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PROOF OF INSURANCE (2005) CLOSEDvncnarr. v..�� DATE (MMlDD/Y A CORD., CERTIFICATE OF LIABILITY INSURANCE 08131/04 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY Certificate Desk 626) 792 -5522 AND CONFERS NO RIGHTS UPON THE CERTIFICATE ( HO PRODUCER LDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR S II' CurtisMonroe 40721187 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. U Ivan 135 N. Los Robles, Suite 275 INSURERS AFFORDING COVERAGE Pasadena, CA 91101 -- - - — -- INSURED J,INSURER A: Admiral insurance Company — J. Cab and Sons Roofing, Inc. 1 ,NSURERB: Landmark American Insurance Compan Reyes Roof Tear Off, Inc. INSURER C: 4530 Pacific Way j INSURER D_— -- City of Commerce, CA 90040 j INSURER E: COVERAGES TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTAND' THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SU MAY PERTAIN, THE INSURANCE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - - - -- POLICIES. AGGREGATE - — — — — POLICY EXPIRATIONr POLICY EF'FECTI LIMITS NSR L R POLICY NUMBER DATE M/DD/Y DATE M/DD/Y TYPE OF INSURANCE 08/30/04 08/30/05 EACH OCCURRENCE $1,000 OOO _ A GENERAL LIABILITY CA00000103102 FIRE DAMAGE (Anyone tire) � $50,000 . MERCIALGENERALLIA6ILITY - X COM f MED EXP (Any one person) $Excluded CLAIMS MADE X OCCUR L — PERSONAL & ADV INJURY $1 }000,000 i X Ij$5,000 Ded._Per - _ — GENERAL AGGREGATE $2 000,000 _'Claim BI & PD -- -- — PRODUCTS - COMP /OP AGG 1$1,00 O 000 -— } IGEN'L AGGREGATE LIMIT APPLIES PER'. — -- - -_ - PRO- �.__. . LOC POLICY X 1ECT COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY (Ea accident) ANY AUTO. ALL OWNED AUTOS - BODILY INJURY (Per person) $ — SCHEDULED AUTOS - ..--------- ---- -- --__- _- - -'�-- - --- HIRED AUTOS BODILY INJURY $ (Per accident) NON -OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY ANY AUTO B EXCESS LIABILITY NHA212504 X'OCCUR CLAIMS MADE DEDUCTIBLE WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OTIIER AUTO ONLY -_EA ACCIDENT_ OTHER THAN EA ACC $_ j AUTO ONLY: AGG $ 08/30/04 08/30/05 ( EACH OCCURRENCE- _ $2,000 000 AGGREGATE - $2,000,000 s I I $ $ 1 WCSTATU- BOTH- . j LTORY LIMITS j E.L. EACH ACCIDENT E.L.DISEASE -EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ Workers' Compensation Certificate Issued By Insurance Co. _ DESCRIPTION OF OPERATIONS / LOCATIONS /VEIHCLES/EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS For additional insured information see attached ADD City of El Segundo 350 Main St El Segundo, CA 90245 ACORD 25 -S (7/97) 1 of 2 #M7459 SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, TIE ISSUING INSURER WILLENDEAVOR TOMAIL30 —. DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TOTHE LEFT, BUTFAILURE TODOSOSHALL IMPOS E NO OB LIGATION OR LIAB H1TY OF ANY KIND UPON THE INS URER,HS AGENTS OR JLP O ACORD CORPORATION 1988 V" 93 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 -S (7/97) 2 0 t 2 41vi / 4 n y Policy Number: CA000001031 -02 Effective Date: 08/30/04 CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Locations Of Covered O erations Or Or anization s ANY ENTITY FOR WHOM YOU ARE PERFORMING ALL COVERED PROJECTS ONGOING OPERATIONS, BUT ONLY IF REQUIRED BY WRITTEN CONTRACT PRIOR TO AN "OCCURRENCE" OR LOSS Information re uired to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II —Who Is An Insured is amended to This insurance does not apply to "bodily injury" or 11 dama e" occurring after: p e g include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with pro p 1. All work, including materials, p arts orequipment respect to liability for "bodily injury", "property furnished in connection with such work, on the damage" or "personal and advertising injury" caused, by: project (other than service, maintenance or repairs) to be performed by or on behalf of the in whole or in part, additional insured(s) at the location of the 1. Your acts or omissions; or covered operations has been completed; or 2. The acts or omissions of those acting on your 2. That portion of "your work" out of which the behalf; injury or damage arises has been put to its in the performance of your ongoing operations for the intended use by any person or organization other additional insured(s) at the location(s) designated than another contractor or subcontractor engaged above. in performing operations for a principal as a part B. With respect to the insurance afforded to these of the same project. additional insureds, the following additional exclusions apply: CG 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 ❑