PROOF OF INSURANCE (2009) CLOSEDAC,. CERTIFICATE OF LIABILITY INSURANCE
ORD
D ATE (MMIDDNY"
9/2/2008
DD
DATE THEREOF, THE ISSUING INSURER WILL ENBE*VeR TO MAIL 30 DAYS WRITTEN
PRODUCER Barney &Barney LLC
CA Insurance Lie: 0003950
101 Enterprise, Ste. 330
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
POLICY EXPIRATION
LIMITS
Aliso Viejo, CA 92656
949 - 900 -1780
INSURED
GEOSEMBLE TECHNOLOGIES, INC.
841 APOLLO STREET. #400
EL SEGUNDO. CA 90245
INSURERS AFFORDING COVERAGE
INSURER A: HARTFORD CASUALTY INS. CO.
NA1C #
INSURER B.
1/5/2008
INSURER C'
EACH OCCURRENCE
INSURER D:
PREMISES r n
$ 300,000
INSURER E:
$ 10,000
PERSONAL 3 ADV INJURY
GENERAL AGGREGATE
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.
INSR
DD
DATE THEREOF, THE ISSUING INSURER WILL ENBE*VeR TO MAIL 30 DAYS WRITTEN
POLICY NUMBER
p CY EFFECTIVE
POLICY EXPIRATION
LIMITS
JXL—
A
30 MAIN STREET
)F INSURANCE GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE T OCCUR
72SBATV6631
1/5/2008
1/5 /2009
EACH OCCURRENCE
S 2,000,000
PREMISES r n
$ 300,000
MED EXP (Any one person)
$ 10,000
PERSONAL 3 ADV INJURY
GENERAL AGGREGATE
$ 2,000,000
$ 4,000,000
PRODUCTS - COMPIOP AGG
S 000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO- LOC J,T
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
(Ea accidenl)
$2,000,000
ANY AUTO
ALL OWNED AUTOS
72SBATV6631
1/5/2008
1/5/2009
BODILY INJURY
(Per persm)
S
A
X
%(
SCHEDULEDAUTOS
HIRED AUTOS
NON-OWNED AUTOS
BODILY INJURY
(Per accident)
-- - ---
$
--
PROPERTY DAMAGE
(Per accideni)
S
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
S
ANY AUTO
OTHER THAN EA ACC
AUTO ONLY: AGG
S
S
EXCESSIUMBRELLA LIABILITY
EACH OCCURRENCE
S
AGGREGATE
$
OCCUR F7 CLAIMS MADE
$
DEDUCTIBLE
X WC STATU• OTH-
s
RETENTION S
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
72 W ESH9195
11/16/2007
11 / 16/2008
E.L. EACH ACCIDENT
S1,000,000
E.L. DISEASE -EA EMPLOYE
$ 1,000.000
A
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICERIMEMSER EXCLUDED?
If yes, describe under
SPECIAL ROVISI N ow
E.L. DISEASE . POLICY LIMIT
$ 1.000,000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
THE CITY OF EL SEGUNDO. ITS OFFICERS, EMPLOYEES, AGENTS AND CERTIFIED VOLUNTEERS ARE INCLUDED AS ADDITIONAL
INSUREDS ON POLICY #72SBATV6631. PER THE ATTACHED FORM SS0080405. PAGES 10 -15, AS RESPECTS WORK PERFORMED BY
THE NAMED INSURED.
CERTIFICATE HULUtIi
—
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENBE*VeR TO MAIL 30 DAYS WRITTEN
CITY OF EL SEGUNDO
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, 6
ATTN: CITY MANAGER
THE INSURER. Re
IMPOSE PIG 013HEMISN OR LIABIM;M' OF ANY KINIS UPEN
__
pew'
30 MAIN STREET
EL SEGUNDO. CA 90245-3813
[AUTHORIZED REPRESENTATIVE
� w/�nD11 I+AD DAD ATIAIJ �OAA
ACORD 25 (2001/08) Client # Mst # Cen I: �-
Subject:
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 (2001108)
BUSINESS LIABILITY COVERAGE FORM
2. Applicable To Medical Expenses Coverage
We will not pay expenses for "bodily injury":
a. Any Insured
To any insured, except "volunteer workers ".
