PROOF OF INSURANCE (2004) CLOSEDPRODUCER
Aon 07 Risk Services Inc. of southern California
suite 6000
Los Angeles CA 90017 -0460 USA
Fns -(213) 689 -44
INSURED
Kelly Pipe Company, LLC
c/o Shapco Inc.
1666 20th Street, suite 100
Santa Monica CA 90404 USA
-!� 11/24/03
IS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
D CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
RTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
VERAGE AFFORDED BY THE POLICIES BELONN'.
INSURERS AFFORDING COVERAGE
IN SURF RA Zurich American Ins Co
INSURER Firemans Fund Ins Co
INSURER C . St Paul Fire & Marine Insurance Co.
INSURER D.
INSURER E.
COVER G ThisCertiFcRte iSS not intendeato etFS all Cnilut�cuw +,w; -1— .,._...._. -- - --
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDIN
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. POLICY g/O n POLICY EXPIRATION L1111TS
NSR POLICY NUMBER DATEUI N) DATEp1\T,DD'A-Y)
LTR T\ "PE OF IXSL'RANCE 11/243 11/24/04 EACH OCCURRENCE $1,000,000
B GENERALLIA6IL►Tl. MXC80405374 $100,000
General Liability FIRE D.ANIAGE(Atry one fire
K COMMERCIAL GENERAL LIABILITY
CLAIMS MADE X OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER
PRO-
] POLICY [I JECT LOC
AUTOMOBILE LIABILITY
ANY AUTO
ALL OR' \ED At
SCHEDULED AUTOS
{ HIRED AUTOS
K NON' OWNED ALTOS
GARAGE LIABILITI"
-1 ANY AUTO
Automobile
EXCESSLIABH-ITY umbrella - Primary $25M
OCCUR M CLAIMS MADE
DEDUCTIBLE
RETENTION
\\ORKERS COMPENSATION AND
EMPLOYERS' LIABILITI'
OTHER
Workers Compensation (CA)
MED EXP IAna one Derwin) S5,000
PERSONAL R ADV INJURY S1,000,000
GENERAL AGGREGATE $2,000,000
iPRODUCTS - COMP "OPAGG $2,000,000
3 11/24/04 (OMBIKEDSf \GLELII6T $1,000,000
tEa accidentl
BODILY INJURY
( Perpersonl
BODILY INJURY
i Per accident)
PROPERTY DAMAGE
(Per accident)
ALTO ONE)' - EA ACCIDENT
OTHER THAN EA -ACC
AUTO ONLY AGG
EACH OCCURRENCE $25,000,
AGGREGATE $25,000,
10/22/03 10/22/04 X \ \C STATL- utrt-
TORlYLLIMITS ER, -
EL EACHACCIDEN'T $1,000,000
F.L DISEASE-POLICY LIMIT $1,000,000
EL DISEASE- EAEMPLOYEE $1,000,000
[DESCRIPTION' OF OPERATIONS L- OCATIONS VEHICLES'ENCLL'SIONS NDOED BY LNDORSEMEti I SPECIAL PR( \ SIONS
The Certificate Holder is Additional Insured as respects the operations of the Named Insured.
City of ElSegundc
Attn: Patti Kight
350 Main street
E1 Segundo CA 90245 USA
• Coon 25 -S 01971
Cprtifirato No • c�nnmatincann
&N .CL ATION
SHOULD A \) ' OI *1 [it ABO\'L DESCRIBED POLICIES BE C \\CELLED BEFORE -IIiE F. \PIR.ATIO\
DATE THEREOF. THE IS';[ NCi COA1P,ANV VV'IL I L.ADFAA OR 10 \1 \11
i0 DAYS \\ RI 1 TEN \O1ICE TO THE CER1 "IFIC ATE MOLDER \ \MED TO THE LEI'1 .
BLT FAILLRE'T0 DO SO SHALL IMPOSE NO OBLIGA FION OR 1-1 ABILITY
OF ANI hI\D l I O\ 17iE; COMP: \S1'. ITS AGENTS OR REPRESE\TA "FI \'ES.
AL TFIORIZF,D RI PRESSA'TATIYE � � � �-�
aCORD CORPORATION I 9&
1- Inlrinr IrlPntifir�r
9/11?