Loading...
PROOF OF INSURANCE (2009) CLOSEDACORD,. CERTIFICATE OF LIABILITY INSURANCE 71DATE 222009n� PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION BB&T Insurance Services of CA, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 680 Langsdorf Drive Suite 100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Fullerton, CA 92831 INSURERS AFFORDING COVERAGE NAIC # INSURED iNSURERA: American Int'I Specialty 26883 Fleming Environmental Inc. INSURER B: American States Insurance Co 19704 1372 East Valencia Drive INSURERc: Travelers Property Casualty Co 25674 Fullerton, CA 92831 INSURER D: INSURER E: 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. LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE D MM DD POLICY EXPIRATION DAM (MMIDDNII LIMITS A GENERALLIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR X Pollution Incl. PROP2018813 09/01/08 09101109 EACH OCCURRENCE $1000300 DAMAGE TO RENTED MED EXP (Any one person) $10i),fl�0 $101000 PERSONAL &ADV INJURY OQO 000 G) NERALAGGREGAIE - $2 0O0 000 X Prof. Liab. InCI. PRODUCTS - COMP/OP AGG $2,000,000 GEN`L AGGREGATE LIMIT APPLIES PER: POLICY X PRO LOC ECI B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULEDAUTOS HIRED AUTOS NON -OWNED AUTOS 01CH1764763 09/01/08 09101109 COMBINED SINGLE LIMIT (Ea accident) $1,000,00 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ A EXCESSIUMBRELLA LIABILITY X OCCUR F� CLAIMS MADE DEDUCTIBLE X RETENTION S10,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? Des describe under SPECIAL PROVISIONS below PROU2019429 09/01/08 09/01/09 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 $ WC STATU- OTH- T.WJIMITS $ E.L. EACH ACCIDENT Is E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT S C OTHER Equipment Rented /Leased OT6606686M19ATIL08 09/01/08 09/01/09 $1,000 Deductible $160,000 Max Per Item DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Re: SS989 Repairs and Retest The City, its officers, officials, employees, agents and volunteers are named additional insured as respects general and auto liability,'this insurance is primary and noncontributory with any other insurance of the additional Insured, and waiver of subrogation applies as respects workers' compensation as required by written contract, per endorsement atached. Severability of interest is included in policy form. i,r-m i irwrA l c rrvL-ucrc - - -- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 114E EXPIRATION City of El Segundo - DATE THEREOF, THE ISSUING INSURER WILL RWa0 �jtrRMAIL 3Q_ DAYS WRITTEN 150 Illinois Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, ADtX(E XjX?J�7ff77X�d XX El Segundo, CA 9024 see�oner �iaae ns>« vlac >aacxaeuaxllmmlxiarsrxoea>omcx etxxx AIROCOESXDPJtx,X AUTHORIZED REPRESENNTIVE ACORD 25 {2001108) 1 of 2 #S3 29951M3863426 GAGAB 0 ACORD CORPORATION 1988 .3973.,,,; 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-S (2001108) 2 of 2 #S3872995/M3863426 a� ENDORSEMENT NO. This endorsement, effective 17:01 AM, 911/08 Forms a part of Policy No: PROP 2018813 Issued to: Fleming Environmental Inc. By. American International Specialty Lines 3973 ,t THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED /PRIMARY COVERAGE ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY AND PROFESSIONAL LIABILITY POLICY In consideration of an additional premium of 9 it is hereby agreed that the following is included as an Additional Insured as respects Coverage A and B but only as respects liability arising out of your work for the Additional Insured by or for you. Additional Insured: As Required by written contras N This does not apply to bodily injury or property damage arising out of the sole negligence or willful misconduct of, or for defects in design furnished by, the Additional Insured. As respects the coverage afforded the Additional Insured, this insurance is primary and non - contributory, and our obligations are not affected by any other insurance carried by such Additional Insured whether primary, excess, contingent, or on any other basis. This endorsement does not increase the Company's limits of liability as specified in the Declarations of this policy. All other terms, conditions, and exclusions shall remain the same. J /� AUTHORI O"REPRESENTATIVE or counfersignoture (in'states where applicable) 90667 (04106) PAGE 1 OF 1 C12791 Policy No. 01CH1784763 cafe g 36, 3. COMMERCIAL AUTO CA 71 10 03 07 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTO PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE. FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. EXTENDED CANCELLATION CONDITION BLANKET ADDITIONAL INSURED Paragraph 2.b. of the CANCELLATION Common SECTION II — LIABILITY COVERAGE — A.1. WHO IS AN INSURED provision is amended by the addition Policy Condition is replaced by the following: of the following: b. 60 days before the effective date of cancellation if we cancel for any other reason. e. Any person or organization for whom you are re- quired by an `insured contract to provide