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PROOF OF INSURANCE (2009) CLOSEDACORD
-�- - -TM. CERTIFICATE OF LIABILITY INSURANCE
DATE (MM /DD/YYYY)
1 10/30/2008
PRODUCER Phone: (949) 580 -1969 Fax: 949- 580 -1963
PACIFIC PARTNERS
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
25283 CABOT ROAD SUITE 224
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
LAGUNA HILLS CA 92653
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
POLICY EFFECTIVE
DATE MM /DDNY
POLICY EXPIRATION
DATE MM /DD/Y1'
LIMITS
INSURERS AFFORDING COVERAGE
NAIC #
Agency Lic#: OC46086
72SBATV5036
11/15/08
INSURED
INSURERA: HARTFORD CASUALTY INS. CO
29424
INSURER B: HARTFORD FIRE INSURANCE CO
13269
HDL COREN & CONE
1340 VALLEY VISTA DR
DIAMOND BAR CA 91765
INSURER C: TWIN CITY FIRE INSURANCE CO
29459
INSURER D:
MED. EXP (Any one person)
INSURER E:
PERSONAL & ADV INJURY
$ 3,000,000
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
LTR
ADO'L
INSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MM /DDNY
POLICY EXPIRATION
DATE MM /DD/Y1'
LIMITS
GENERAL LIABILITY
72SBATV5036
11/15/08
11/15/09
EACH OCCURRENCE
$ 3,000,000
DAMAGE TO RENTED
PREMISES (Ea occurence)
$ 300,000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE X i OCCUR
MED. EXP (Any one person)
$ 10,000
PERSONAL & ADV INJURY
$ 3,000,000
A
GENERAL AGGREGATE
$ 5,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP /OP AGG.
$ 5,000,000
PRO -
POLICY JECT LOC
AUTOMOBILE
LIABILITY
ANY AUTO
72SBATV5035
11/15/08
11/15/09
COMBINED SINGLE LIMIT
(Ea accident)
$ 3,000,000
BODILY INJURY
ALL OWNED AUTOS
(Per person)
$
SCHEDULED AUTOS
A
HIRED AUTOS
NON -OWNED AUTOS
X
BODILY INJURY
(Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
AUTO ONLY: AGG
$
EXCESS / UMBRELLA LIABILITY
EACH OCCURRENCE
$
OCCUR 1-1 CLAIMS MADE
AGGREGATE
$
$
DEDUCTIBLE
RETENTION $
$
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
72WECTZ0882
11/15/08
11/15/09
X I TORYTLIMTS OTHER
E.L. EACH ACCIDENT
$ 2,000,000
B
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED?
E.L. DISEASE -EA EMPLOYEE
$ 2,000,000
yes,describe under
S PECIAL PROVISIONS below
S
E.L. DISEASE - POLICY LIMIT
$ 2,000,000
OTHER: PROFESSIONAL LIABILITY
OOPGO246728
11/15/08
11/15109
AGGREGATE $1,000,000
C
OCCURRENCE $1,000,000
DEDUCTIBLE $25,000
DESCRIPTION OF OPERATIONS /LOCATIONS/VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
FOR THOSE OPERATIONS USUAL TO INSURED.
10 NOTICE FOR NON - PAYMENT OF PREMIUM.
CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED IN REGARDS TO GENERAL LIABILITY PER BUSINESS LIABILITY FORM SS0008.
CERTIFICATE HOLDER CANCELLATION
CITY OF EL SEGUNDO
350 MAIN STREET
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.
