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PROOF OF INSURANCE (2009) CLOSEDAS�BDM CERTIFICATE OF LIABILITY INSURANCE 10/10 /2008) PROI ^ER (949)297 -5962 FAX (949)297 -5960 Insurance Office of America, Inc. DBA IDA Insurance Services 130 Vantis, Suite 165 Al iso Vie'o CA 656 -2703 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURE , Inc. 1411 North Batavia Street Suite 202 Orange, CA 92867 INSURER A: Travelers P&C Co. of America 25674 INSURERS: Travelers Indemnity Co of Ct 25682 INSURER C: St Paul Fire & Marine INSURER D: I68031611-881TIL08 INSURER E: 08/21/2009 A 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. INSR DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DDIYYI POLICY EXPIRATION DATE IMMIDDNYI LIMITS GENERAL LIABILITY I68031611-881TIL08 08/21/2008 08/21/2009 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED $ 11000,000 X COMMERCIAL GENERAL LIABILITY MED EXP (Any one person) $ 10,000 CLAIMS MADE a OCCUR PERSONAL & ADV INJURY $ 2,000,000 A X Additional Insured X Waiver of Subro GENERAL AGGREGATE $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 1,000,000 POLICYFX71 jE LOC AUTOMOBILE LIABILITY I6803161L881TIL08 08/21/2008 08/21/2009 COMBINED SINGLE LIMIT $ (Ea accident) Included ANY AUTO BODILY INJURY $ ALL OWNED AUTOS (Per person) A SCHEDULED AUTOS X HIRED AUTOS BODILY INJURY $ NON -OWNED AUTOS (Per accident) X PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE $ OCCUR F ]CLAIMS MADE $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND XEUB7346Y745 10/09/2008 10/09/2009 X I WC STATU- OTH- E.L. EACH ACCIDENT $ 1,000,000 EMPLOYERS' LIABILITY B ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,00 If yes, describe under SPECIAL PROVISIONS below roessional QP03810937 08/21/2008 08/21/2009 $1,000,000 Per Claim' C $2,000,000 Annual Aggregate !Liability-Claims Made Retro Date: Full Prior Acts DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS All operations of the Named Insured. General Liability: The City of E1 Segundo, its officers, officials, employees and designated volunteers are an additional per the attached Endorsement. * A ten (10) day notice will be given for non - payment of premium. The City of E1 Attn: Director Building Safety 350 Main Street E1 Segundo, CA Segundo of Planning and 90245 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL KMX0 MAIL 30* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, x�cxa�ara�wxxxxacx�xdwrx�x >xxxxx AUTHORIZED REPRESENTATIVE Earleen Thomas /FA( ON ACORD 26 (2001/08) VAGUKW GUKI'UKF11 wry I V00 z N 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 (2001108) INSURED: MRH Structural Engineer S TRAVELS R POLICY DATES: October 9, 2008 -09 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 03 76 (00) - 001 POLICY NUMBER: 1 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT — CALIFORNIA (BLANKET WAIVER) We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 5 % of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description ALL PERSONS OR ORGANIZATIONS THAT ARE PARTIES TO A CONTRACT THAT REQUIRES YOU TO OBTAIN THIS AGREEMENT, PROVIDED YOU EXECUTED THE CONTRACT BEFORE THE LOSS. POLICY NUMBER: 168031611-881TIL08 COMMERCIAL GENERAL LIABILITY NAMED INSURED: MRH Structural Engineers, Inc. DATE PULLED: 10/10/08 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM 1. WHO IS AN INSURED (Section II) is amended to include any person or organization that you agree in a "contract or agreement requiring insurance" to include as an additional insured on this Coverage Part , but: a. Only with respect to liability for "bodily injury", "property damage" or "personal injury"; and b. If the injury or damage arises out of the performance, by you or your subcontractor, of "your work" to which the "contract or agreement requiring Insurance" applies. Such person or organization does not qualify as an additional insured with respect to their independent acts or for "bodily injury", "property damage" or "personal injury" for which that person or organization has assumed liability in a contract or agreement. 2. The insurance provided to the additional insured by this endorsement is limited as follows: a. This insurance does not apply on any basis to any person or organization for which coverage as an additional insured specifically is added by another endorsement to this Coverage Part. b. This insurance does not apply to the rendering of or failure to render any "professional services ". c. The limits of insurance afforded to the additional insured shall be the limits which you agreed to provide in that "contract or agreement requiring insurance ", or the limits shown in the Declarations for this Coverage Part, whichever are less. This endorsement does not increase the limits of insurance stated in the LIMITS OF INSURANCE (Section III) for this Coverage Part. 3. The following is added to Paragraph a. of 4. Other Insurance In COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): However, if you specifically agree in a "contract or agreement requiring insurance" that the insurance provided to an additional insured under this Coverage Part must apply on a primary basis, or a primary and non- contributory basis, this insurance is primary to other insurance that is available to such additional insured which covers such additional insured as a named insured, and we will not share with the other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought occurs; and (2) The "personal injury" for which coverage is sought arises out of an offense committed; CG D3 81 09 06 Includes copyright material of Insurance Services Offices, Inc., with its permission. Page 1 of 2 Copyright, Insurance Services Offices, Inc. after you have entered into that "contract or agreement requiring insurance ". But this insurance still is excess over valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the insured when the insured is an additional insured under any other insurance. 4. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us in COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): We waive any rights of recovery we may have against any person or organization because of payments we make for "bodily injury", "property damage" or "personal injury" arising out of "your work" performed by you, or on your behalf, under a "contract or agreement requiring insurance" with that person or organization. We waive these rights only where you have agreed to do so as part of the "contract or agreement requiring insurance" with such person or organization entered into by you before, and in effect when, the "bodily injury" or "property damage" occurs, or the "personal injury" offense is committed. 5. As respects the insurance provided to the additional insured by this endorsement, the following definition is added to DEFINITIONS (Section V): "contract or agreement requiring insurance" means that part of any contract or agreement under which you are required to include a person or organization as an additional insured on this Coverage Part, provided that the "bodily injury" and "property damage" occurs, and the "personal injury" is caused by an offense committed: a. After you have entered into that contract or agreement; b. While that part of the contract or agreement is in effect; and C. Before the end of the policy period. All other terms of your policy remain the same. CG D3 81 09 06 Includes copyright material of Insurance Services Offices, Inc., with its permission. Page 2 of 2 Copyright, Insurance Services Offices, Inc.