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PROOF OF INSURANCE (2009) CLOSED( 5'� <,- 1 -.1) sx `LAZKf11-K;A1-tQF LIABILITY INSURANCE �� O'� THIS CERTIFICATE IS ISSUE DO i 310)798-6100 rAX: (310) 798-6151 Kinter-Buchanan Tnsurance Agency ONLY AND CONFERS NO F License Number: DE40872 HOLDER. THIS CERTIFICATE ALTER THE COVERAGE AFFOR 2041 Rosecrans Ave. Suite 245 undo CA 90245 El Se9 �-O--- INSURERS AFFORDING COVERAC INSURED IN;3UER A. Ft 4-F Christopher A. Jose ph & Associates INSURER a Ll of London 11,849 W. Olympic Blvd. Suite Jol INSURER C, Las Angeles CA 90064 a- ....... . .. INSURER E THE POLICIES OF INSURANCE —LISTED BELOW HAVE BEjN— ISSUED TO THE INSURED 11 -P-E- —THE NAMED ABOVE TO R POLICY RIOD INDICATED. 0. N07W THS TANDI NG ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUR)FCT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, ITV.CW�AAI—y Ayg _tr;F_N TO ALI, THE TERMS. E XCLUSIONS AND CONDITIONS OF SUCH POLICIES, r_ftWQaUkY_PAjaLjAjM.j INSR INSR ADD*L TYPEOF �POLCYNUMW�.R 1POLICY �EFFVCTIVF POLICY �EXPIRATION DATE MWOOM DATE MWDDIY LIMITS �11$11PAIICE GENERAL LIABILITY COMMERCiAL GENERAL CLAINIS MACE .AC�, ME 'D AGGREGATF. UMIT APKIES PER, --2- �EALAG�GREGATE_ PR f?QCY U f I J,,FT LO_ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANYAuTO (Es OCG4") ALL OWNED AU'ros i CIIHEOIIJI,EC; AUTOS @ 80();LYINJURY (Per Person) HQF0AijI'0S _j 1`404,OWNEl) AUTOS MOILY INJURY QPer acrvierd) L- ... -._... .. PROPERTY 0AMAGF GARAGELiASILITY A U'O �LN.LYL-t. Al-XC I C. ENI ANY AUTO OTHEIJ THAN ACC .T AUTO ONLY- AgG_$ EXCESWUMSRELLA LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY § 'STAILI- OTH• T E.L.,EACH ACCIDE:M,_,__ - Q 1,000,000 ANY F$ROPRtETORiPARTNER,EXEIt,"rIVC OFFICERVENI&ER, EXC.L1JCF,,0', O'� r El..DISFASE - EA EMPLOYE PLO �. 3 1 3 1,000,000 it �*s,er�scr�b* Wide' EIG 1040574-0 1 8/1/2008 8/1/2009 I �. SKQ1AL PR T Poo, 000 B OTHER F,.rr 11/21/2009 1/21/2010 $2,000,00t)pex $15,000 per c1 aim deductible DESCRIPTION OF OPERATIONS&OCATtONWVF141CLEWEXCLUSIONS ADDED BY ENDORSEVENTfSPECiAL PROI431ONS EvIdence of Coverage CERTIFICATE HOLDER --- - -- (310)322"4167 City of El Segundo Planning and Building Dept. Attn: Kimberly Christensen 350 Main Street El Segundo, CA 90245-3813 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL XAK%Y")W MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, AUTHORVED REPRESENTATIVE 4-ichael 19103/X]31 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) INS025 (moe).osa Page 2 of 2 ACOR , CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDNYYY) 1 03/19/2009 PRODUCER (626)795 -7059 FAX (626)792 -2321 FIA Insurance Services, Inc. 99 South Lake Avenue, #300 Pasadena, CA 91101 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 # INSURED Christopher A. Joseph & Associates 11849 W. Olympic Blvd, Ste 204 Los Angeles, CA 90064 INSURERA: Mitsui Sumitomo Ins Co of Amer A Attn • Kimberly Christensen INSURER B: GENERAL LIABILITY INSURER C: 08/01/2008 INSURER D: EACH OCCURRENCE INSURER E: DAMAGE TO RENTED Eatt 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 DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS Attn • Kimberly Christensen BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY GENERAL LIABILITY PKG3122016 08/01/2008 08/01/2009 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED $ 100,0001 X COMMERCIAL GENERAL LIABILITY MED EXP (Any one person) $ 10,00( CLAIMS MADE 1—i-I OCCUR PERSONAL & ADV INJURY $ 1,000,00( A GENERAL AGGREGATE $ 2,000,00( GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 1,000,00( T POLICY PRO ECT LOC J AUTOMOBILE LIABILITY ANY AUTO PKG3122016 