PROOF OF INSURANCE (2009) CLOSED10/29/2008 17:29 FAX LAWSON HAWKS INSURANCE [a 002/
OATS (hMAIDOMIYT)
14 q CERTIFICATE OF LIABILITY INSURANCE °PS 10/29/06
PROOUGER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Stephen* and Long Ynsuraace ONLY AND CONFERS NO RIGHT'S uoON THE CERTIFICATE
01806 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Lie. 504
1091 N. 41reline Blvd, P08ox 39 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Mountain View CA 94042
Phone1800 -964 -8121 Fax :650 - 964 -0816-
Sphi► L. Haunteer an Associated
anta FIE SSyriagd$CA 00607 - A3
INSURERS AFFORDING COVERAGE I NAIC 0
INSURER A; AI.■w.sty lu. Sim.. UW
INSURER& SafeCo Insurance CCM&nY 347)
INSURER C:
INSURER D• -
COVERAGES
THE POLrms OF MBURANCE LISTED BELOW HAVE BEEN ISSUED TO THE SeSUREO HAMEO ABOVE FOR TK POLICY PERIOD NOICATED. NOTVATH STANdNG
ANY NQUW4WWT. TOM OR CONDITION OF ANY CONTPACT OR OTHER DOCUMENT WITH REfPECT TO WHICH THIS CERTIFICATE MAY 9E ISSUED OR
MAY PERTAIN. THE INSLOANGE AFFORDED BY THE POLICIES cLumISEo HEREIN IS 9US.IECT TO ALL THE TERMS. EXCLUSIONS AND COHl mms OP SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLANS.
,................._._
SHOULD ANY OF THE AWw OESCR■m POLICIES BE CANCELLED BEFORE THE LWWTION
TYPE OF 01SURANCE
POLICY NUMBER
OAT
Attu: Mary Lewis
LIMITS
EACH OCCURRENCE
: 2, 0 0 0, 0 0
PRr*INasty•a
650,000
A
aoIeRAL T
x COMMQ%CUILGGINERALLIASILRY
CLAMS MAN � OCCUR
034032644 001
08/05/06
08/05/09
MIND lXP (Afey one pMton)
PERaow►L A Aw IuuRV
115,000
s 3 , 000 000
- -
GENERAL AGORCDATE
s 2 f 000, 000
92 , 0001000
NElwtwcrs. CALIPNOP AOG
GBNL AGGPEGAM LIMIT APPLIES PER;
POLICY LOC
x
AUTOMOBLt
x
LIABLRY
,ANY AUTO
02CE18932403
12/13/07
12/13/08
W40 SINOLI LIMIT
81,000,000
ALL OWNED AUTOS
OODILY MuURY
(ION Oman)
—'
S
SCHBDULEDAUTOS
- ----'
HMSO AUTOS
BODILY WURY
(Fee' modro)
s
NON4)WNSD AUTOS
AUTO ONLY - EA ACGDENT
s
OTHER THAN EA ACC
AUTO ONLY: AGO
:
aA LIASKirII
wOe
ANYAUTO
i
A
MWAoBAMER LLALIABILM
x OcCuR I J cLANMSMADE
024039791001
09/25/08
09135/09
EACH OCCURRENCE
s 1,000, OOO
AWREGATE
s
s
s
DEDUCTIBLE
RETENTION S
i
WORKERS COMPENSATION ANO
BW%DVERS' UABLITY
T
Fi EACH ACCIDENT
i
f
ANY PROPRIETORIPARTNEMOEX9CUTrvE
OPPICERIMEMSBI! EXCLUDED9
E.l. OIS:ASS • EA EMPLOYS
E.L. DISEASE -POLICY LIMIT
i
N ye{. NePom" Yn M
A
DTHER
pollution Liab and
924033644 001
08/05/08
08/05/09
Cl Made 2,000,000
Pro[esdi i
D!>aBITION oP OPLERATNGIIS / L.00ATIDIq / / w BNDORBEIIBAIi / SPBCLAL PROVISIONS
The City of Bl 309=60 is included as additional inaused as required by
written Contract.
