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PROOF OF INSURANCE (2010) CLOSEDFROM : FAX NO. : Dec. 24 2008 01:18PM P3 ACED,« CERTIFICATE OF LIABILITY INSURANCE D1�IM4W�g) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Joseph D Walters ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. T1113 CERTIFICATE DOES NOT AMEND, EXTEND OR 2706 South Park Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Bethel Park, PA 15102 7,SURED GREAT AMERICAN CLEANING SYSTEMS Russell Neese 740 Maryland Street El Segundo, CA W245 [`nVMArFR INSURERS AFFORDING COVERAGE NAIC # INSURERK PEES LESS INSURANCE COMPANY 24198 INSURER B' _ INSURER C' WURF.R0 THE POLICIES OF INSURANCE LISTED BELOW HAVE 5fr-N 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 DI°_SCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L� AWL POLICY NUMBER POLICY EFFECTNE POLICY EIRION— LIMITS _ XPAT _ Limumpify'l A GENERAL LIABILITY CBP9062927 01/01109 01/01/10 ! EAC �E�o . I S ,1,000 000 v ' COMMERIAL GENERAL LIABILITY I �REMISIYS p c� pucenq) 3 100 ,IX0 CLAMB MADE i ) __ EXP y W- 0�,00 I PERSONAL i ADV INJURY. 13 i �0�000 ,�_ ` i � GENERALAGCiREGo.7fi � S _ Z.Da0,000 GENL AGGRGCATTE L"T APPLIES PER PRODUCTS - COMPIOP AGG IS 2.000.000 POLICY 1 ' PRA -I LOC I I I - AUTOMOBILE LIA61LITV I j COMBINED SINGLE LJMIT ANY AUTO I I (Ea soadent) S ALL OWNED AUYO$ j ! T -_- '— I I ,BODILY INJURY $ SCHEDULED AUTOS I tPeY09I8on) N1RED AUT05 i I I I BODILY INJURY NON-OWNED AUTOS ! {Pp xeident) S I PROPERTY DAMAGE $ (Per acci(3ent) QARAGE uAB,LIYY AUTO ONLY - EA ACCIDENT I S ANY AUTO I OTHER THM EAAGCa f EXCESBNrBRELLA� uABAIYY I ' EACH OCCURRENCE S OCCUR CLAIMS MADE ! I AGGREGATE $ DEDUCTIBLE RETENTION t AND I EMPLOYERS' UAVEUTYTgN I TORY ANY PROPRII<TOMPARTNER1XECUTNE ' I I E.L. EACH ACCiDEM S OFFRM CE mbm ExCLUDED? I i i E.L. DISEASE • FJi EMPLOYEE: S $PEC I I I OTHER � I I i I I E.L. DISEASE • POLICY UMrr S • DESCRIPYION OF OPERATIONS I LOCATM3 )VEHICLES I EXCLUMONS ADDED BY ENDORSEMENT t SPECIAL PROVIStDNS RE: EL SEGUNDO POOL ALTERNATIVE STUDY - A 30 DAY NOTICE OF CANCELLATION WILL APPLY EXCEPT FOR NON - PAYMENT WHICH IS 10 DAYS. i CEFMFICAYF NM nco - CITY OF EL SEGUNDO ATTN: MR. DAN GARCI& ASSIST. CITY ENGINEER 350 MAIN STREET EL SEGUNDO, CA 90245 ACIORD 25 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL XWGVX") %MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Kxxxj6* cm&v&zxxx I �o�xxa�cu�moxi�axQta�c�co�alc I�Icxxx � mxaxKxxxx _ IVACORD CORPORATgN Ig" FROM : FAX NO. : Jan. 07 2009 09:55AM P4 ADDITIONAL INSURED PRIMARY COVERAGE POLICY NUMBER: CBP9662927 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. It is agreed that any person or organization described below is an additional insured. but only with respect to liability arising out of the operation performed for the additional insured by or on behalf of the named insured. the insurance afforded to such additional insured is primary. Any other insurance such additional insured may have will be non - contributing. Any other endorsement provisions, conditions and exclusions of this insurance shall remain unchanged and apply to the additional insured described below. o1I li• ;. THE CITY OF EL SEGUNDO, ITS OFFICERS, AGENTS AND EMPLOYEES CG 07 04 FROM : POLICY NUMBER: CBP9662927 FAX NO. : Jan. 