08/01/2008 08/01/2009 COMBINED SINGLE LIMIT (Ea accidenQ $ 1,000,000 BODILY INJURY (Per person) $ A X X ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per acddent) $ PROPERTY DAMAGE (Per acddent) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ ANY AUTO $ EXCESS/UMBRELLA LIABILITY UMB5400382 08/01/2008 08/01/2009 EACH OCCURRENCE $ 5,000,00 AGGREGATE $ S,000,000 X OCCUR F] CLAIMS MADE $ A $ DEDUCTIBLE $ X RETENTION $ 10,000 WORKERS COMPENSATION AND WC S TATU- OTH- ER E.L. EACH ACCIDENT $ EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ If yes, describe under SPECIAL PROVISIONS below OTHER DESCRIPTION OF PERATIONS / LOCATIONS / VEHICL / EXCL SIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS he City o? E1 Segundo, its o icia�ls and employees are named as additionalinsured, but only as respects to operations of the named insured, as their interest may appear. This insurance is primary. *10 day notice in case of non - payment ^A klI 01 I ATIl kl ACORD 25 (2001/08) FAX: (310)322 -4167 ©ACORD CORPORATION 18!55 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL City of El Segundo 11,30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Planning & Bldg Dept Attn • Kimberly Christensen BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 350 Main Street OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIV/EESSS..�� AUTHORIZED REPRESENTATIVE y iKeiko El Segundo, CA 90245 -3813 Matsuoka KEIKO ACORD 25 (2001/08) FAX: (310)322 -4167 ©ACORD CORPORATION 18!55 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) POLICY NUMBER PKG3122016 COMMERCIAL GENERAL LIABILITY CG 2010 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or nizafJ s : Locations Of Covered Operaflons ON FILE WITH THE COMPANY ON FILE WITH THE COMPANY Information required to complete this Schedule if not shown above will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury ", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) desig- nated above. CG 2010 07 04 B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of 'your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a princi- pal as a part of the same project. 0 ISO Properties, Inc., 2004 AGENTS COPY Page 1 of 1 ❑ FIA INSURANCE SERVICES, INC. March 31, 2009 City of El Segundo Planning & Bldg Dept 350 Main Street El Segundo CA 90245 -3813 Re: Christopher A Joseph & Associates - #PKG3122016 & #UMB5400382 To Whom It May Concern: As a service to the insured, FIA Insurance Services, Inc., agrees to send copies of any cancellation notifications received in our office from the Mitsui Sumitomo Insurance Company of America to City of El Segundo, for the policies listed above. It is understood and agreed that in the event Mitsui Sumitomo issues 30 day notices of cancellation of the policy for any reason other than non - payment of premium, FIA Insurance Services, Inc will provide a copy, as soon as it is received in their office, to the City of El Segundo by mail. In the event Mitsui Sumitomo issues 10 day notice of cancellation for nonpayment of premium, FIA Insurance Services Inc., once a copy is received in their office, will send a copy to the City of El Segundo by mail. Notification(s) will be addressed to City of El Segundo at the address noted above. FIA Insurance Services, Inc. is NOT responsible for any delay in receiving copies of cancellation notices from Mitsui Sumitomo. Sincerely, Keiko I Matsuoka VP, Commercial Lines Manager FLINAKOSHI — ITO & ASSOCIATES 99 South Lake Avenue, Suite 300 • Pasadena, CA 91101 -2697 Tel: (626) 795 -7059 . Fax: (626) 792 -2321 . Lic. #0175794 . e -mail: mail @fia- insurance.com