PROOF OF INSURANCE (2010) CLOSEDCOVERAGES
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
DATE (MNVppmrn
LIABILITY
INSURANCE OP IDCo
TYPE OF INSURANCE
CERTIFICATE OF
MARTIN2
04/16/10
LIMITS
EACH OCCURRENCE
S 1,000,000
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Attn: office of the City Clerk
PRODUCER
nX
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
PIASC Insurance Services, Inc.
02/18/10
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Lic.# 0747420
f I, 000, OOO
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P.O. Box 910936
CLAIMS MADE X❑ OCCUR
Los Angeles CA 90091 -0936
NAIC#
Phone: 323 - 728 -9500 Fax: 323 - 728 -0483
GENERAL AGGREGATE
INSURERS AFFORDING COVERAGE
INSURED
INSURER A'. America i
20621
INSURE0. B_ .d Xar Pmya. I-
10900
Martin & Chapman Company
INSURER
Attn: Scott Martin
--
1951 Wright Circle
11000,000
INSURER D.
Anaheim CA 92806 -6028
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.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITYOFI
TYPE OF INSURANCE
POLICY NUMBER
POLICMWDDICYIVE
PATE (MMD)DIYYYY)
DATE( EXPIRATION
DATE (MMIDO/YYYY)
LIMITS
EACH OCCURRENCE
S 1,000,000
REPRESENTATIVES.
Attn: office of the City Clerk
nX
RAL LIABILITY
COMMERCIAL GENERAL LIABILITY
717009449 -03
02/18/10
02/18/11
-
DAMAGETORENTED
PREMISES (E a¢Vi -)
f I, 000, OOO
MED UP (Any one person)
$ 10,000
CLAIMS MADE X❑ OCCUR
PERSONALSADVI NJURY
f 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GL BROAD FOR::E ND
PRODUC TS - COMP /OP AGO
S 2,000,000
GENT AGGREGATE LIMIT APPLIES PER.
PRO- LOC
X POLICY JECT
Empl . Ben
11000,000
A
AUTOMOBILE
X
LIABILITY
ANY AUTO
717009449 -03
02/18/10
02/18/11
COMBINED SINGLE LIMIT
(Ee axitleM)
S 500,000
ALL OWNED AUTOS
BODILY INJURY
(Per Person)
$
SCHEDULED AUTOS
X
HIRED AUTOS
BODILY INJURY
(Par accltlaM)
$
X
NON -0WNED AUTOS
PROPERTY DAMAGE
(Par eddd.M)
$
AUTO ONLY - EA ACCIDENT
$
GARAGE LU181LJTY
ANY AUTO
OTHER THAN EA ACC
AUTO ONLY AGO
f
S
EACH OCCURRENCE
S 3,000,000
EXCESS I UMBBELLA LIABILITY
--
AGGREGATE
$
A
g OCCUR ❑ CLAIMSMADE
717009449 -03
02/18/10
02/18/11
S
S
DEDUCTIBLE
WG STATU- OTH-
X TORY LIMITS ER
S
X RETENTION $ O
WORKERS COMPENSATON
E.L. EACH ACCIDENT
S 1,000,000
B
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETORIPARTNEWEXECUTIVE
WKN122873 -6
06/01/09
O6 /O1 /IO
OFFICERIMEMBER EXCLUDED?
❑
E.L. DISEASE -EA EMPLOYEE
f
(ILriMOry In NH)
-- -"
If yea. Eeanri. under
E . DISEASE - POLICY LIMIT
f
SPECIAL PROVISIONS .1—
OTHER
A
Errors & Omissions
717009449 -03
02/18/10
02/18/11
Special 1,000,000
Form 25,000 Ded
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS
Certificate holder is named as ADDITIONAL INSURED with respects to liability
arising out of work performed by the Named insured.
* *Workers' Compensation- -Proof of Coverage Only **
** *Errors & Omissions- -Proof of Coverage Only * **
ULK IirIUA l C rlVLU=f%
- - - - -- -- -
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITYOFI
DATE THEREOF, THE ISSUING INSURER WALL ENDEAVOR TO MAIL DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR
City of El Segundo
REPRESENTATIVES.
Attn: office of the City Clerk
350 Main Street
�IIII
1 Segundo CA 90245- 3389
won rnoonCAT1nN All rinhfc rRSrarvad.
AGUKU 25 (ZOU9 /U9)
The ACORD name and logo are registered marks of ACORD
Reproduction of Insurance Services Office, Inc. Form
INSURER: ISO FORM CG 20 10 11 85: (MODIFIED)
POLICY NUMBER: COMMERCIAL GENERAL LIABILITY
ENDORSEMENT NUMBER: EXHIBIT 1 -A
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:
CONMMRCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
The City, its officers, officials, employees, agents, and volunteers
(If no entry appears above, the information required to complete this endorsement
will be shown in the Declarations as applicable to this endorsement.)
WHO IS AN INSURED (Section II) 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 work" for that insured by or
for you.
Modifications to ISO form CG 20 10.11 85:
1. The insured scheduled above includes the Insured's officers, officials, employees and
volunteers.
2. This insurance shall be primary as respects the insured shown in the schedule above,
or if excess, shall stand in an unbroken chain of coverage excess of the Named
Insured's scheduled underlying primary coverage. In either event, any other insurance
maintained by the Insured scheduled above shall be in excess of this insurance and
shall not be called upon to contribute with it.
3. The insurance afforded by this policy shall not be canceled except after thirty days
prior written notice by certified mail return receipt requested has been given to the
Entity.
4. Coverage shall not extend to any indemnity coverage for the active negligence of the
additional insured in any case where an agreement to m emni the additional insured
would be invalid under Subdivision (b) of section t1i I'll pw.
CG 20 CO 1185
Address
Insurance Services Office, Inc. Form (Modified)