EL SEGUNDO, CA. 90245
AUTHORIZED REPRESENTATIVE
Attention:
ACORD 25 (2001/08) Certificate # 8474 , 1 © ACORD CORPORATION 1988
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C
SPECTRUM POLICY DECLARATIONS (Continued)
POLICY NUMBER: 72 SBA TV5035
Form Numbers of Forms and Endorsements that apply:
SS
00
01
04
93
SS
00
05
12
06
SS
00
07
07
05
SS
00
08
04
05
SS
00
45
12
06
SS
84
32
04
06
SS
01
21
08
97
SS
SS
04
04
15
39
07
07
05
05
SS
04
19
07
05
SS
04
30
07
05
SS
SS
04
04
38
44
06
07
01
05
SS
04
45
07
05
SS
04
41
07
07
05
05
SS
SS
04
04
42
47
07
07
05
05
SS
04
78
07
05
SS
04
80
03
00
SS
SS
04
04
46
86
03
00
SS
40
05
07
05
SS
40
18
07
05
SS
40
93
07
05
SS
41
12
09
05
IH
10
01
09
86
SS
05
47
09
01
SS
50
19
01
08
SX
80
01
06
97
SS
38
25
09
05
SS
83
76
01
08
IH
12
00
11
85 ADDITIONAL
INSURED
- PERSON - ORGANIZATION
Form SS 00 0212 06
Process Date: 09/04/08
Page 007
Policy Expiration Date: 11/15/09
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.
Page 10 of 24
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 must 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,
Form SS 00 08 04 05
' BUSINESS LIABILITY COVERAGE FORM
contract, written agreement or because of a
(e) Any failure to. make such
permit issued by a state or political
inspections, adjustments, tests or
subdivision, that such person or organization
servicing as the vendor has
be added as an additional insured on your
agreed to make or normally
policy, provided the injury or damage occurs
undertakes to make in the usual
subsequent to the execution of the contract or
course of business, in connection
agreement, or the issuance of the permit.
with the distribution or sale of the
A person or organization is an additional
products;
(f) Demonstration, installation,
insured under this provision only for that
servicing or repair operations,
period of time required by the contract,
except such operations performed
agreement or permit.
at the vendor's premises in
However, no such person or organization is an
connection with the sale of the
additional insured under this provision if such
product;
person or organization is included as an
(g) Products which, after distribution
additional insured by an endorsement issued
or sale by you, have been labeled
by us and made a part of this Coverage Part,
or relabeled or used as a
including all persons or organizations added
container, part or ingredient of any
as additional insureds under the specific
other thing or substance by or for
additional insured coverage grants in Section
the vendor; or
F. — Optional Additional Insured Coverages.
(h) "Bodily injury" or "property
a. Vendors
damage , arising out of the sole
Any person(s) or organization(s) (referred to
negligence of the vendor for its
below as vendor), but only with respect to
own acts or omissions or those of
"bodily injury" or "property damage" arising
its employees or anyone else
out of "your products" which are distributed
acting on its behalf. However, this
or sold in the regular course of the vendor's
exclusion does not apply to:
business and only if this Coverage Part
(I) The exceptions contained in
provides coverage for bodily injury or
Subparagraphs d or
() (�; or
"property damage" included within the
"products - completed operations hazard ".
(ii) Such inspections, adjustments,
(1) The insurance afforded to the vendor
tests or servicing as the vendor
has agreed to make or normally
is subject to the following additional
undertakes to make in the usual
exclusions:
course of business, in
This insurance does not apply to:
connection with the distribution
(a) "Bodily injury" or "property
or sale of the products.
damage" for which the vendor is
(2) This insurance does not apply to any
obligated to pay damages by
insured person or organization from
reason of the assumption of
whom you have acquired such products,
liability in a contract or agreement.
or any ingredient, part or container,
This exclusion does not apply to
entering into, accompanying or
liability for damages that the
containing such products.
vendor would have in the absence
b. Lessors Of Equipment
of the contract or agreement;
(b) Any express warranty
(1) Any person or organization from
whom you lease equipment; but only
unauthorized by you;
with respect to their liability for bodily
(c) Any physical or chemical change
injury", "property damage" or
in the product made intentionally
"personal and advertising injury"
by the vendor;
caused, in whole or in part, by your
(d) Repackaging, except when
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
' 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
Oflnsurance.
How 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. The 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.
Page 14 of 24
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 2.16. 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.
Form SS 00 08 04 05