b. Hired Person
To a person hired to do work for or on behalf
of any insured or a tenant of any insured.
c. Injury On Normally Occupied Premises
To a person injured on that part of
premises you own or rent that the person
normally occupies.
d. Workers' Compensation And Similar
Laws
To a person, whether or not an
"employee" of any insured, if benefits for
the "bodily injury" are payable or must be
provided under a workers' compensation
or disability benefits law or a similar law.
e. Athletics Activities
To a person injured while practicing,
instructing or participating in any physical
exercises or games, sports or athletic
contests.
f. Products- Completed Operations Hazard
Included with the "products- completed
operations hazard ".
g. Business liability Exclusions
Excluded under Business Liability Coverage.
C. WHO IS AN INSURED
1. If you are designated in the Declarations as:
a. An individual, you and your spouse are
insureds, but only with respect to the
conduct of a business of which you are the
sole owner.
b. A partnership or joint venture, you are an
insured. Your members, your partners, and
their spouses are also insureds, but only with
respect to the conduct of your business.
c. A limited liability company, you are an
insured. Your members are also insureds,
but only with respect to the conduct of your
business. Your managers are insureds, but
only with respect to their duties as your
managers.
d. An organization other than a partnership,
joint venture or limited liability company, you
are an insured. Your "executive officers" and
directors are insureds, but only with respect
to their duties as your officers or directors.
Your stockholders are also insureds, but only
with respect to their liability as stockholders.
e. A trust, you are an insured. Your trustees
are also insureds, but only with respect to
their duties as trustees.
2. Each of the following is also an insured:
a. Employees And Volunteer Workers
Your "volunteer workers" only while
performing duties related to the conduct of
your business, or your "employees ", other
than either your "executive officers" (if you
are an organization other than a
partnership, joint venture or limited liability
company) or your managers (if you are a
limited liability company), but only for acts
within the scope of their employment by
you or while performing duties related to
the conduct of your business.
However, none of these "employees" or
"volunteer workers" are insureds for:
(1) "Bodily injury" or "personal and
advertising injury":
(a) To you, to your partners or
members (if you are a partnership
or joint venture), to your members
(if you are a limited liability
company), or to a co- "employee"
while in the course of his or her
employment or performing duties
related to the conduct of your
business, or to your other
"volunteer workers" while
performing duties related to the
conduct of your business;
(b) To the spouse, child, parent,
brother or sister of that co-
"employee" or that "volunteer
worker' as a consequence of
Paragraph (1)(a) above;
(c) For which there is any obligation
to share damages with or repay
someone else who imust pay
damages because of the injury
described in Paragraphs (1)(a) or
(b) above; or
(d) Arising out of his or her providing
or failing to provide professional
health care services.
If you are not in the business of
providing professional health care
services, Paragraph (d) does not apply
to any nurse, emergency medical
technician or paramedic employed by
you to provide such services.
(2) "Property damage" to property:
(a) Owned, occupied or used by,
Page 10 of 24 Form SS 00 08 04 05
(b) Rented to, in the care, custody or
control of, or over which physical
control is being exercised for any
Purpose by you, any of your
"employees ", "volunteer workers ",
any partner or member (If you are
a partnership or joint venture), or
any member (if you are a limited
liability company).
b. Real Estate Manager
Any person (other than your "employee" or
"volunteer worker "), or any organization
while acting as your real estate manager.
c. Temporary Custodians Of Your
Property
Any person or organization having proper
temporary custody of your property if you
die, but only:
(1) With respect to liability arising out of the
maintenance or use of that property; and
(2) Until your legal representative has
been appointed.
d. Legal Representative If You Die
Your legal representative if you die, but
only with respect to duties as such. That
representative will have all your rights and
duties under this insurance.
e. Unnamed Subsidiary
Any subsidiary and subsidiary thereof, of
yours which is a legally incorporated entity
of which you own a financial interest of
more than 50% of the voting stock on the
effective date of this Coverage Part.
