLICY 7 T LOC
PRODUCT$ - COMP /OP AGG
S 1,000,000
C
AUTOMOBLE
UAWUTY
ANY AUTO
ALL OWNED AUTOS
SCHEDULEDAUT06
HIRED AUTOS
NON -OWNED AUTOS
2862775
6/17/2006
12/17/2006
COMBINED SINGLE LIMIT
(Ee ecadenp
S
g 255,000
BODILY INJURY
(Per person)
80DILYINJURY
(Per acoldent)
S 550,000
PROPERTY DAMAGE
(Per aWdent)
S 25,000
MRAOi LIAWUTY
ANY AUTO
AUTO ONLY - EA ACCIDENT_
3
OTHER THAN EAACC
AUTO ONLY: AGO
$
$
EXCESS LUIBIUTY
OCCUR ED CLAIMS MADE
DEDUCTIBLE
RETENTION S
EACH OCCURRENCE
$
AGGREGATE
E
3
B
WORRER8 COIAPiN8AT10N AND
EMPLOYERV LIANUTr
75102
11/4/2005
11/2/2006
WC STATU
X TORY LIMITS,. ,., ER
E,E.L. EACH ACCIDENT
E.L.
-
s 1,000,000
DISEASE - EA EMPLOYEE
$ 1,000,000
El. DISEASE - POLICY LIMIT
$ 1,000,000
OTNDt
-7
DESCRIPTION OF OPLMtMWLOCA'nONWEMLEVEXCLUSIONS Anorn BY ENpoRBEMENTIBPECIAL PROVISIONe
r-mm-n IrATe NAI nPR I I AoeITIONALN6URED:NSURER11-ETTER: CANCELLATION
1
CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS,
EMPLOYEES, AGENTS & CERTIFIED VOLUNTEERS
CHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE GRPIRATION
OATS THEREOF, THE IBSUNO INSURER WILL dME t TO MAIL 30 DAYS t+rmrm
1001106 TO THE CCRTIFICATEHOLDER NAMED 70 THE LEFT,
ATTN: PUBLIC WORKS DIRECTOR
350 MAIN STREET
EL 5EGUNDO CA 90245 -3813
AUTHORl2ELTATI
REPRESEN
ACORD 25-S (7197) 0 AUM cvRPVliAnvTY Taub
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BGL 99.001 0705 1005
Bankers Insurance Company 04- 0031039
St. Petersburg, Florida 33701 9/26/06
5000 00000 VEGA GL AMENDED DECLARATIONS PAGE
Vector
EFFECTIVE: 9/25/06
Page 1 of 2
9/26/06
From: 6/12/06 To: 6/12/07 12:01 Standard Time 1 12 mos 6/12/AO 12:01 AM 04-00310391,(800)888-9891
At the insured's mailing address shown below:
Agent (800) 868 -9891
AMERICAN TEAM MANAGERS CARE FOR THE CHILDREN
1030 N ARMANDO ST RG HENDERSON
ANAHEIM CA 92806 11418 FIDEL AVE
WHITTIER CA 90605 -3504
In return for the payment of the premium, and subject to all the terms of this policy, we agree with you to provide the insurance
as stated in this policy.
General Aggregate LLsit (Other Than Product Completed upera[ions) -?1,vvv,vw
Products /Completed Operations Limit $1,000,000
Peraonal Advertising Injury Limit $1,000,000
Each Occurrence Limit $1,000,000
Fire Damage Limit (Any One Fire) $100,000
Medical payments Limit (Any One Person) $5,000
Property Damage Liability Deductible Per Claim $1,000
Form of Business:
❑ Individual ❑ Joint Venture ❑ Partnership Organization (Other than Partnership or Joint Venture)
Business Description:
PARKING AND DRIVEWAY CURB NUMBERING SERVICE
THIS POLICY CONTAINS A DESIGNATED WORK ENDORSEMENT. DAMAGES RESULTING FROM WORK OR OPERATIONS
WHICH ARE NOT SPECIFIC AND CUSTOMARY TO THE CLASSIFICATION SHOWN OR OTHERWISE LISTED IN THE
ENDORSEMENT AS EXCLUDED ARE NOT COVERED ON THIS POLICY.
