PROOF OF INSURANCE (2009) CLOSEDTHIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY
PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS AND EXCLUSIONS OF SUCH POLICIES, LIMITS SHOWN
MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO
LT TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION
R DATE (MM /DD/YY) DATE (MIM/DD/YY) LIMITS
A GENERAL LIABILITY (1) (3) (4)
X COMMERCIAL GENERAL LIABILITY HDOG23746396 10 -1 -2008 '101 --2009 GENERAL AGGREGATE $ 5,000,000
CLAIMS MADE X OCCUR
PRODUCTS- COMP /OP AGG $ 5,000,000
OWNER'S &CONTRACTOR'S PROT
PERSONAL & ADV INJURY $ 5,000,000
X Contractual EACH OCCURRENCE $ 5 000 000
AUTOMOBILE LIABILITY (2) (3) (4)
ICI Branch No/Location: 9120 LA Metro Whittier, CA
MARSH USA INC.
CERTIFICATE OF INSURANCE, DATE
looucER "'
09/22/2009
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE
Marsh USA Inc.
411 East Wisconsin Avenue
PROVIDED IN THE
POLICY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
Suite 1600
AFFORDED BY THE POLICIES DESCRIBED HEREIN.
Milwaukee, Wisconsin 53202 -4419
Attn: CPU, Phone (414) 290 -4912 Fax (414) 290
COMPANIES AFFORDING COVERAGE
AM Bast Rating
(As or ostouoa)
-4953
CPU_Milwaukee@marsh.com
Company
*See Below
wcsrnru- or
ACE American Insurance Company
TORY LIMITS ER
,URED
A P.O. Box 41484, Philadelphia, PA 19101
A+ XV
Johnson Controls, Inc. Attn: Corp. Risk Mgmt. X -92
Johnson Controls Battery Group, Inc.
Company Sentry Insurance A Mutual Co.
B 1800
A+ XV
P.O. BOX 591
Johnson Controls Interiors, L.L.C.
North Point Drive, Stevens Point, WI 54481
coverage for Additional Insureds and Lose Payee as required by contract.
(3) PRIMARY COVERAGE: Where required by lease or contract, this coverage Is primary and
Company Indemnity Insurance Company of North America
not excess of or contributing with other Insurance or self - Insurance.
4 WAIVER OF SUBROGATION: Insured waives subrogation to the extent re ulred b contract.
JCIM US LLC Milwaukee, WI 53201
Cal -Air, Inc.
C and for CA, WI and EX WC: ACE
GES America, L.L.C.
American Insurance Company
A+ XV
Metro Mechanical, Inc.
P.O. Box 41484, Philadel hia, PA 19101
Company
Optima Batteries, Inc.
USI Companies Inc.
D ACE Property & Casualty Insurance Company
York International Corporation
436 Walnut Street, Philadelphia, PA 19106
q+ XV
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY
PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS AND EXCLUSIONS OF SUCH POLICIES, LIMITS SHOWN
MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO
LT TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION
R DATE (MM /DD/YY) DATE (MIM/DD/YY) LIMITS
A GENERAL LIABILITY (1) (3) (4)
X COMMERCIAL GENERAL LIABILITY HDOG23746396 10 -1 -2008 '101 --2009 GENERAL AGGREGATE $ 5,000,000
CLAIMS MADE X OCCUR
PRODUCTS- COMP /OP AGG $ 5,000,000
OWNER'S &CONTRACTOR'S PROT
PERSONAL & ADV INJURY $ 5,000,000
X Contractual EACH OCCURRENCE $ 5 000 000
AUTOMOBILE LIABILITY (2) (3) (4)
X
ANY AUTO
ALL OWNED AUTOS
10-1-2009
SCHEDULED AUTOS
X
HIRED AUTOS
X
H
NON -OWNED AUTOS
GARAGE LIABILITY
7 ANY AUTO
90- 04606 -01
FIRE DAMAGE An one fire $ 5,000,000
$ 50,000
MED EXP An one arson
10- 1_2008 10_1_2009 COMBINED SINGLE LIMIT $ 5,000,000
BODILY INJURY
(Per person)
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
D EXCESS LIABILITY
EACH ACCII
10-1-2009
EACH OCCURRENCE
X UMBRELLA FORM
XOO G23865014
10 -1 -2008
OTHER THAN UMBRELLA FORM
AGGREGATE
.�. WORKERS COMPENSATION AND WLR42850585 —ACS 10 -1 -2008 10 -1 -2009
EMPLOYERS' LIABILITY (4)
wcsrnru- or
WLRC42850573 — CA
TORY LIMITS ER
SCFC42850615 — WI
THE PROPRIETOR/ X INCL WCUC42850627 — EX WC
EACH ACCIDENT
rEL
PARTNERS /EXECUTIVE DISEA SE - POLICY LIMIT
OFFICERS ARE: EXCL
OTHER EL DISEASE -EACH EMPLO'
(7) ADDITIONAL INSURED: If required by contract, Includes coverage for Additional Insureds per attached endorsement.
(2) ADDITIONAL INSURED: If required by contract, Includes
coverage for Additional Insureds and Lose Payee as required by contract.
(3) PRIMARY COVERAGE: Where required by lease or contract, this coverage Is primary and
not excess of or contributing with other Insurance or self - Insurance.
4 WAIVER OF SUBROGATION: Insured waives subrogation to the extent re ulred b contract.
ESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES/SPECIAL ITEMS JCI
roject Name: Contract No
$ 5,000,000
$ 5,000,000
$ 1,000,000
$ 1,000,000
$ 1,000,000
CANCELLATIQN
SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,
City of El Segundo THE ISSUING COMPANY WILL iMDGAYCR Tp MAIL 3_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER
350 Main Street NAMED HEREIN,
El Segundo, CA 90245
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POLICY NUMBER: HDOG23746396 COMMERICAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Additional Insured Persons Or Organization (s):
If required by contract, The City of El Segundo, its officers, officials, employees, agents,
representatives, and certified volunteers
Location(s) Of Covered Operations
As required by contract,
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
Endorsement #A2
;ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - NAMED INSURED'S ACTS
OR OMISSIONS ONLY
A. Section II —Who is An Insured is amended to include as
B. With respect to the insurance afforded to these additional
insureds, the following additional exclusions apply:
an additional insured the person(s) or organization(s)
shown in the Schedule, but only with respect to liability for
"bodily injury", "property damage" or "personal and
This insurance does not apply to "bodily injury" or
advertising injury" caused solely by:
"property damage" occurring after:
1. Your acts or omissions; or
1. All work, including materials, parts or equipment
furnished in connection with such work, on the
2. The acts or omissions of those acting on your behalf;
project (other than service, maintenance or repairs)
to be performed by or on behalf of the additional
in the performance your ongoing operations for the
insured(s) at the location of the covered operations
additional insureds) ) at the location(s) designated above.
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 another
contractor or subcontractor engaged in performing
operations for a principal as a part of the same
ro'ect.
Endorsement #A2A
ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - CQ PLM ETED OPER/i►TT ONS -
NAMED INSUREDS ACTS OR OMISSIONS ONLY
Section II —Who Is An Insured is amended to include as an additional insured the person(s) or organizations) shown in the
Schedule, but only with respect to liability for "bodily injury" or "property damage" caused solely by "your work" at the location
designated and described in the schedule of this endorsement performed for that additional insured and included in the "products-
completed operations hazard."