The insurance afforded herein for any
subsidiary not shown in the Declarations
as a named insured does not apply to
injury or damage with respect to which an
insured under this insurance is also an
insured under another policy or would be
an insured under such policy but for its
termination or upon the exhaustion of its
limits of insurance.
3. Newly Acquired Or Formed Organization
Any organization you newly acquire or form,
other than a partnership, joint venture or
limited liability company, and over which you
maintain financial interest of more than 50% of
the voting stock, will qualify as a Named
Insured if there is no other similar insurance
available to that organization. However:
a. Coverage under this provision is afforded
only until the 1130th day after you acquire
or form the organization or the end of the
policy period, whichever is earlier; and
BUSINESS LIABILITY COVERAGE FORM
b. Coverage under this provision does not
apply to:
(1) "Bodily injury" or "property damage"
that occurred; or
(2) "Personal and advertising injury"
arising out of an offense committed
before you acquired or formed the
organization.
4. Operator Of Mobile Equipment
With respect to "mobile equipment" registered in
your name under any motor vehicle registration
law, any person is an insured while driving such
equipment along a public highway with your
permission. Any other person or organization
responsible for the conduct of such person is
also an insured, but only with respect to liability
arising out of the operation of the equipment, and
only if no other insurance of any kind is available
to that person or organization for this liability.
However, no person or organization is an insured
with respect to:
a. "Bodily injury" to a co- "employee" of the
person driving the equipment; or
b. "Property damage" to property owned by,
rented to, in the charge of or occupied by
you or the employer of any person who is
an insured under this provision.
5. Operator of Nonowned Watercraft
With respect to watercraft you do not own that
is less than 51 feet long and is not being used
to carry persons for a charge, any person is an
insured while operating such watercraft with
your permission. Any other person or
organization responsible for the conduct of
such person is also an insured, but only with
respect to liability arising out of the operation
of the watercraft, and only if no other
insurance of any kind is available to that
person or organization for this liability.
However, no person or organization is an
insured with respect to:
a. "Bodily injury" to a co- "employee" of the
person operating the watercraft; or
b. "Property damage" to property owned by,
rented to, in the charge of or occupied by
you or the employer of any person who is
an insured under this provision.
6. y
114"it
The person(s) or organization(s) identified in
Paragraphs a. through f. below are additional
insureds when you have agreed, in a written
Form SS 00 08 04 05 Page 11 of 24
BUSINESS LIABILITY COVERAGE FORM
contract, written agreement or because of a
permit issued by a state or political
subdivision, that such person or organization
be added as an additional insured on your
policy, provided the injury or damage occurs
subsequent to the execution of the contract or
agreement, or the issuance of the permit.
A person or organization is an additional
insured under this provision only for that
period of time required by the contract,
agreement or permit.
However, no such person or organization is an
additional insured under this provision if such
person or organization Is Included as an
additional insured by an endorsement issued
by us and made a part of this Coverage Part,
including all persons or organizations added
as additional insureds under the specific
additional 'insured coverage grants in Section
F. -- Optional Additional Insured Coverages.
a. Vendors
Any person(s) or organization(s) (referred to
below as vendor), but only with respect to
"bodily injury" or "property damage" arising
out of "your products" which are distributed
or sold in the regular course of the vendor's
business and only if this Coverage Part
provides coverage for "bodily injury" or
"property damage" included within the
"products- completed operations hazard ".
(1) The insurance afforded to the vendor
is subject to, the following additional
exclusions:
This insurance does not apply to:
(a) "Bodily injury" or "property
damage" for which the vendor is
obligated to pay damages by
reason of the assumption of
liability in a contract or agreement.