07 2009 09:54AM P3 COMMERCIAL GENERAL LIABILITY 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 OF EL SEGUNDO, ITS OFFICERS, AGENTS AND EMPLOYEES (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement) WHO IS AN INSURED (Section II) 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. CG 20 10 03 97 Copyright Insurance Service Offices, Inc., 1996 12/16/2008 08:29 310 - 376 -0354 MIKE KARAS CERTIFICATE OF INSURANCE SUCH INSURANCE AS RESPECTS THE INTEREST OF TI CANCELED OR OTHERWISE TERMINATED WITHOUY CERTIFICATE HOLDER, BUT IN NO EVENT SHALL THO THE DATE WRITTEN. THIS CERTIFICATE OF INSURAN, ANY POLICY DESCRIBED BELOW. This certifies that 10 STATE FARM MUTUAL. AUTOMOI ❑ STATE FARM FIRE AND CASUAL' STATE FARM COUNTY MUTUAL STATE FARM INDEMNITY COMP) hAa nnumsm in kerA fnr Om fr&,mfne NamAd Inalued as d PAGE 01 E CERTIFICATE HOLDER NAMED BELOW WILL NOT BE GIVING 10 DAYS PRIOR WRITTEN NOTICE TO THE CERTIFICATE BE VALID MORE THAN 30 DAYS FROM E DOES NOT CHANGE THE COVERAGE PROVIDED BY LE INSURANCE COMPANY of Bloomington, Illinois f COMPANY of Bloomington, Illinois ISURANCE COMPANY OF TEXAS of Dallas, Texas, or 4Y of Bloomin tm, Illinois mn Salow' NAWD INSURED: Ruseell and Kona Nees• ADDRESS OF NAMED INSURED: 740 Maryland Street Segundo, CA 90245 -3117 POLICY NUMBER 043 6523- DO1 -15D EFFECTIVE DATE OF POLICY DESCRIPTION OF VEHICLE (Induding VIN) 200] Ford F150 ® YES ❑ NO ❑ YES '! ❑ NO C] YES �❑ NO LIABILITY COVERAGE ❑ YES ❑ NO LIMITS OF LIABILITY a. SodYy Injury Eatri Perron 1 million Each Acckk It 1 million b. Property Dernelp Esph Aciddant 1 million c. Bomy Ir*" a Proporty Damp SkVW LImM Each Accident PHYSICAL COVERAGES ® YES ❑ NO ❑ YES []NO EI YES ❑ NO ❑ YES ❑ NO a. Comprehensive $ 500 Deductible $ Dedtrcift $ DedlXmm $ Deduc" ® YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO b. Conislon $.500 Deductible $ oaduadge $ Deductible $ Deductible CAR LL aIL TY C AGED ❑ YES ❑ NO ❑ YES I (] NO [l YES ❑ NO ❑ YES [] NO MIRED CAR LIABILITY COVERAGE YES a_ ❑ NO [] YES I NO ❑ ❑ YES (] NO Q YES ❑ NO ____T FLEET - COVERAGE FOR - - -- —_ --�— ALL CAD AND LICENSED I ❑ YES ❑ NO ❑ YES ❑ NO YES ❑ Iv0 ❑ YES Q NO MOTOR VEHICLES 51911alUfe Of AUthonZed RepresenlatNe Name and Ad&eu of CarfficMe Holder A ^r'T` );Qtr rNST Rr'I7: City ui C,1 SayUtldU INTERNAL STATE FARM USE ONLY 122429.2 Rev. 06-10-2004 ,r _22 12 -16 -2210$ Itid Agents Code 141;;'nber Ogle (Name and Address d AaeM +CJr_p Warn, TC:ur.�nc.e k P. Ka iela Manhattan aeach blvd. I' NdnhaL.at: B-34,-;h, t, CA 90266 I � II � I I li Request per*ranent Certificate f Insurance for Ilaoliky Cover2ge. Request Certificate Molder to b# added as an Additional Insured. I DEC -16 -2008 09:46 310 376 0354 97% P.01 FrF 0 W 0=41 FROU91 GREA,r AmE, RICAN ` /�_a�r1�1.i`�T�1VCs SYSTEMS 740 MARYLAND STREET - EL SEGUNDO, CALIFORNIA 90245 , (310) 640 -2902 Attn; Mona Tobiason Senior Admin. Sp. City of El Segundo From: Russell Neese Great American Cleaning Systems 740 Maryland St. El Segundo. CA. 90245 Re: Workers Comp. RECEIVED I Russell Neese will be performing all the work stated in the contract with the city of El Segundo. I will not hire any outside labor while steam cleaning or performing graffiti removal for the City. Regards, Ru ell Neese Great American Cleaning Systems