PROOF OF INSURANCE (2009) CLOSEDL UCTIBLE
ENTION $ g/l/2008 8/1/2009
WORK COMPENSATIONAND WC2083557952
EMPLOYERS' LIABILITY
OTHER
policy period. The City of E1 Segundo, its officials, and employees are named as
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY END- 0,
uny and all work during the p Y
additional insured.
City of E1 Segundo
City Hall
350 Main Street
EL Segundo CA 90245
L-
W
4NCELLATION
DULD ANY OF THE ABOVE DESCRIBED POTHEIISSUINGINSURER
FORE THE EXPIRATION DATE THEREOF,
LL MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER
MED TO THE LEFT.
AUTHORIZED REPRESENTATIVE _t /
i
DATE (MMIDDNY)
OF LIABILITY INSURANCE ISSUED AS A MATTNRTHEICERT TE
CERTIFICATE
A R ,,, �+
THIS NO RIGHTS UPON CERTIFICATE
ONLY AND CONFERS EXTEND
THIS CERTIFICATE DOES NOT AMEND,
THE POLICIES BELOW.
PRODUCER Inc.
3aughn &Associates,
HOLDER.
ALTER THE COVERAGE AFFORDED BY
6050 Tain Drive
INSURERS AFFORDING COVERAGE
Dublin OH 43017
INSURERA: Continental Casualty Co
Union Fire Insurance
INSURED
The Fish el Company
INSURERB:Nationa1
INSURER C: American Cas Co of Readin PA
1366 Dublin Road
INSURER D:
Columbus OH 43215
INSURER E:
THE INSURED NAMED ABOVE FOR THE POLICY PERIODD INDICATED.
RESPECT TO WHICH THIS
COVERAGES R DOCUMENT
DESCRIBED HEREIN IS SUBCEIMTO ALL THE
CONDITION OF ANY CONTRACT OR OTHER POLICIES DOCUMENT WITH
OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO
POLICIES TERM OR BY THE B
HE REQUIREMENT, BEEN REDUCED
OTWITHSTANDING ANY THE INSURANCE AFFORDED
IN
OR MAY PERTAIN,
ERTIFICATE MAY BE ISSUED
AND CONDITIONS OF SUCH POLICIES. AGGREGATP
L� YEFFECTI EFFECTIVE OLIC EXPIRATION LIMITS
O O O
ERTI EXCLUSIONS
POLICY NUMBER
INSR TYPE OF INSURANCE
8/l/2 0 0 9 EACH OCCURRENCE $1 000
8/l/2008 fire) $1 OOO OO
GL2083557983
FIRE DAMAGE (Any one
A GENERAL LIABILITY
ED EXP (Any one person) $ 5 0 0
X COMMERCIAL GENERAL LIABILITY
PERSONAL & ADV INJURY $1 000 0 0 0
CLAIMS MADE [0 OCCUR
GENERAL AGGREGATE $
PRODUCTS - COMPIOP AGG $ 2 000 0 0 O
GEN'L AGGREGATE LIMIT APPLIES PER:
PRO- LOC
8/1/200$ $ 1 2 0 0 9 COMBINED SINGLE LIMIT $2,000,000
POLICY
BUA 2083557997
(Ea accident)
A AUTOMOBILE LIABILITY
X ANY AUTO
BODILY INJURY $
(Per person)
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY $
(Per accident)
HIRED AUTOS
PROPERTY DAMAGE $
NON -OWNED AUTOS
(Per accident)
AUTO ONLY - EA ACCIDENT $
GARAGE LIABILITY
EA ACC $
OTHER THAN
AUTO ONLY: AGG $
ANY AUTO
$/1/2009 EACH OCCURRENCE $2 000-000
BE 744 04 26
8/1/200$
AGGREGATE $2 000,000
B EXCESS LIABILITY
CLAIMS MADE
0
$
}( OCCUR
L UCTIBLE
ENTION $ g/l/2008 8/1/2009
WORK COMPENSATIONAND WC2083557952
EMPLOYERS' LIABILITY
OTHER
policy period. The City of E1 Segundo, its officials, and employees are named as
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY END- 0,
uny and all work during the p Y
additional insured.
City of E1 Segundo
City Hall
350 Main Street
EL Segundo CA 90245
L-
W
4NCELLATION
DULD ANY OF THE ABOVE DESCRIBED POTHEIISSUINGINSURER
FORE THE EXPIRATION DATE THEREOF,
LL MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER
MED TO THE LEFT.