This exclusion does not apply to
liability for damages that the
vendor would have in the absence
of the contract or agreement;
(e) Any failure to make such
inspections, adjustments, tests or
servicing as the vendor has
agreed to make or normally
undertakes to make in the usual
course of business, in connection
with the distribution or sale of the
products;
(f) Demonstration, installation,
servicing or repair operations,
except such operations performed
at the vendor's premises in
connection with the sale of the
product;
(g) Products which, after distribution
or sale by you, have been labeled
or relabeled or used as a
container, part or ingredient of any
other thing or substance by or for
the vendor; or
(h) "Bodily injury" or "property
damage" arising out of the sole
negligence of the vendor for its
own acts or omissions or those of
its employees or anyone else
acting on its behalf. However, this
exclusion does not apply to:
(1) The exceptions contained in
Subparagraphs (d) or (f); or
(ii) Such inspections, adjustments,
tests or servicing as the vendor
has agreed to make or normally
undertakes to make in the usual
course of business, in
connection with the distribution
or sale of the products,
(2) This insurance does not apply to any
insured person or organization from
whom you have acquired such products,
or any ingredient, part or container,
entering into, accompanying or
containing such products,
b. Lessors Of Equipment
(b) Any express warranty
(1) Any person or organization from
unauthorized by you;
whom you lease equipment; but only
(c) Any physical or chemical change
with respect to their liability for "bodily
in the product made Intentionally
injury", "property damage" or
"
by the vendor;
personal and advertising injury"
(d) Repackaging, except when
caused, in whole or in part, by your
maintenance, operation or use of
unpacked solely for the purpose of
equipment leased to you by such
inspection, demonstration, testing,
person or organization.
or the substitution of parts under
Instructions from the manufacturer,
and then repackaged in the
original container;
Page 12 of 24 Form SS 00 08 04 05
(2) With respect to the insurance afforded
to these additional insureds, this
insurance does not apply to any
"occurrence" which takes place after
you cease to lease that equipment.
c. Lessors Of Land Or Premises
(1) Any person or organization from
whom you lease land or premises, but
only with respect to liability arising out
of the ownership, maintenance or use
of that part of the land or premises
leased to you.
(2) With respect to the insurance afforded
to these additional insureds, this
insurance does not apply to:
(a) Any "occurrence" which takes
place after you cease to lease that
land or be a tenant in that
premises; or
(b) Structural alterations, new
construction or demolition
operations performed by or on
behalf of such person or
organization.
d. Architects, Engineers Or Surveyors
(1) Any architect, engineer, or surveyor, but
only with respect to liability for "bodily
injury", "property damage' or "personal
and advertising Injury" caused, in whole
or in part, by your acts or omissions or
the acts or omissions of those acting on
your behalf:
(a) In connection with your premises;
or
(b) In the performance of your
ongoing operations performed by
you or on your behalf.
(2) With respect to the insurance afforded
to these additional insureds, the
following additional exclusion applies:
This insurance does not apply to
"bodily injury", "property damage' or
"personal and advertising injury"
arising out of the rendering of or the
failure to render any professional
services by or for you, including:
(a) The preparing, approving, or
failure to prepare or approve,
maps, shop drawings, opinions,
reports, surveys, field orders,
change orders, designs or
drawings and specifications; or
(b) Supervisory, inspection,
architectural or engineering
activities.
BUSINESS LIABILITY COVERAGE FORM
e. Permits Issued By State Or Political
Subdivisions
(1) Any state or political subdivision, but
only with respect to operations
performed by you or on your behalf for
which the state or political subdivision
has issued a permit.
(2) With respect to the insurance afforded
to these additional insureds, this
insurance does not apply to:
(a) "Bodily injury", "property damage'
or "personal and advertising
injury" arising out of operations
performed for the state or
municipality; or
(b) 'Bodily injury" or "property damage"
included within the "products -
completed operations hazard ".
f. Any Other Party
(1) Any other person or organization who
is not an insured under Paragraphs a.
through e. above, but only with
respect to liability for "bodily injury",
"property damage" or "personal and
advertising injury" caused, in whole or
in part, by your acts or omissions or
the acts or omissions of those acting
on your behalf:
(a) In the performance of your
ongoing operations;
(b) In connection with your premises
owned by or rented to you; or
(c) In connection with "your work" and
included within the "products -
completed operations hazard ", but
only if
(i) The written contract or written
agreement requires you to
provide such coverage to
such additional insured; and
(tt) This Coverage Part provides
coverage for "bodily injury" or
"property damage" included
within the "products -
completed operations hazard ".
