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PROOF OF INSURANCE (2005) CLOSEDr1,A► A A! A I Kit% wient *-ac ,3o - ACORN„ CERTIFICATE OF LIABILITY INSURANCE 10/01104DnY> - THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION PRODUCER Dealey, Renton & Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 199 S Los Robles Ave Ste 540 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Pasadena, CA 91101 INSURERS AFFORDING COVERAGE 626 844 -3070 — INSURED X COMMERCIALGENERALLIABILITY INSURER A: United States Fidelity & Guaranty INSURER B Zurich American Insurance Co. _ CWA, AIA, Inc. MED EXP (Any one person)_ INSURER C:_ 320 Arden Avenue, Suite 210 —]CLAIMS MADE n OCCUR INSURER D: —_-- —_- Glendale, CA 91203 INSURER E: $2 OOO 000__ ___ t:UvCMALMCco POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING THE CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR ANY REQUIREMENT, TERM 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. - -- - -- - POLICY EFFECTIVE POLICY EXPIRATION INSR TYPE OF INSURANCE POLICY NUMBER DATE MM /DD/YY DATE MM/DD/YY LIMITS A GENERAL LIABILITY BKO1221277 10/09/04 10/09/05 EACH OCCURRENCE $2 000,000 FIRE DAMAGE (Any one tire) $1,000,000 X COMMERCIALGENERALLIABILITY MED EXP (Any one person)_ $10,000 —]CLAIMS MADE n OCCUR PERSONAL & ADV INJURY $2 OOO 000__ ___ J $4000,00 -GENERAL-AGGREGATE PRODUCTS - COMP /OPAGG $4,00_0,000 — GEN'LAGGREGATELIMITAPPLIESPER: POLICY PEOT LOC A AUTOMOBILE LIABILITY BK01221277 10109/04 10/09/05 COMBINED SINGLE LIMIT $2,000,000 (Ea accident) ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS — - BODILY INJURY X HIRED AUTOS $ X j NON -OWNED AUTOS Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT ----- $ - ANY AUTO EA ACC OTHER THAN $ 1 AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ -- - -- AGGREGATE 1 OCCUR CLAIMS MADE $ $ DEDUCTIBLE $ WC STATU- OTH- RETENTION $ $ WORKERS COMPENSATION AND _ _ ER- TORY LIMIT _ E.L. EACH ACCIDENT $ EMPLOYERS' LIABILITY E L DISEASE -_EA EMPL ,$ � E.L. DISEASE - POLICY LIMIT $ B OTHER Professional E00508782300 10/03/04 10/03/05 $1,000,000 per claim Liability $2,000,000 annl aggr. DESCRIPTION OF OPERATION S /LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS City of El Segundo, its officers, officials, employees and volunteers are named as additional insured as respects general liability for claims arising from the operations of the named insured. Waiver of subrogation applies for workers' compensation coverage. GERTIFICAItnUI_UCM AoU111U14AL1N5UneU;maUnenL=11— _- SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of El Segundo DATE THEREOF, THE ISSUING INSURER WILL IEMRRfQftMX PMAIL30__._DAYSWRITTEN City Clerk's Office NOTICETOTHE CERTIFICATE HOLDERNAMED TOTHE LEFT, BK30ftl=7ifi!AA16RAKJ=X 350 Main Street, Room 5 w�eiC>sX # �tIKpCX1iR1C4C1( 71KOC7QR4iDCxOCOCk467QRRRJOl6Mt9 [4CX El Segundo, CA 90245 -3895 XXFSM o X AUTH IZED REPRESENTATIVE �+Ae9n f�ASffA0AT1A61 i�QO ACORD 25 -S (7/97)1 of 1 #M112304 r I nn r I � /lL 1/ Policy Number: BKO1221277 Owners Lessees or Contractors (Form B) ADDITIbNAL INSURED Change(s) Effective: 10 / 01 / 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance policy under the following: LIABILITY COVERAGE PART: Schedule Name of Person or Organization: City of El Segundo City Clerk's Office 350 Main Street, Room 5 El Segundo, CA 90245 -3895 SECTION II - WHO IS AN INSURED 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 work" for that insured by or for you. City of El Segundo, its officers, officials, employees and volunteers are named as additional insured as respects general liability for claims arising from the operations of the named insured. PRIMARY INSURANCE: IT IS