insur- TEMPORARY SUBSTITUTE AUTO — PHYSICAL ance is an "insured ", subject to the following DAMAGE COVERAGE additional provisions: (1) The "insured contract" must be in effect Under paragraph C. — CERTAIN TRAILERS, MO- during the policy period shown in the Decla- BILE EQUIPMENT AND TEMPORARY SUBSTITUTE rations, and must have been executed prior AUTOS of SECTION 1 — COVERED AUTOS, the to the "bodily injury" or "property damage ". following is added: (2) This person or organization is an "insured" If Physical Damage coverage is provided by this Cov- only to the extent you are liable due to your erage Form, then you have coverage for: ongoing operations for that insured, whether the work is performed by you or for you, and Any "auto" you do not own while used with the per- only to the extent you are held liable for an "accident" occurring while a covered "auto" mission of its owner as a temporary substitute for a is being driven by you or one of your em- covered "auto you own that is out of service be- "loss" cause of its breakdown, repair, servicing, or ployees. destruction. (3) There is no coverage provided to this person or organization for `bodily injury" to its em- BROAD FORM NAMED INSURED ployees, nor for "property damage" to its property. SECTION 11 — LIABILITY COVERAGE — A.I. WHO IS AN INSURED provision is amended by the addition 4 Coverage for this person or organization () shall be limited to the extent of your negli- of the following: gence or fault according to the applicable d. Any business entity newly acquired or formed by principles of comparative negligence or fault. you during the policy period provided you own (5) The defense of any claim or "suit" must be 50% or more of the business entity and the tendered by this person or organization as business entity is not separately insured for soon as practicable to all other insurers Business Auto Coverage. Coverage is extended which potentially provide insurance for such. up to a maximum of 180 days following acquisi- claim or "suit ". tion or formation of the business entity. Coverage under this provision is afforded only until the end of the policy period. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Copyright, Insurance Services Office, Inc., 1997 Weco and the Safeco logo are registered 'trademarks of Sa1e00 Corporation CA 71 10 03 07 Page 1 of 6 EP (6) The coverage provided will not exceed the lesser of: (a) The coverage and /or limits of this policy; or (b) The coverage and /or limits required by the insured contract ". (7) A person's or organization's status as an insured" under this subparagraph d ends when your operations for that "insured" are completed. EMPLOYEE AS INSURED Under Paragraph A. of Section 11 — LIABILITY COV- ERAGE item f. is added as follows: Your "employee" while using his owned "auto ", or an "auto" owned by a member of his or her household, in your business or your personal affairs, provided you do not own, hire or borrow that "auto ". This coverage is excess to any other collectible insurance coverage. FELLOW EMPLOYEE COVERAGE Exclusion 5. FELLOW EMPLOYEE of SECTION II — LIABILITY COVERAGE — B. EXCLUSIONS is amended by the addition of the following: However, this exclusion does not apply if the "bodily injury" results from the use of a covered "auto" you own or hire, and provided that any coverage under this provision only applies in excess over any other collectible insurance. BLANKET WAIVER OF SUBROGATION We waive the right of recovery we may have for pay- ments made for "bodily injury" or "property damage" on behalf of the persons or organizations added as "insureds" under Section II — LIABILITY COVERAGE — A.I.D. BROAD FORM NAMED INSURED and A.1.e. BLANKET ADDITIONAL INSURED. PHYSICAL DAMAGE — ADDITIONAL TRANS- PORTATION EXPENSE COVERAGE The first sentence of paragraph AA. of SECTION III — PHYSICAL DAMAGE COVERAGE is amended as follows: We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense incurred by you because of the total theft of a covered "auto" of the private passenger type. 3973 -..# PERSONAL EFFECTS COVERAGE A. SECTION III — PHYSICAL DAMAGE COVER- AGE, AA. COVERAGE EXTENSIONS, is amended by adding the following: c. Personal Effects Coverage For any Owned "auto" that is involved in a covered "loss ", we will pay up to $500 for "personal effects" that are lost or damaged as a result of the covered "foss ", without applying a deductible. EXTRA EXPENSE — BROADENED COVERAGE Paragraph A. — COVERAGE of SECTION III — PHYSICAL DAMAGE COVERAGE is amended to add: 5. We will pay for the expense of returning a stolen covered "auto" to you. AIRBAG COVERAGE Under paragraph B. — EXCLUSIONS of SECTION III — PHYSICAL DAMAGE COVERAGE, the following is added: The exclusion relating to mechanical breakdown does not apply to the accidental discharge of an airbag. NEW VEHICLE REPLACEMENT COST Under Paragraph C — LIMIT OF INSURANCE of Section III — PHYSICAL DAMAGE COVERAGE sec- tion 2 is amended as follows: 2. An adjustment for depreciation