AUTHORIZED REPRESENTATIVE _t /
i
IMPORTANT
If the certificate holder
is 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(sn• policies may the policy,
If SUBROGATION IS WAIVED, subject to the tserc rtificateodoesnnotf confer rights to the certificate
require an endorsement. A statement on
holder in lieu of such endorsement(s).
DISCLAIMER
producer, and the certificate holder, nor thereon.
ate of Insurance on the reverse side of this form does not constitute a contract between does it
The Certificate the policies listed
the issuing insurer(s), authorized representative or p
affirmatively or negatively amend, extend or alter the coverage afforded by
h
G Ed. 01 / /0A
CNA 83 THE
The Fishel Company —
Policy No-. GL20835579 THAT APPLY OR SUIT.
CONTAINS DUTIESOFFENSE, CLAIM
SEMENT OF OCCURRENCE'
THIS ENDOR EVENT THESE DUTIES.
It IN THE
ApDITIONAL INSURED IN
THIS ENDORSEMENT FO SE REAP IT CAREFUI -LY•
SEE PARAGRAPH
THIS ENDORSEM
ENT CHANGES THE POLICY. PLET ADDITIONAL INSUREDGE
' SCHEDULED AND BLASTED OPERATIONS COVE
CONTRACTOR S
ENDORSEMENT ENT WITH PRODUCTS -COMPin
rovided under the follow 9
This endorsement modifies ns LIABILITY COVERAGE PART
COMMERCIAL GENE SCHEDULE
Name of Person or Organization: Designated Project:
All Projects of the Named Insured
an entry or lack of entry in the Schedule above.)
(Coverage under this endorsement is not affected by These Limits of Insurance are inclusive of, and
IS AN INSURED (Section II) is amended to not in addition to, the Limits of Insurance shown
A. WHO erson or organization, in the Declarations.
include as an insured any p e provided to the additional insured
including any person or organization shown in 3. The coverag P f. of the
schedule above, (called additional insured) this endorsement and paragraph contract" under
Y
"insured
you are required to add as an additional insured on Section V) do not apply to
this policy under a written contract or written DEFINITIONS ( e arising out
but the wri "bodily injury" or "property damage"
agreement; of the "products- completed operations hazard"
agreement must be: in
effective during the written contract or
unless required by
1. Currently in effect or becoming written agreement.
the term of this policy; and
"property 4 The insurance provided to the additional
I to "bodily injury
2. Executed prior to the "bodily injury,
„ or "personal and advertising injury". insured does not oaPP apply and advertising
damage, "property damage, sneer's,
injury" arising out of an architect's, engineer's,
B. The insurance provided to the additional insured is surveyor's rendering of or failure to render
limited as follows: or
anization is an additional any professional services including:
1. That person or
or
negligence a The preparing, approving, or failing to
insured solely for liability due ou your the rove maps, shop drawings,
additional insured which
specifically resulting from "your re are or approve field orders,
ect o No opinions, reports, surveys, and
t the subject the p orders or drawings
written contract or written agreement. change
coverage applies to liability resulting from the specifications; and
sole negligence of the additional insured. Supervisory, or inspection activities
applicable to the b. Sup art of any related
2. The Limits of Insurance app performed as part
additional insured are those specified in the architectural or engineering activities.
written contract or written agreement or is less.
Declarations of this policy, Page 1 of 2
G- 140331 -A
(Ed. 01/01)
CNA this
provided under
respects the coveragely _ amended
COMMERCIAL
C. As SECTION are
GENERAL LI T endorsement, CONDITIONS
ABI► -ITY
is added to the Duties In The
as follows Claim
Event of or Suit
i , The following Offense,
Occurrence,
Condition: insured under this
e. An
additional Practicable,
endorsement will as soon as
result in a
Give writtnto utis whi h may occurrence or of an
an offense
claim or "suit, under this insurance,
the defense and indemnity of
�2) Tender or °suit,, to any other insurer
any claim
which also has insurance part;lan and
cover under this Coverage
other
(3) Agree to make available any
insurance which the additional insured
G- 140331 -A
(Ed. 01/01)
GA 40331
(Ed. W/O)
has for a loss we cover under this
Coverage Part,
to defend or indemnify an
f We have no duty under this endorsement
additional insured
receive written notice of a claim or
until we the additional insured.
"suit' from the ` Other Insurance
2 Paragraph . 4.b. of and replaced With the
Condition is deleted
following
4, other Insurance
b. Excess Insurance other
the additional
This ante ncnam ng ess over any ,
insurance any other
insured as
contingent dorVhonher
excess, unless a written contract or
basis specifically requires
written agreement sp either primary or
that this ainsurance be
nd nd noncontrributing.
Page 2 of 2