UNDERSTOOD AND AGREED THAT THIS INSURANCE IS PRIMARY AND ANY OTHER INSURANCE MAINTAINED BY THE ADDITIONAL INSURED SHALL BE EXCESS ONLY AND NOT CONTRIBUTING WITH THIS INSURANCE. SEVERABILITY OF INTEREST: IT IS AGREED THAT EXCEPT WITH RESPECT TO THE LIMIT OF INSURANCE, THIS COVERAGE SHALL APPLY AS IF EACH ADDITIONAL INSURED WERE THE ONLY INSURED AND SEPARATELY TO EACH INSURED AGAINST WHOM CLAIM IS MADE OR SUIT IS BROUGHT. CL /BF 22 40 03 95 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" needs to be completed only when this endorsement is issued subsequent to preparation of the policy.) This endorsement forms a part of Policy No. Issued to: CWA, AIA, Inc. By Premium (if any) TBD We have a right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us). You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2 -5% of the California workers compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description City of E1 Segundo Waiver applies for: City of El Segundo, City Clerk's Office its officers, officials, employees and 350 Main Street, Room 5 agents. E1 Segundo, CA 90245 -3895 WC 04 03 06 (Ed. 4 -84) Countersigned by Authorized Representative - -- --- ••v• aye: vva-vvs CERTIFICATE OF LIABILITY INSURANCE DATE .A�� PRODUCER 818 - 662 -4272 FAX 714 - 278 -9472 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Knight Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 53S N Brand 10th Floor HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Glendale, CA 91203 Marie G. Swaney Mari eS@arinsurance. con INSURERS AFFORDING COVERAGE NAIC # INSURED Charles Walton Associates AIA, Inc. 320 Arden Ave 8210 ff �}} Glendale, CA 91203 -0000 W NSURERA Preferred Employers Insurance POLICY EXPIRATION INSURERS INSURER C GENERAL LIABILITY INSURER D FAX (818) 546 -8503 INSURER E. I nt rVLrc,Its Vr INSUKA NUI: LISTED BELOW NAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. IIJOR ADDIL TYPE OF INSURANCE POLICY NUMBER POLICY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES IF, m—rm-) $ CLAIMS MADE OCCUR WED EXP (Any one person) S PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GENL AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG S POLICY jE —] LO AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILYIFlATRY S SCHEDULED AUTOS (Per person) FIRED AUTOS N09OWNED AUTOS BODILYII"RY (Per accident) $ PROPERTYDAMAGE S (Per accident) GARAGE LIABILITY AUTO ONLY- EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY qGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE S OCCUR 71 CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION AM WKNI177482 09/01/2004 09/01/200S X I TORYUMRS OTI ER EMPLOYERS' LIABILITY AS EVIDENCE ONLY E L. EACH ACCIDENT $ 1,000, A AWPROPRIETOR,PARTNERRECUTIVE OFF ICERMIEMBER EXCLL ED" If describeunder E.L. DISEASE - EA EMPLOYEE S j QQ0 1,000, E.L. DISEASE - POLICY LIMIT $ j QQQ SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS AWED BY EHDORSEMENTI SPECIAL PROVISIONS roject #23800.00 - E1 Segundo Library Remodeling ihould the above described policy cancel before the expiration date thereof, the issuing company will it with 30 days written notice to the certificate holder named to the left. Except 10 days for non - payment or non - submission of payroll RTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE City of El Segundo EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL *)WjMyj6IAIL El Segundo Library Remodeling 30" DAYS WRRTENNOTTCETO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Attn: 3udy Ramirez KVLMUMWUWJMMXWKUMON)oKVAXVVAXVWWXXXXX 350 Main St Rm #S XXXXX El Segundo, CA 90245 -3895 [ALq ORIZED REPRESENTATIVE rie Swane W Acuku zs (z00110B) OACORD CORPORATION 1988 310-