PROOF OF INSURANCE (2005) CLOSED` G
TIMATE OPIN URANCE CERTIFICATE NUMBER "
LOS- 000433840 -04
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
`RODUCER
t Marsh Risk & Insurance Services
NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE
777 South Figueroa Street
POLICY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
CA License #0437153
AFFORDED BY THE POLICIES DESCRIBED HEREIN.
Los Angeles, CA 90017
Attn: Lori Bryson (213)- 346 -5464
COMPANIES AFFORDING COVERAGE
COMPANY
6510 - AECOM- CAS -2004 CBA JWHIT PASAD CA
A ACE American Insurance Company
INSURED
COMPANY
COTTON /BRIDGES /ASSOCIATES
B
A DIVISION OF P &D CONSULTANTS
800 E. COLORADO BLVD., SUITE 270
COMPANY
PASADENA, CA 91101
C Illinois Union Insurance Company
COMPANY
D N/A
te-:suedes:and:rtpiacwss arse peuiousry issued csttN{c:farihs policy:pe>iact nati #tavi+
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY
PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS AND EXCLUSIONS OF SUCH POLICIES. AGGREGATE
LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MM /DDNY)
POLICY EXPIRATION
DATE (MM /DD/YY)
LIMITS
A
GENERALLIABILITY
HDO G20591365
04/01/04
04/01/05
GENERAL AGGREGATE
$ 2,000,000
X
COMMERCIAL GENERAL LIABILITY
PRODUCTS - COMP /OP AGG
$ 4,000,000
CLAIMS MADE I OCCUR
PERSONAL & ADV INJURY
$ 2,000,000
EACH OCCURRENCE
$ 2,000,000
OWNER'S & CONTRACTOR'S PROT
FIRE DAMAGE (Any one fire)
$ 1,000,000
MED EXP (Any one parsO n
$ 5,000
A
AUTOMOBILE
LIABILITY
ISA H07850451
04/01/04
04/01/05
COMBINED SINGLE LIMIT
$ 1,000,000
X
A
ANY AUTO
CAL H0785058A
04/01/04
04/01/05
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN AUTO ONLY:
ANY AUTO
EACH ACCIDENT
$
AGGREGATE
$
EXCESS LIABILITY
EACH OCCURRENCE
AGGREGATE
$
UMBRELLA FORM
$
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
TORY LIMITS ER
EL EACH ACCIDENT
_
$
THE PROPRIETOR/ INCL
PARTNERS /EXECUTIVE
OFFICERS ARE: EXCL
EL DISEASE - POLICY LIMIT
$
EL DISEASE -EACH EMPLOYEE
$
C
OTHER
EON G21654693 001
04/01/04
04/01/05
$1,000,000
ARCHITECTS & ENG.
" "'CLAIMS MADE" "'
PER CLAIM /AGGREGATE
PROFESSIONAL LIAB.
DEFENSE INCLUDED
DESCRIPTION OF OPERATION S /LOCATIONSNEHICLES /SPECIAL ITEMS
RE: Contract 3360 /THE CITY OF EL SEGUNDO, ITS OFFICALS, AND EMPLOYEES ARE NAMED AS ADDITIONAL INSURED FOR GL & AL
COVERAGES, BUT ONLY AS RESPECTS WORK PERFORMED BY OR ON BEHALF OF THE NAMED INSURED. SUCH INSURANCE AFFORDED SHALL
BE PRIMARY INSURANCE AND ANY INSURANCE CARRIED BY CERTIFICATE HOLDER & ADDITIONAL INSURED SHALL BE EXCESS AND NOT
CONTRIBUTORY INSURANCE FOR GL & AL COVERAGES.
CERTJFtCATE HOLDER
CANCELLATION
SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,
THE INSURER AFFORDING COVERAGE WALL ENDEAVOR TO MAIL _g0 DAYS WRITTEN NOTICE TO THE
CITY OF EL SEGUNDO
ATTN: PATTI KIGHT
CERTIFICATE HOLDER NAMED HEREIN, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
OFFICE OF THE CITY CLERK
LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE, ITS AGENTS OR REPRESENTATIVES, OR THE
350 MAIN STREET
EL SEGUNDO, CA 90245
ISSUER OF THIS CERTIFICATE.
MARSH USA INC.
