PROOF OF INSURANCE (2009) CLOSEDACORD CERTIFICATE OF
LIABILITY INSURANCE r,, r L1M?t1 R11 Q o9
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
PRODUCER
INSRJNSR T POLICY NUMBER
LTR NSR TYPE OF INSURANCE I
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Insurance Incorporated of
I I EACH OCCURRENCE S 1 000,000
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Southern California
! 1 I CLAIMS MADE II X I OCCUR
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1199 S. Fairway Dr., #101
_
i I PERSONAL & ADV INJURY $ !_'q00' 000
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Industry CA 91789
GEN'L AGGREGATE LIMIT APPLIES PER i I
I PRODUCTS - COMPIOP AGG $2,000,000
Phone: 909 - 468 -2233 Fax:909- 468 -2232
I INSURERS AFFORDING COVERAGE I NAIC#
INSURED - - - -- ----- - - - -
-- - - - -- INSURER SURERA Liberty Surplus Ins. _COT - - - - - - -- --
INSURER B Safeco Insurance CoLnpany _2_4_7_40 _
H.P. Builders Inc.
INSURER C: National ion Fire Insurance 19_445
Union at
_ _ I
_
12523 Limonite Ave Ste 440 -357 INSURER0 Granite State Insurance Co 23809
Mira Loma CA 91752 I- - - -- ---- - - - - -- ----- - - - - --
+
INSURER E
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
INSRJNSR T POLICY NUMBER
LTR NSR TYPE OF INSURANCE I
I LIMITS —
DATE MM /DDIYY DATE MM /DD/YY
GENERAL LIABILITY I
I I EACH OCCURRENCE S 1 000,000
r- I I
A X I XLCOMMERCIALGENERALLIABILITY I DGLLA207435018 1
b/vTUxEIVrE�— ' - - -'- - -- -
08/22/08 08/22/09 I PREMISES (Ea occurence) 1$50,000
! 1 I CLAIMS MADE II X I OCCUR
I MED EXP (Any one person) $ Excluded
A�
_
i I PERSONAL & ADV INJURY $ !_'q00' 000
1 I I
I LGENERAL AGGREGATE 152,000,000
GEN'L AGGREGATE LIMIT APPLIES PER i I
I PRODUCTS - COMPIOP AGG $2,000,000
POLICY IX I PRQ- I LOC
_
AUTOMOBILE LIABILITY
I X ,I I
B I X I ANY 25CC2240981 I
08/22/08
COMBINED SINGLE LIMIT 1
(Ea accident) 1$1,000,000
08/22/09
+
r� I
r
BODILY INJURY $
ALL OWNED AUTOS I
I SCHEDULED AUTOS I
(Per person)
I
1 HIRED AUTOS I
—
I
NON -OWNED AUTOS
1 BODILY INJURY I
$
(Per accident) $
I
I I
— — — --
(- -- - - - -- - --
I
PE DAMAGE
(Per accident) den
I( ) IS
GARAGE LIABILITY I
r-
AUTO ONLY - EA ACCIDENT I $
ANY AUTO
- --
OTHER THAN EA ACC 1 $
I I
I I AUTO ONLY. A G S -- - -- --
I EXCESS/UMBRELLALIABIUTY I I
EACH OCCURRENCE - I S 5, 000, 000
C I Ix OCCUR 1- I CLAIMS MADE i BE1658144 I
08/22/08
08/22/09 AGGREGATE I s5,000,000
�---
I DEDUCTIBLE
IS
-
I RETENTION $ I I
I
r— $
I WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
I I
X LIM I TS I ER
TORY I 1-- - - -- - - -
D I ANY PROPRIETOR/PARTNER/EXECUTIVE
1 009925048
J-
09/01/08 I 09/01/O9 FE.L.EACHACCIDENT 1 $1,000,000
OFFICER/MEMBER EXCLUDED? I
I
_
I LE L DISEASE - EA EMPLOYEEI $1,000,000
I If yes. describe under I
SPECIAL PROVISIONS below
I
-- -
I I E.L. DISEASE - POLICY LIMIT $1,000,000
OTHER I
I I
I I
I I
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
*10 day notice of cancellation for nonpayment
of premium. RE: HR Remodel
Project. The City of El Seguno, its officers,
officials, employees, agents,
and volunteers are named as Additional Insured
regarding the General
Liability policy per form CG 20 10 11 85. * *SEE NOTES **
GtK 111-IGA I t MULUtK CANCELLATION
City of E1 Segundo
Attn: Louis Morales
Planning & Building Safety
350 Main Street
El Segundo, CA 90245
CTYOELS 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,
AL:UKU Z5 (ZU01 /U9) m ACORD CORPORATION 1988
38 97 . , ,
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
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 (2001108)
,-, bz ,, r J _' t s ` HPBUZ =i'� W °'v +r _ • AGE 3
LD
OP,�t�CODE CTYOELS, z; z�
€'*NSURED'SNAME' H:P. Builders,iaa r f K.� "•• '1191 A'� 0/26/09
Insurance is primary regarding the General Liability policy per f`CGL `�-
1031 0403.
3897.
171.1 €r r ; r 0
aw
1pLS1 Commercial General Liabilitq —II'l 'i
LIBERTY SURPLUS INSURANCE CORPORATION
(A mcnilm of Lthcrti Mutual Group, htminaticr "dw Compan) ')
ENDORSEMENT NO. 3
Effective Date: 8/22/2008 _ 4
Policy Number. DGLLk2U7435019
Issued To: Ii P BUILDEIS, IN(:.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED — OWNERS, LESSEES OR CONTRACTORS (FORM B)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCI3EDULF.
Name of Person or Organization:
Blanket basis where required by written contrtct - COMMERCIAL ONLY
(If no entry appears above, information reLluited to complete this endorsement will be shown in the Declarations as
applicable to this endorsement.)
WHO IS AN INSURED (Section I I) is amended to include as an insured the person or organization shown in the
Schedule, but only with respect to liability ansing out of "your work" for that insured by or for you.
CGL 2010 1185
3897.,,,.,
_T 0
LSI itIraIio,o
Commercial General Liability ................
LIBERTY SURPLUS INSURANCE CORPORATION
(A member (if Lthrrt% Mutual Group, hereinafter "the t;umpAny'�
ENDORSEMENT NO. I 1
Effective Date: 8/22/2008
Policy Number: DGLIy-\207435018
Issued To: li P BUILDERS, INC.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY INSURANCE CLAUSE ENDORSEMENT
To the extent that this insurance is afforded to any additional insured under the policy, such insurance shall apply as
primary and not contributing with any insurance carried by such additional insured, as required by written contract.
Nothing herein contained shall be held to waive, vary, alter or extend any condition or provision of the policy other than
as above stated.
CGL 1031 0403