CG 21 46 1093 1093
CG
20 10 0704 0505
BGL
04.333 0798
BGL
99.335 0704
IL 02 70 1296 1296
IL
00 17 1185 1185
CG
03
00
0196
0196
CG
21 47 1093 1093
BGL 99.300 0597
BGL
04.331 0304
CG
00
01
0196
0196
BGL
04.335 0798
BGL 99.301 1195
BGL
99.306 1095
IL
00
21
1185
1185
BGL
04.200 0203
BGL 99.336 0798
BGL
04.334 0798
BGL 99.304 0597
CL
175 0286 0286
BXXX99.207 0202
IL
09 85 0103 0403
CG
21
49
0196
0196
CG
21 70 1102 0403
CG 21 96 0305 0505
CG
00 67 0305 0505
CG
21
86
1204
0505
CG
21 67 1204 0505
BXXX99.206 0305
Countersigned by Authorized Representative
Copies Sent To: As Indicated On The Back
00310390400480061600626900004
Imaged
9/25/06
Date
ro /22'd 9998 009 6b6 QN390 39NONnSNI INOWOZ ES:TT 9002- LZ -d3S
&0'd i96 EaIMNOIIVN T9: TT 9002- LZ -d21S
BGL 99.001 0705 1005
Bankers Insurance Company 04- 0031039
St. Petersburg Florida 33701 9/26/06
R&N a MOUP 5000 00000 VEGA GL AMENDED DECLARATIONS PAGE
e
Vector
EFFECTIVE: 9/25/06
Page 2 of 2
9/26/06
Code # 1Jescri lion
92215 - DRIVEWAY, PARKING AREA OR SIDEWALK - INCLUDES POURING, PLACING 6 FINISHING OF
ABOVE -GRAM CONCRETE FLATWORK, ASPHALT 01 PAVER INSTALLATION. NO STREET OR ROAD
WORK. NO EXCAVATION.
Code Premium Base Pr /Co All Other I Pr /Co All Other
92215 1 Full -Time Incl.
1 Part -Time Incl.
Policy Fee
Total Advanced Premium
Total Changed Premium
Total Changed Fees
Terrorism Premium (Certified Acts)
$10213.00 Incl.
$404.00 Incl.
$1.,213.00
$404.00
$250.00
$1,867.00
$.00
$.00
$.00
IMPORTANNT NOTICE TO POLICYHOLDERS - Subcontract Work
If you subcontract work, you must obtain a Certificate of Insurance showing limits that are at least equal to
or greater than those on your policy. Operations performed by subcontractors without adequate insurance shall
be classified and rated in the same manner as though the work was performed by your own employees.
00310340400480061600626900004
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Addl Insured
CITY OF CYPRESS
5275 ORANGE AVE
CYPRESS CA 90630 -2957
Contractors Form B
Addl Insured
CITY OF FULLERTON
303 W COMMONWEALTH AVE
FULLERTON CA 92832 -1710
Contractors Form B
Addl Insured
CITY OF STANTON
7800 RATELLA AVE
STANTON CA 90680 -3123
Contractors Form B
00310390400480061600626900004
b0ib0'd 9998 009 GV6
3G I Mx0I lvN T 9: T T 9003- LZ -d3S
BGL 99,001 0705 1005
04- 0031039
Addl Insured
CITY OF EL SEGUNDO, ITS OFFICERS,OFFICAL
S,EMPLOYEES, AGENTS,& CERT VOLUNTEERS
350 MAIN ST RK 5
350 MAIN ST RM. 5
EL SEGUNDO CA 90245 -3813
Contractors Form B
Addl Insured
CITY OF LA HABRA
GENERAL DELIVERY
201 E LAHABRA BLVD
LA HABRA CA 90631 -9999
Contractors Form B
Lender
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Imaged
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