*8xeept 10 days notice of cancellation for non - payment of pseaium
CrieRTIFICATII NOLDER
,................._._
SHOULD ANY OF THE AWw OESCR■m POLICIES BE CANCELLED BEFORE THE LWWTION
DATE THEREoP, THE IBSLVM INSURER YNL.L *30 oAYf wmrrEN
City of 81 Segundo
NOTICE To THE CERWWATE HOLOM NANO To THE L
Attu: Mary Lewis
3SO Main Street
sl gag-undo CA 90245
g
ArIvE
�/. ---�•-
ds ac —0 CORPORATION 1888
Ar;ARW m IswTNLw1 � \ �
10/29/2008 17:30 FAX LAWSON HANKS INSURANCE la 003/004
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 fort 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 (1901MO)
10/29/2006 17:30 FAX
John L. Hunter & Associates, Inc.
rolicy
EP r 624032644 001 08/0512008 To 08/0512009
beuad Sy (Name of Insurance omoany)
Westchester Surplus Lines Insurance Company
In"(, the popsy ntsnbsr. The renfeelder Orthe lnkwmstlon Is to be completed only when this eneorsemeM is Issued subsequent to the pnparatlon Of du policy,
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED ENDORSEMENT
OWNERS, LESSEES OR CONTRACTORS — SCHEDULED PERSON OR ORGANIZATION
This endorsement modifies Insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE
CONTRACTOR'S POLLUTION LIABILITY COVERAGE
SCHEDULE:
Name of Petaon or OrosnFeetaon:
Any person or organization that Is an owner of real property or personal property on which you are
performing operations, or a contractor on whose behalf you are performing operations, and only at the
speem written request of such person or organisation to you, wherein such request is made prior to
commencement of operations.
(It no entry appears above, Information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement)
A. SECTION 11 . WHO IS AN INSURED Is amended to include as an insured the person or organization
shown in the Schedule, but only with respect to liability arising out of your ongoing operations
performed for that insured.
B. With respect to the insurance afforded to these additional insureds, the tollaowlng exclusion is added.
2. Exclusions
This Insurance does not apply to bodily injury or property damage occurring after:
(1) All work, including materials, parts or equipment famished in eonnectirt with such
work, on the project (other than service, maairtenanee or repairs) to be pe by
on beha8 of the additional insured(s) at the site of the covered operations has been
completed; or
(2) 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 principal r contractor r
subcontractor engaged in performing operations
project.
EW-3100 (00-04) ln&xiu r pyd9h with its permission Pape 1 of 1
C()PY
CERTHOLDER COPY
STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142 -0807
COMPENSATION
INSURANCE
FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 01 -01 -2009 GROUP:
POLICY NUMBER: 1113148 -2009
CERTIFICATE ID: 94
CERTIFICATE EXPIRES: 01 -01 -2010
01 -01- 2009/01 -01 -2010
CITY OF EL SEGUNDO SC
CITY CLERKS OFFICE
350 MAIN ST
EL SEGUNDO CA 90245 -3813
This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the
California Insurance Commissioner to the employer named below for the policy period indicated.
This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer.
We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration.
This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded
by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document
with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance
afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy.
THORIZED REPRESENTATI PRESIDENT
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE.
ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2008 -01 -01 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED:
CITY OF EL SEGUNDO
ENDORSEMENT #1600 - JOHN L. HUNTER, PRES „ SECRETARY TREASURER - EXCLUDED.
ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 01 -01 -2000 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY.
EMPLOYER
JOHN L. HUNTER & ASSOCIATES, INC. SC
13310 FIRESTONE BLVD STE A2
SANTA FE SPRINGS CA 90670
M0408
PRINTED : 12 -20 -2008
(REV.2-05)
SC