(2) With respect to the insurance afforded
to these additional insureds, this
insurance does not apply to:
"Bodily injury", "property damage' or
"personal and advertising injury"
arising out of the rendering of, or the
failure to render, any professional
architectural, engineering or surveying
services, including:
Form SS 00 08 04 05 Page 13 of 24
BUSINESS LIABILITY COVERAGE FORM
(a) The preparing, approving, or
failure to prepare or approve,
maps, shop drawings, opinions,
reports, surveys, field orders,
change orders, designs or
drawings and specifications; or
(b) Supervisory, inspection,
architectural or engineering
activities.
The limits of insurance that apply to additional
insureds are described in Section D. — Limits
Of Insurance.
Flow this Insurance applies when other
insurance is available to an additional insured
is described in the Other Insurance Condition
in Section E. — Liability And Medical Expenses
General Conditions.
No person or organization is an insured with
respect to the conduct of any current or past
partnership, joint venture or limited liability
company that is not shown as a Named Insured in
the Declarations.
D. LIABILITY AND MEDICAL EXPENSES
LIMITS OF INSURANCE
1, Tile Most We Will Pay
The Limits of Insurance shown in the
Declarations and the rules below fix the most
we will pay regardless of the number of:
a. Insureds;
b. Claims made or "suits" brought; or
c. Persons or organizations making claims or
bringing "suits ".
2. Aggregate Limits
The most we will pay for:
a. Damages because of "bodily injury" and
"property damage" included in the
"products- completed operations hazard" is
the Products - Completed Operations
Aggregate Limit shown in the
Declarations.
b. Damages because of all other "bodily
injury ", "property damage" or "personal
and advertising injury", including medical
expenses, is the General Aggregate Limit
shown in the Declarations.
This General Aggregate Limit applies
separately to each of your "locations"
owned by or rented to you.
"Location" means premises involving the
same or connecting lots, or premises
whose connection is interrupted only by a
street, roadway or right -of -way of a
railroad.
This General Aggregate limit does not
apply to "property damage" to premises
while rented to you or temporarily
occupied by you with permission of the
owner, arising out of fire, lightning or
explosion.
3. Each Occurrence Limit
Subject to 2.a. or 2.b above, whichever
applies, the most we will pay for the sum of all
damages because of all "bodily injury",
"property damage" and medical expenses
arising out of any one "occurrence" is the
Liability and Medical Expenses Limit shown in
the Declarations.
The most we will pay for all medical expenses
because of "bodily injury" sustained by any
one person is the Medical Expenses Limit
shown in the Declarations.
4. Personal And Advertising Injury Limit
Subject to 2.b. above, the most we will pay for
the sum of all damages because of all
"personal and advertising injury" sustained by
any one person or organization is the Personal
and Advertising Injury Limit shown in the
Declarations.
5. Damage To Premises Rented To You Limit
The Damage To Premises Rented To You
Limit is the most we will pay under Business
Liability Coverage for damages because of
"property damage" to any one premises, while
rented to you, or in the case of damage by fire,
lightning or explosion, while rented to you or
temporarily occupied by you with permission of
the owner.
In the case of damage by fire, lightning or
explosion, the Damage to Premises Rented To
You Limit applies to all damage proximately
caused by the same event, whether such
damage results from fire, lightning or explosion
or any combination of these.
6. How Limits Apply To Additional Insureds
The most we will pay on behalf of a person or
organization who is an additional insured
under this Coverage Part is the lesser of:
a. The limits of insurance specified in a
written contract, written agreement or
permit issued by a state or political
subdivision; or
b. The Limits of Insurance shown in the
Declarations.
Such amount shall be a part of and not in
addition to the Limits of Insurance shown in
the Declarations and described in this Section.
