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PROOF OF INSURANCE (2010) CLOSEDAC R CERTIFICATE OF LIABILITY INSURANCE GREAT 9 DATE (MMIDD/YYYY) TYPEOFINSURANCE POLICY NUMBER 09/25/09 DATE MM/DD EXPIRATION LIMITS THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION X PRODUCER 021 GL 00002 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 04/01/10 EACH OCCURRENCE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Ogilvy -Hill Insurance $ 100,000 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. O. Box 929 PERSONAL &ADV INJURY $ 1,000,000 Santa Barbara CA 93102 Phone: 805 - 966 -4101 Fax: 805 - 966 -7810 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Sparta Insurance Company 20613 Great Scott Tree Service Inc GEN'L AGGREGATE LIMIT APPLIES PER: INSURER B: California Capital Insurance 13544 Elite Nursery LLC Scott Griffiths INSURER C: American Alternative Insurance 10761 Couurrt9068set INSURER D: Majestic Insurance Company 42269 B AUTOMOBILE X LIABILITY ANY AUTO 1- BAA -1- 004279 04/01/09 INSURER E: COMBINED SINGLE LIMIT (Ea accident) GUVtKALvCJ 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 TYPEOFINSURANCE POLICY NUMBER POLICY MIDDC /YYYY DATE MM/DD EXPIRATION LIMITS A X GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE [)(]OCCUR 021 GL 00002 04/01/09 04/01/10 EACH OCCURRENCE $ 1,000,000 PREMISES(Eaoccurence) $ 100,000 MED EXP (Any one person) s5,000 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE 2, 000, 000 $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGO s2,000,000 POLICY PRO JE CT LOC B AUTOMOBILE X LIABILITY ANY AUTO 1- BAA -1- 004279 04/01/09 04/01/10 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEDULED AUTOS X HIRED AUTOS BODILY INJURY (Per accident) $ X NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGO $ - H ANY AUTO $ C EXCESS /UMBRELLA LIABILITY X OCCUR CLAIMSMADE 60A2UB0003458 -00 04/01/09 04/01/10 EACH OCCURRENCE s2,000,000 AGGREGATE $ 2,000,000 $ — DEDUCTIBLE X RETENTION $10,000 - -- / $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N OFFICER/MEMBER OPRIET RIPARTNER /E ECUTIVE� (Mandatory In NH) LJ If yes, describe under SPECIAL PROVISIONS below C200906700 -01 01/01/09 01/01/10 X TORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1 , 000,000 E.L. DISEASE - POLICY LIMIT $ 1 , 000 , 000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS *10 Days Notice of Cancellation for Non - payment of premium. THIS CERTIFICATE REVISES AND SUPERSEDES THE CERTIFICATE ISSUED ON 9/24/09. RE: Tree Trimming Operations Contract #3476. City of E1 Segundo, City's Officers, Officials, Employees, Agents, Representatives and Volunteers are named as Additional Insured under the General Liability per form CG2026 L.crc nrr%.h r c nw­ - -- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CIT -350 DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL *30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL City of EL Segundo IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR c/o City Clerk REPRESENTATIVES. 350 Main Street AUTHD,�R RE NTATIVE Bl Segundo CA 90245 ACORD 25 (2009/01) �...� .,...,... - -- The ACORD name and logo are registered marks of ACORD 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 This Certificate of Insurance 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 (2009/01) .;: dam?%"„ 3,*aMrc rc2',- e✓, s »s s'a;,., ;,w ,� ,.,:_r, a:�.. ,,,,., ,.,. >. , ,.,.,,e ..,.... 07/04 Insurance is Primary per the attached form CG2010 07/04. POLICY NUMBER: 021GL 00002 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Persons Or Organization(s) City of El Segundo, City's Officers, Officials, Employees, Agents, Representatives, and Volunteers c/o City Clerk 350 Main Street El Segundo, CA 90245 RE: Tree Trimming Operations Contract #3476 ,j Information required to complete this Schedule if not shown above will be shown in the Declarations. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organiza- tion(s) shown in the Schedule, 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 omis- sions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 © ISO Properties, Inc., 2004 INSURED Page 1 of 1 ❑ NAMED INSURED: Great Scott Tree Service, Inc. POLICY NUMBER: 021 GL00002 EFFECTIVE: 4/1/09 to 4/1/10 INSURANCE COMPANY: Sparta Insurance Company IMPORTANT CERTIFICATE INFORMATION Your request to amend the cancellation clause to cross out the "endeavor to" and "but failure to mail: wording on the Certificate of Insurance cannot be fulfilled. The Insurance Company no longer allows any alteration to the Certificate of Insurance, nor will they endorse the policy to include a guarantee to provide written notice of cancellation to certificate holder. From: Dao Vongpanya [mailto:svongpanya @ohins.com] Sent: Friday, September 25, 2009 8:53 AM To: Ramos, Vina Subject: RE: Certificate: City of El Segundo Hi Vina, I will issue a certificate every 21 days to show policy is still in force, as we are not allowed to alter the cancellation clause. Thank You, Dao Vongpanya Account Administrator Ogilvy -Hill Insurance Ph: 805 - 879 -3753 Fax: 805 - 966 -7810 SVongpanya @ohins.com CONFIDENTIALITY NOTICE: The information contained in this electronic message and any attachments to this message is privileged and confidential, and intended solely for the use of the individual or entity named above. If the reader of this message is not the intended recipient, or the agent responsible for delivering it to the intended recipient, you are hereby notified that any dissemination, distribution, copying, or unauthorized use of this communication is strictly PROHIBITED. If you have received this electronic message in error, please notify the sender immediately by telephone at (805) 966 -4101 and delete or destroy any copy of this message. Thank You for your attention to this matter.