PROOF OF INSURANCE (2010) CLOSEDOP ID AP
ACORD CERTIFICATE OF LIABILITY INSURANCE DUKES -1
DATE (MMroD/YYYYJ
12 17/08
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
McLaughlin -Kehoe Insurance
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Affordable Insurance
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
PO Box 130 / 225 W Manlius St.
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
LIMITS
East Syracuse NY 13057
Phone: 315- 437 -2821 Fax:315 -437 -5272
INSURERS AFFORDING COVERAGE NAIC #
INSURED
INSURER A- National airs Ina. co. of Hart
20478
INSURER B: Valle Forge Insurance CO
Dukes Root Control
Dukes Sales 6 Servicee, , Inc. &
1020 Hiawatha Blvd West
Syracuse NY 13204
INSURER C: The Hartford
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE FX] OCCUR
INSURER D: Continental Casualty
20443
INSURER E:
PREMISES Eaoccurence
COVERAGES
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.
BLTR
NSR
TYPE OF INSURANCE
POLICY NUMBER
DA E D
DATE MM/DD
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE FX] OCCUR
C6004239018
01/01/09
01 /01 /10
PREMISES Eaoccurence
_$1000000
$100000
MED EXP (Any one person)
s5000
PERSONAL SADVINJURY
$1000000
• Premises /Opp
•
Contractual Lia
GENERAL AGGREGATE
s2000000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/013 AGG
$1000000
7 POLICY X jECT LOC
B
AUTOMOBILE
LIABILITY
ANY AUTO
01002379701
01/01/09
01/01/10
COMBINED SINGLE LIMIT
(Ea accident)
E 1000000
X
B
B
X
ALL OWNED AUTOS
SCHEDULEDAUTOS
BODILY INJURY
(Per Person)
$
X
X
BODILY INJURY
(Per accident)
$
B
B
HIRED AUTOS
NON -OWNED AUTOS
X
PROPERTY DAMAGE
(Per accident)
3
GARAGE LIABILITY
I
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
AUTO ONLY: AGG
_
$
ANY AUTO
$
EXCESSIUMBRELLA LIABILITY
I
EACH OCCURRENCE
$10000000
B
X OCCUR 0 CLAIMS MADE
2090460194
01/01/09
01/01/10
AGGREGATE
$10000000
$
$
DEDUCTIBLE
hX
RETENTION $10000
;$
D
WORKERS COMPENSATION AND
EMPLOYERV LIABILITY
ANY PROPRIETORIPARTNERIEXECUTIVE
OFFICERIMEMBER EXCLUDED?
WC 2 74575957
01/01/09
01 /01 /10
X TORY LIMITS ER
E.L. EACH
$1000000
E.L. DISEASE - EA EMPLOYEE
$1000000
If yes describe under
SPECIALPROVISIONS below
E.L. DISEASE - POLICY LIMIT
$1000000
OTHER
C
NYS Disability
2P63996A3AA
01/01/09
01 /01 /10
Statutory
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
City of El Segundo is included as additional insured, but only insofar as
their interest may appear. Form CG2010 attached applies. This insurance is
Primary.
10 day notice for non - payment of premium
CERTIFICATE HOLDER CANCELLATION
ELSEGUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF. THE ISSUING INSURER WILL 99M0M MAIL 3 0 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT
City of El Segundo
Office of the City Clerk
350 Main St
El Segundo CA 90245 AUTHORIZED REPRESENTATIVE
a-"5 � �1. % �: - Z.._ I el�
ACORD 26 (2001108) v ® ACORD CORPORATION 1988
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.
29 MMIMA►
CG 20 10 10 01 Page I of 1
Dukes hoot Control, Inc.
06004239018
CG 20101001
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:
The City (City of El Segundo) its officers, officials, employees,
agents and volunteers
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement.)
A. Section U — 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 ongoing operations performed for that insured.
B. With respect to the insurance afforded to these additional Insureds, the following exclusion is added:
2. Exclusions
This insurance does not apply to "bodily injury" or "property damage" occurring after:
(1) All work, including materials, parts or equipment famished 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 site.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 intended use
by any person or organization other than another contractor or subcontractor engaged in performing
operations for a principal as a part of the same project.
CG 20 10 10 01
LLiyaeX I Legal Nosjces
02004'tie St. Paul Travelers Companies. inc.
http : / /eforms.travelers.comINXTI gateway. dlllfssformsllgeneral %20liabilityleg20101001.h... 8/26/2005