� � �
BY: John F Wesley <K'.4
MM1(3102) VALID AS OF: 09/02/04
, ?gG v
POLICY NUMBER: HDO G20591365 COMMERCIAL GENERAL LIABILITY
CG 20 10 03 97
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 Person or Organization:
CITY OF EL SEGUNDO
OFFICE OF THE CITY CLERK
350 MAIN STREET
EL SEGUNDO, CA 90245
ITS OFFICIALS AND EMPLOYEES
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as
applicable to this endorsement.)
WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the
Schedule, but only with respect to liability arising out of your ongoing operations for that insured.
CG 20 10 03 97 Copyright, Insurance Services Office, Inc., 1996
sky-
POLICY NUMBER: ISA H07850451 COMMERCIAL BUSINESS AUTO LIAB.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
ADDITIONAL INSURED - DESIGNATED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL BUSINESS AUTO LIABILITY COVERAGE PART.
Name of Person or Organization: Schedule
CITY OF EL SEGUNDO ANY AUTO
OFFICE OF THE CITY CLERK
350 MAIN STREET
EL SEGUNDO, CA 90245
ITS OFFICIALS, AND EMPLOYEES
(If no entry appears above, information required to complete this endorsement will be
shown in the Declarations as applicable to this endorsement.)
WHO IS AN INSURED (Section II) is amended to include as an insured the person or
organization shown in the Schedule as an insured but only with respect to liability
arising out of your operations or premises owned by or rented to you.
CG 20 26 11 85
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SEP -14 -2004 1025 P &D CONSULTANTS
714 285 0102 P.021bS
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ISSUE DATE (MMIDDIYY)
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PRODUCER DM THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO
RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND.
Aon Risk Services, Inc. of Southern CaNf Dmia
707 Wilshire Boulevard, Suite 6000 EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
Los Angeles, California 90017
(213) 630 -3200 COMPANIES AFFORDING COVERAGE
COWART
LETM A Insurance Co. of the State of PA
CODE SUP -CODE COWART
B
INSURED Lump
Cotton/Bridges /Associates OO"'PA"Y C
800 East Colorado Blvd., Suite 270 LETTER
Pasadena, CA 91101 COWART
LETTER D
COMPANY E
LETTER
A
THIS IS TO CERTIFY THAT 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 16 SUBJECT TO ALL THE TERMS.
CLUSIONS, AND CoNpMON3 OF 3u CH POjJC THIE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CA
TYPE OF INSURANCE
POLICY NUMBER
POLICTEFFECTIYE
POLICY EXPIRATION
ALL LIMITS IN THOUSANDS
LTR
DATE LAINIOGIVVI
601E NC
OENERALLIABILITY
CEMBRA&ACCRECATE
f
COMMERCIAL GENERAL UAlnITY
PROORICT"OMPIOPS AGGREGATE
f
CLPJW Mw. OCCURRENCE
PEIUIO t AAOVHIT.SINC INAJM
s
p1ftNERE4COMTRAC1w-PROIEGIni
EACH OCCURRENCE
_
FOE OAAUGE 0" ONE FIRE)
MEOICAI EXPEMSE (ANY ONE PERS014
AUTOMOBILE LIABILm
AW AUTO
I:SL
SOOILY IWURT
ALL ORNEOAUTOS
(PER OER$nM1
3CMI I'm AVTOE
DOILY INJURY
::
HIRED AUTOS
NON -OWKD AUTO!
ACCIDENT)
GARAGE LIABILITY
PROPERTY OAAIACE
EXCESS LU1ELl IY
EACH
AGGR EGATE
OCCURRENCE
UMBRELA FORM
O'STATUTORY
OTHER TRAM UMBRELLA FORM
s
A
WORKERS' COMPENSATION
WCS21 24 60 (ACS)
4/1/2004
4/12005
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' 1'' ; •�,,IA
S 1.000 WACN ACOKNT)
A
AND
W C521 24 61 (CA)
41112004
4/12005
EMPLOYERS' LIABILITY
WC671 24 02 (WI)
4/1/2004
411P2005
6 1,000 OCEAN POLICYUMT)
6 1.00D @1EA4EEACHEMPLOYE19
OTHER
DESCRIPTION OF OPERATIONSILOCATWNSNEHICLES IRESTRICTIONSISPECIAL ITEMS: CeAW457
Contract k 3360
R
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE THE
,flu
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
City of Ell Segundo
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.
OIRce of the City Clerk
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
moo' Paid KAght
OF ANY KIND UPON THE COMPANY. ITS AGENTS OR REPRESENTATNES-
Street
AUTHORUED REPRESENTATIVE
E A BOAS
S Segundo.
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