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PROOF OF INSURANCE (2010) CLOSEDACOR,Dr CERTIFICATE OF LIABILITY INSURANCE Date (mm /dd /yy) Producer 11 /19/2009 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. Wood Gutmann & Bo art Insurance Brokers THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE 15901 Red Hill Ave., Suite 100 COVERAGE AFFORDED BY THE POLICIES BELOW. Tustin, CA 92780 INSURERS INSURER Scottsdale Insurance Company 714 505.7000 License No. 0679263 NAIC #41297 www.wgbib.com INSURER Great American Insurance Company nsured NAIC #16691 INSURER Zurich American Insurance Company Hardy & Harper, Inc. NCCI #10863 TKM Enterprises, Inc. 1312 E. Warner Avenue INSURER Santa Ana CA 92705 INSURER OVERAGES E 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 POLICIFS ArrprroTV I nkfillc, _TR TYPE OF INSURANCE POLICY NUMBER tFI't(:IIVE DATE EXPIRATION DDATE 7/1/2010 LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIAB CLAIMS MADE RIOCCUR XCU Included BCS0020044 7/1/2009 EACH OCCURRENCE $ FIRE DAMAGE (Any one fire) $ MED EXP (An one person) x:c: PERSONAL & A INJURY $ C AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS BAP3736454 -01 10/1/2009 10/1/2010 $ COMBINED SINGLE LIMIT $ 1 SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (Per person) $ NON -OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE GARAGE LIABILITY (Per accident) $ ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ B EXCESS LIABILITY OCCUR [—] CLAIMS MADE TUE5950069 7/1/2009 7/1/2010 $ EACH OCCURRENCE $ 10 C I WORKERS' COMPENSATION & $ EMPLOYERS' LIABILITY WC3736453 -02 10/1/2009 10/1/2010 STATUTORY LIMIT THER EL EACH ACCIDENT $ 1,00010C EL DISEASE - EA EMPLOYEE $ 1 000 0C EL DISEASE - POLICY LIMIT $ 1,000.0c ERATIO R ity of El Segundo, its officials, employees, and agents, are named as additional insured per the attached CG 20 33 07 04 and CG 20 37 07 04. his certificate supersedes all previously issued certs. 10 days notice of cancellation for non - payment of premium by registered or certified mail. ;ERTIFICATE HOLDER "CANCELLATIO N City of El Segundo Public Works Department 350 Main Street El Segundo CA 90245 ACORD 25 -S (7/97) CERT NO.: 6275073 Ruby Muniz 11/19/2009 4:39:40 PM Page 1 of 4 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL AVM MAIL 30• DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,%(( L�ti�iX %Q�XJKX$�WiS�QaSC%i�i�(piPX F4A��tXA�tt? 4�J�XitXlq�i# X► i4? ttfXt�f# MK��4KL�i� '+Xl4�X�l(Df��(iW4#lk1t�X g *( y,X • 10 Days for Non - Payment of Premium. AUTHORIZED REPRESENTATIVE Kevin S. Bogart OACnRn rnPPn0A'tl0"%ns Inon R R ! 1 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 endorsernent(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 (7197) created at www.eCertsONLINL.com 1. n .a - ,,, .. I ;.1 „y= ,.r .. BCS0020044 Hardy & Harper, Inc. TKM Enterprises, Inc. 1312 E. Warner Avenue ' 1 1 11/6/2009 COMMERCIAL GENERAL LIABILITY CG 20 33 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to include as an additional insured any person or or- ganization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an addi- tional insured on your policy. Such person or or- ganization is an additional insured only with re- spect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are com- pleted. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the render- ing of, or the failure to render, any professional architectural, engineering or surveying ser- vices, including: a. The preparing, approving, or failing to pre- pare or approve, maps, shop drawings, opinions, reports, surveys, field orders. change orders or drawings and specifica- tions; or b. Supervisory, inspection, architectural or engineering activities. 2. "Bodily injury" or "property damage" occurring after: a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than ser- vice, maintenance or repairs) to be per- formed by or on behalf of the additional in- sured(s) at the location of the covered operations has been completed; or b. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontrac- tor engaged in performing operations for a principal as a part of the saine project. CG 20 33 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 ❑ Hardy & Harper, Inc. TKM Enterprises, Inc. POLICY NUMBER' BCS0020044 4006 - �+ 11/6/2009 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY, ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following! COMMERCIAL GENERAL. LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Any person or organization that the insured is required by written contract to name as an additionainsured. It is agreed that such insurance as is afforded by this policy tot the benefit of the Additional Insured shall be primary insurance as respects any claim, loss or liability caused in whole or in part by the Named Insured(s) operations, and any other insurance maintained by the `Additional Insured shall be excess and non - contributory with the insurance provided hereunder, Location And Description Of Completed Operations ired to complete this Schedule, if not shown above, will be shown in the Declar Section 11 — Who is An Insured is amended to in- clude as an additional insured the person(s) or organ- izations) shown in the Schedule, but only with re- spect to liability for "bodily injury" or "property dam- age" caused. in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that additional in- sured and included in the "products- completed oper- ations hazard ". CG 20 37 07 04 cp ISO Properties, Inc., 2004 s Page 1 of 1 ❑ 4 : T.. 1� t: SCC7TTS ENDORSEMENT DALE INSURANCE COMPANY" NO, ATTACHED TO AND ENDORSEMENT EFFECTIVE PATE FORMING A PART OF ENDO POLICY NUMBER (12:01 A.M. STANDARD TIME) NAMED INSURED AGENT NO. BCS0020044 7/1/2009 Hardy & Harper, Inc. TKM Enterprises, Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following forms: Additional Insured — Owners, Lessees Or Contractors — Automatic Status When Required In Construction Agreement With You (CG 20 33 07/04) Additional Insured — Owners, Lessees Or Contractors — Completed Operations (CG 20 37 07/04) The insurance provided by these endorsements shall be primary and noncontributory. UT 3 (,) AUTHORIZED REPRESENTATIVE DATE