Page 14 of 24 Form SS 00 08 04 05
BUSINESS LIABILITY COVERAGE FORM
If more than one limit of insurance under this
(1) Immediately send us copies of any
policy and any endorsements attached thereto
demands, notices, summonses or
applies to any claim or "suit ", the most we will pay
legal papers received in connection
under this policy and the endorsements is the
with the claim or "suit';
single highest limit of liability of all coverages
(2) Authorize us to obtain records and
applicable to such claim or "suit ". However, this
other information;
paragraph does not apply to the Medical Expenses
(3) Cooperate with us in the investigation,
limit set forth in Paragraph 3. above,
settlement of the claim or defense
The Limits of Insurance of this Coverage Part apply
against the "suit'; and
separately to each consecutive annual period and to
(4) Assist us, upon our request, in the
any remaining period of less than 12 months, starting
enforcement of any right against any
with the beginning of the policy period shown in the
person or organization that may be
Declarations, unless the policy period is extended
liable the insured because of injury
after issuance for an additional period of less than 12
or damage to which this insurance
months. In that case, the additional period will be
also a pply.
may also a
deemed part of the last preceding period for purposes
of determining the Limits of Insurance.
d. Obligations At The Insured's Own Cost
E. LIABILITY AND MEDICAL EXPENSES
No insured will, except at that insured's own
cost, voluntarily make a payment, assume
GENERAL CONDITIONS
any obligation, or incur any expense, other
1. Bankruptcy
than for first aid, without our consent.
Bankruptcy or insolvency of the insured or of
e. Additional Insured's Other Insurance
the insured's estate will not relieve us of our
If we cover a claim or "suit" under this
obligations under this Coverage Part.
Coverage Part that may also be covered
2. Duties In The Event Of Occurrence,
by other insurance available to an
Offense, Claim Or Suit
additional insured, such additional insured
a. Notice Of Occurrence Or Offense
must submit such claim or "suit" to the
other insurer for defense and indemnity,
You or any additional insured must see to
However, this provision does not apply to
it that we are notified as soon as
practicable of an "occurrence" or an
the extent that you have agreed in a
offense which may result in a claim. To
written contract, written agreement or
the extent possible, notice should include:
permit that this insurance is primary and
non - contributory with the additional
(1) How, when and where the "occurrence"
insured's own insurance.
or offense took place;
f. Knowledge Of An Occurrence, Offense,
(2) The names and addresses of any
Claim Or Suit
Injured persons and witnesses; and
Paragraphs a, and b. apply to you or to
(3) The nature and location of any injury
any additional insured only when such
or damage arising out of the
"occurrence ", offense, claim or "suit" is
"occurrence" or offense.
known to:
b. Notice Of Claim
(1) You or any additional insured that is
If a claim is made or "suit" is brought
an individual;
against any insured, you or any additional
(2) Any partner, if you or an additional
insured must:
insured is a partnership;
(1) Immediately record the specifics of the
(3) Any manager, if you or an additional
claim or "suit" and the date received;
insured is a limited liability company;
and
(4) Any "executive officer" or insurance
(2) Notify us as soon as practicable.
manager, if you or an additional
You or any additional insured must see to
insured is a corporation;
it that we receive a written notice of the
(5) Any trustee, if you or an additional
claim or "suit" as soon as practicable.
insured is a trust; or
c. Assistance And Cooperation Of The
(6) Any elected or appointed official, if you
Insured
or an additional insured is a political
You and any other involved insured must:
subdivision or public entity.
Form SS 00 08 04 05 Page 15 of 24
Page 1 of 1
Shilling, Mona
From:
Amy Fisher [amyf@barneyandbamey.com]
Sent:
Thursday, September 11, 2008 11:23 AM
To:
Shilling, Mona
Cc:
Lanette Cooke
Subject:
Geosemble
Attachments: SKMBT_C55008091111150.pdf
Mona,
Here are the forms that I thought I attached to the certificate. Maybe you didn't get them.
Anyway, I did go ahead a request a specific additional insured endorsement from the Hartford.
It will take a few days. I am on vacation next week, but I will leave this with my colleague Lanette
Cooke to follow up on and have her send you the endorsement when we receive it.
Regards,
Amy
Amy Fisher
Senior Client Executive
Barney & Barney, LLC
101 Enterprise, #330
Aiiso Vlejo, CA 92656
949 -900 -1780 Phone, or
949-544-8464 Direct
949 -643 -3719 FAX
License #0003950
amyf@bameyandbamey.com
Insure your Sucess
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9/16/2008