and physical con- dition will be made in determining actual cash value in the event of a total loss. However, in the event of a total loss to your "new vehicle" to which this coverage applies, as shown in the declarations, we will pay at your option: a. The verifiable "new vehicle" purchase price you paid for your damaged vehicle, not in- cluding any insurance or warranties pur- chased; Page 2 of 6 b. The purchase price, as negotiated by us, of a new vehicle of the same make, model and equipment, not including any furnishings, parts or equipment not installed by the manufacturer or manufacturer's dealership. If the same model is not available pay the purchase price of the most similar model available; c. The market value of your damaged vehicle, not including any furnishings, parts or equip- ment not installed by the manufacturer or manufacturer's dealership. This coverage applies only to a covered "auto" of the private passenger, light truck or medium truck type (20,000 Ibs or less gross vehicle weight) and does not apply to initiation or set up costs associated with loans or leases. TWO OR MORE DEDUCTIBLES Under SECTION 111 — PHYSICAL DAMAGE COV- ERAGE, if two or more "company" policies or cover- age forms apply to the same accident, the following applies to paragraph D. Deductible: a. If the applicable Business Auto deduct- ible is the smaller (or smallest) deduct- ible it will be waived; or b. If the applicable Business Auto deduct- ible is not the smaller (or smallest) de- ductible it will be reduced by the amount of the smaller (or smallest) deductible; or c. If the loss involves two or more Busi- ness Auto coverage forms or policies the smaller (or smallest) deductible will be waived. For the purpose of this endorsement "company" means: a. Safeco Insurance Company of America b. American States Insurance Company c. General Insurance Company of America d. American Economy Insurance Company e. First National Insurance Company of America f. American States Insurance Company of Texas g. American States Preferred Insurance Company h. Safeco Insurance Company of Illinois LOAN /LEASE GAP COVERAGE Under paragraph C — LIMIT OF INSURANCE of SECTION III — PHYSICAL DAMAGE COVERAGE, the following is added; f /3 a. Actual cash value of the damaged or stolen property as of the time of the "loss ", less an adjustment for depreciation and physical condition; or b. Balance due under the terms of the loan or lease that the damaged covered "auto" is subject to at the time of the "loss ", less any one or all of the following adjustments: (1) Overdue payment and financial penalties associated with those payments as of the date of the "loss ". (2) Financial penalties imposed under a lease due to high mileage, exces- sive use or abnormal wear and tear. (3) Costs for extended warranties, Cre- dit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease. (4) Transfer or rollover balances from previous loans or leases. (5) Final payment due under a `Balloon Loan". .t (6) The dollar amount of any un- repaired damage that occurred prior to the "total loss" of a covered "auto ". (7) Security deposits not refunded by a lessor. (8) All refunds payable or paid to you as a result of the early termination of a lease agreement or any war- ranty or extended service agree- ment on a covered "auto ". (9) Any amount representing taxes. (10) Loan or lease termination fees GLASS REPAIR -- WAIVER OF DEDUCTIBLE Under paragraph D. — DEDUCTIBLE of SECTION III — PHYSICAL DAMAGE COVERAGE, the following is added: No deductible applies to glass damage if the glass is repaired rather than replaced. AMENDED DUTIES IN THE EVENT OF ACCI- DENT, CLAIM, SUIT OR LOSS 4. The most we will pay for a total "loss" in any one The requirement in LOSS CONDITION 2.a. — "accident" is the greater of the following, subject DUTIES IN THE EVENT OF ACCIDENT, CLAIM, to a $1,500 maximum limit: SUIT OR LOSS — of SECTION IV — BUSINESS AUTO CONDITIONS that you must notify us of an CA 71 10 03 07 Page 3 of 6 EP "accident" applies only when the "accident" is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; or (3) An executive officer or insurance manager, if you are a corporation. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS SECTION IV — BUSINESS AUTO CONDITIONS — 13.2. is amended by the addition of the following: If you unintentionally fail to disclose any hazards ex- isting at the inception date of your policy, we will not deny coverage under this Coverage Form because of such failure. However, this provision does not affect our right to collect additional premium or exercise our right of cancellation or non - renewal. HIRED AUTO -- LIMITED WORLD WIDE COVER- AGE .