PROOF OF INSURANCE (2010) CLOSED�iton D. CERTIFICATE OF LIABILITY INSURANCE
:::6
DATEIMM /DD/09
AUTOMOBILE LIABILITY
02 -CA- 019656311 -0
/1/20)0
5/29/2009
Insurance Brokers, LLC
. Figueroa Street, 35th FI.
PROPERTY DAMAGE
(Per accident)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
icense #OF15767
B
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
os Angeles CA 90017
$ XXXXXXX
HOLDER. THIS CERTIFICATE DOES NOT AMEND,
ALTER THE COVERAGE AFFORDED BY THE POLICIES
EXTEND OR
BELOW.
(213) 689 -0065
�( WC STATU- OTH-
T RY LIMI .R
$ XXXXXXX
INSURED
HIRED AUTOS
INSURERS AFFORDING COVERAGE
NAIC #
Joe's Swee i a , I,
1026052 dba:�>
X
INSURER A : Granite State Insurance Company
23809
and JNL Building Services
INSURER B : United States Fire Insurance Company
21113
11914 Front St.
Norwalk CA 90650
INSURER C : St. Paul Fire and Marine Insurance Company
24767
A
OTHER
Auto Physical Damage
INSURER D:
6/1/2009 1
6/1/2010
THIS
INSURER E:
CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT
BETWEEN THE ISSUINC
COVERAGES JOSS WO 1 P4
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
INSR ADD'L
PAID CLAIMS.
LTR
INSRD
TYPE OF INSURANCE
POLICY NUMBER
DATE t EFFEC YY)
POLICY DATE (MM %DD/YY O)
N
�
X
GENERAL LIABILITY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
02- LX- 086477711 -0
6/1/2009
6/1/2010
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED
PREMISES Ea occurence
$ 300,000
CLAIMS MADE OCCUR
MED EXP (Any one person)
$ 10,000
PERSONAL 8 ADV INJURY
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 200 0 OOO
I-7 PRO-
PRODUCTS - COMP /OP AGG
$ 2- ()()() _firm
A
6/1/2010
AUTOMOBILE LIABILITY
02 -CA- 019656311 -0
i
$ XXXXXXN
X
ANY AUTO
PROPERTY DAMAGE
(Per accident)
$ XXXXXXX
$ XXXXXXX
B
ALL OWNED AUTOS
408 - 698006 -4
$ XXXXXXX
OTHER THAN EA ACC
AUTO ONLY: AGG
H
SCHEDULED AUTOS
�( WC STATU- OTH-
T RY LIMI .R
$ XXXXXXX
X
HIRED AUTOS
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED?
X
NON -OWNED AUTOS
E.L. DISEASE - EA EMPLOYEE
GARAGE LIABILITY
7 ANY AUTO I NOT APPLICABLE
6/1/2009
6/1/2010
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
BODILY INJURY
(Per person)
$ XXXXXXN
BODILY INJURY
(Per accident)
$ XXXXXXx
PROPERTY DAMAGE
(Per accident)
$ XXXXXXX
$ XXXXXXX
B
AUTO ONLY - EA ACCIDENT
408 - 698006 -4
$ XXXXXXX
OTHER THAN EA ACC
AUTO ONLY: AGG
$ XXXXXXX
$ XXXXXXX
C
ExCESS /UMBRELLA LIABILITY
X OCCUR F] CLAIMS MADE
QK4500602
6/1/2009
6/1/2010
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$ 1 OOO,OOO
$ XXXXXXX
B
UMBRELLA
DEDUCTIBLE FORM
X RETENTION $ ] O 000
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
408 - 698006 -4
6/1/2009
6/1/2010
$ XXXXXXX
�( WC STATU- OTH-
T RY LIMI .R
$ XXXXXXX
E.L. EACH ACCIDENT
$ 1,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED?
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
byes, describe under 7 T
SPECIAL PROVISIONS below 1 V o
E.L. DISEASE - POLICY LIMIT
Physical Damage Limit ACV: $50,000
$ 1,000,000
A
OTHER
Auto Physical Damage
02- CA- 019656311 -0
6/1/2009 1
6/1/2010
Ue5GRIPTION OF OPERATIONS /LOCATIONSNEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS
Auto Liability Physical dama a deductibles: $100 Comprehensive and $1,000 Collision. Re: RFP No. 03 -01 - To provide sweeping of streets, alleys and ci
parking lots; The City of El Segundo, its officials, and employees are named as an Additional Insured as their interest may appear as respects to General ty -owned
Liability per the attached endorsement.
1876365
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
El Se undo DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
Clty Of EI Segundo
Attn: Pa ti Knight, City Clerk NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
350 Main Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
El Segundo CA 90245 REPRESENTATIVES.
AUTHORIZED REPRES
L_ I — - I — – _ '/'. 44"p-
ACORD 25 (2001/08) For questions regarding this certificate, contact the number listed in the 'Producer' section above and 7zll cod ,I 11-1'. 0 ACORD CORPORATION 1988
COMMERCIAL GENERAL LIABILITY
POLICY NUMBER: 02 -LX- 086477711 -0
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:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
Name of Person or Organization: WHERE REQUIRED BY WRITTEN CONTRACT
(If no entry appears above, 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.
CG 20 10 11 85 Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1 ❑
Miscellaneous Attachment: M84548
Certificate ID : 1876365