PROOF OF INSURANCE (2008) CLOSED(: i1-I C l e- lc
ACORD CERTIFICATE OF LIABILITY
C*IAtv6RJ -U1 GLJ'3
INSURANCE °t`1W""D°07
PRODUCER (864) 288 -4950
8/13/2007
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Sullivan Company LLC
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
PO Box 2910
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Greenville, SC 29602
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
GENERAL
X
LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE FK OCCUR
LBA009516 -01
INSURERS AFFORDING COVERAGE
I NAIL 0
INSURED ESI Acquisition, Inc.
INSURER A: Landmark American Insurance Co.
3138
699 Broad St # 1100
INSURER B: Auto Owners Insurance Company ♦
8988
Augusta, GA 30901 -1442
INSURER C: Great American
PERSONAL & ADV INJURY
$ 1,000,00
INSURER D: Twin City Fire Insurance
9459
INSURER E:
S 2,000,0
GEN L AGGREGATE LIMIT APPLIES PER:
POLICY X PR LOC
rnveoA r_ce
$ 2,000,OOC
Mr. rVL1WrQ Ur INZUKANCE LIS I EU 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.
IN
City of El Segundo
- TYPE OF INSURANCE
POLICY NUMBER
POLICY E CTIVE
PO N
LINE
A
X
GENERAL
X
LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE FK OCCUR
LBA009516 -01
6/27/2007
612712008
EACH OCCURRENCE
$ 1,000,00
PREMISES Ea ocasence
S 100,
MED EXP (Arty one person)
$ 5,
PERSONAL & ADV INJURY
$ 1,000,00
GENERAL AGGREGATE
S 2,000,0
GEN L AGGREGATE LIMIT APPLIES PER:
POLICY X PR LOC
PRODUCTS - COMP/OP AGG
$ 2,000,OOC
B
AUTOMOBILE
LUUlILITY
ANYAUTO
ALL OWNED AUTOS
HIREDAUTOS
NON-OWNEDAUTOS
156461300
6127/2007
6127/2008
COMBINED
Ea SINGLE LIMIT
$ 1,000,00
BODILY INJURY
er )
$
X
X
BODILY INJURY
(PeraWdent)
S
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT j
$
OTHER THAN EA ACC
AUTO ONLY: AGG
S
E
C
EXCESS/UMBRELLA LIABILITY
OCCUR FI CLAIMS MADE
DEDUCTIBLE
RETENTION $
XS567492103
6127/2007
612712008
EACH OCCURRENCE
$ 5,000,00
AGGREGATE Is
5,000,00
S
$
i
D
WORKERS COMPENSATION AND
EMPLOYERS LIABILITY
ANY PROPRIETORIPARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED?
If yee describe under
SPECIAL PROVISIONS below
OTHER
22WECRH2368
6127/2007
6/27/2008
X T C TATU OTH.
-
E.L. E. EACH ACCIDENT
$ 1,000,
E.L DISEASE - EA EMPLOYE
E 1,�,
E.L. DISEASE - POLICY LIMIT 1 $ 1,000,00
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
City of El Segundo, Its officers, officials, employees, agency $ certified volunteers are named as Additional Insureds / General Llabllity ATIMA;
This insurance will be primary as long as your policy positions Itself as excess.
CERTIFICATF 14n1 nFR
® AGORD CORPORATION 1988
o Ike- -jij$-
IN
City of El Segundo
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
350 Main Street
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
El Segundo, CA 90245 -3813
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE To DO So SMALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY IOND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
�,�r�
ow
ACARTI 7F /9flff4 /flAl
® AGORD CORPORATION 1988
o Ike- -jij$-
0 .
POLICY NUMBER: LBA0095:6 00
COMMERCIAL GENERAL LIABILITY
CG 20 10 10 01
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
This endorsement modes insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
Any person or organiiatJ on whom you are required to add as art addlt:ioral insured
on this policy under a written contract wh -ich ie current:y it et.tect or becoming
effective during the term of the policy and executed prior to the "nod".ly
injury ", "property damage or "personal and advertising injury ".
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement.)
A. Section 11— Who Is An Insured is amended to (1) All work, including materials, parts or
include as an insured the person or organization equipment furnished in connection with
shown in the Schedule, but only with respect to such work, on the project (other than
liability arising out of your ongoing operations service, maintenance or repairs) to be
performed for that insured. performed by or on behalf of the addi-
B. With respect to the insurance afforded to these tional insured(s) at the site of the cov-
additional insureds, the following exclusion is ered operations has been completed;
added: or
2. Exclusions (2) That portion of "your work" out of which
This insurance does not a to "bodily in- the injury or damage arises has been
apply y put to its intended use by any person
jury" or "property damage" occurring after: or organization other than another
contractor or subcontractor engaged in
performing operations for a principal as
a part of the same project.
CG 2010 10 01
® ISO Properties. Inc.. 2000
Page 1 of 1 0
� PT
ESIACOU -01 CLB
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.
^vWFNW Av Iiw 11vu)