� Under Section IV — Business Conditions, Paragraph B.7.b.e(1) is replaced by the following: (1) The "accident" or "loss" results from the use of an, "auto" hired for 30 days or less. RESULTANT MENTAL ANGUISH COVERAGE SECTION V — DEFINITIONS — C. is replaced by the following: "Bodily injury" means bodily injury, sickness or dis- ease sustained by a person including mental anguish or death resulting from any of these. HIRED AUTO PHYSICAL DAMAGE COVERAGE If hired "autos" are covered "autos" for Liability cov- erage and if Comprehensive, Specified Causes of Loss or Collision coverages are provided under this Coverage Form for any "auto" you own, then the Physical Damage Coverages provided are extended to "autos" you hire or borrow. The most we will pay for loss to any hired "auto" is $50,000 or Actual Cash Value or Cost of Repair, whichever is smallest, minus a deductible. The de- ductible will be equal to the largest deductible appli- cable to any owned `auto" of the private passenger or light truck type for that coverage. Hired Auto Phy- sical Damage coverage is excess over any other col- lectible insurance. Subject to the above limit, deductible and excess provisions, we will provide coverage equal to the broadest coverage applicable to any covered "auto" you own. HIRED AUTO PHYSICAL DAMAGE COVERAGE — LOSS OF USE SECTION III — PHYSICAL DAMAGE AA.b. Form does not apply. Subject to a maximum of $1,000 per accident, we will cover loss of use of a hired "auto" if it results from an accident, you are legally liable and the lessor in- curs an actual financial loss. RENTAL REIMBURSEMENT COVERAGE A. We will pay for rental reimbursement expenses incurred by you for the rental of an "auto" be- cause of a covered loss" to a covered "auto ". Payment applies in addition to the otherwise ap- plicable amount of each coverage you have on a covered "auto ". No deductibles apply to this coverage. B. We will pay only for those expenses incurred during the policy period beginning 24 hours after the "loss" and ending, regardless of the policy's expiration, with the lesser -of the following number of days: 1. The number of days reasonably required to repair or replace the covered "auto ". If "loss" is caused by theft, this number of days is added to the number of days it takes to locate the covered "auto" and return it to you. 2. 30 days. C. Our payment is limited to the lesser of the fol- lowing amounts: 1. Necessary and actual expenses incurred. 2. $50 per day. D. This coverage does not apply while there are spare or reserve "autos" available to you for your operations. E. If "loss" results from the total theft of a covered "auto" of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not al- ready provided for under the PHYSICAL DAM- AGE COVERAGE Coverage Extension. F. The Rental Reimbursement Coverage described above does not apply to a covered "auto" that is described or designated as a covered "auto" on Page 4 of 6 Rental Reimbursement Coverage Form CA 99 23. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE A. Coverage 1. We will pay with respect to a covered "auto" for "loss" to any electronic equipment that receives or transmits audio, visual or data signals and that is not designed solely for the reproduction of sound. This coverage applies only if the equipment is permanently installed in the covered "auto" at the time of the "loss" or the equipment is removable from a housing unit which is permanently installed in the covered "auto" at the time of the "loss ", and such equipment is designed to be solely operated by use of the power from the "auto's" electrical system, in or upon the covered "auto ". 2. We will pay with respect to a covered "auto" for "loss" to any accessories used with the electronic equipment described in paragraph A.I. above. However, this does not include tapes, records or discs. 3. If Audio, Visual and Data Electronic Equip- ment Coverage form CA 99 60 or CA 99 94 is attached to this policy, then the Audio, Vi- sual and Data Electronic Equipment Cover- age described above does not apply. B. Exclusions The exclusions that apply to PHYSICAL DAM- AGE COVERAGE, except for the exclusion relat- ing to Audio, Visual and Data Electronic Equipment, also apply to this coverage. In addi- tion, the following exclusions apply: We will not pay for either any electronic equip- ment or accessories used with such electronic equipment that is: Necessary for the normal operation of the covered "auto" for the monitoring of the covered "auto's" operating system; or 2. Both: a. an integral part of the same unit housing any sound reproducing equipment de- signed solely for the reproduction of sound if the sound reproducing equipment is permanently installed in the covered "auto "; and b. permanently installed in the opening of the dash or console normally used by 39 7 3 • 116 the manufacturer for the installation of a radio. C. Limit of Insurance With respect to this coverage, the LIMIT OF IN- SURANCE provision of PHYSICAL DAMAGE COVERAGE is replaced by the following: 1. The most we will pay for "loss" to audio, vi- sual or data electronic equipment and any accessories used with this equipment as a result of any one "accident" is the lesser of. a. The actual cash value of the damaged or stolen property as of the time of the "loss "; or b. The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality. C. $1,000. 