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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 r 0 Ln w M 0 0 Ln M 0 Ln N r 0 0 0 H 0 C 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