2. An adjustment for depreciation and physical condition will be made in determining actual cash value at the time of the "loss ". 3. If a repair or replacement results in better than like kind or quality, we will not pay for the amount of the betterment. D. Deductible 1. If `loss" to the audio, visual or data elec- tronic equipment or accessories used with this equipment is the result of a "loss" to the covered "auto" under the Business Auto Coverage Form's Comprehensive or Colli- sion Coverage, then for each covered "auto" our obligation to pay for, repair, return or re- place damaged or stolen property will be re- duced by the applicable deductible shown in the Declarations. Any Comprehensive Cov- erage deductible shown in the Declarations does not apply to "loss" to audio, visual or data electronic equipment caused by fire or lightning. 2. if "loss" to the audio, visual or data elec- tronic equipment or accessories used with this equipment is the result of a "loss" to the covered "auto" under the Business Auto Coverage Form's Specified Causes of Loss Coverage, then for each covered "auto" our obligation to pay for, repair, return or replace damaged or stolen property will be reduced by a $100 deductible. 3. if "loss" occurs solely to the audio, visual or data electronic equipment or accessories used with this equipment, then for each cov- ered "auto" our obligation to pay for, repair, CA 71 10 03 07 Page 5 of 6 EP return or replace damaged or stolen property will be reduced by a $100 deductible. 4. In the event that there is more than one ap- plicable deductible, only the highest deduct- ible will apply. In no event will more than one deductible apply. SECTION V — DEFINITIONS is amended by adding the following: Q. "Personal effects" means your tangible property that is worn or carried by you, ex- cept for tools, jewelry, money, or securities. R. "New vehicle" means any "auto" of which you are the original owner and the "auto" has not been previously titled and is less than 365 days past the purchase date. Page 6 of 6 ACORN. CERTIFICATE OF LIABILITY INSURANCE 7;222oa9 "Y�`' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION BB &T Insurance Services of CA, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 680 Langsdorf Drive Suite 100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Fullerton, CA 92831 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Everest National Insurance Co 10120 Fleming Environmental Inc. INSURER B: 1372 East Valencia Drive INSURER C: Fullerton, CA 92831 INSURER D: INSURER E: 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. LTR R TYPE OF INSURANCE GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY POLICY NUMBER POLICY EFFECTIVE DATE MMIDDIYY POLICY EXPIRATION LIMITS EACH OCCURRENCE $ DAMAGE TO RENTED $ MED EXP (Any one person) $ CLAIMS MADE n OCCUR PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMPIOP AGG $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY E T O.LOC, AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (Per accident) $ NON -0WNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC AUTO ONLY: AGG S $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE Is OCCUR CLAIMS MADE AGGREGATE $ $ HDEDUCTIBLE A RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 7600001937091 05/01/09 05/01110 X WC STATU- OTF{- $ E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 ANY PROPRIETORIPARTNEWEXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, desaibe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Re: SBO89 Repairs and Retest Waiver of subrogation applies as respects workers' compensation, as required by written contract, per endorsement atached., .,, .,- - �__ .r .. o.,.,... 4 City of El Segundo 150 Illinois Street El Segundo, CA 90245 ACORD 25 (20011081 1 of 2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY FOND UPON THE INSURER, ITS AGENTS OR REPRESENT, +TIVE GAGAB O 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. ACORD 25-S (2001108) 2 of 2 #S3872994/M3682524 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT CALIFORNIA We have the 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 % of the California workers' compensation premium otherwise due on such remuneration, SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION FOR WHOM BLANKET WAIVER OF SUBROGATION THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER This endorsement changes the policy to which it is attached and is effective on the date Issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the po&y.) Endorsement Effective 0 5- 01- 0 9 Policy No. 7 6 0 0 0 0l9 3 7 0 91 Endo ement No. 0 01 Insured FLEMING ENVIRONMENTAL, INC. f� j remium $ IN Insurance Company EVEREST NATIONAL INSURANCE COMPANY r Countersigned By -1988 by the workers' compensation Insurance Patina Bureau of California. All rights reserved. From the WCIRlTs California Worke& Compensation Insurance Forms Manual -1999. INSURED COPY