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PROOF OF INSURANCE (2007) CLOSED29;`'-1007 119:59 `lS- 345135919 h1�� C011�TPUCTI0II taPP PA r;E 136!'13'3 CERTIFICATE OF LIABILITY INSURANCE I 1123 *1200'(''' PRODUCER AGENCY ONE INSURANCE SERVICES INC ~ ^ —J THIS, CERTIFICATE IS ISSUED AS A MArTrc-P OF INFORtv1ATION 2052 WEST AVE K ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIPICATE DOES NOT AMEND, EYTEND OR ALTER THE (:OVERAGE AFFORDGO BY THE POLICiE3 BELOW. LANCASTER CA 93535 i INSURERS AFFORDING COVERAGE �a1s� soa -aa2a _- -__ _ _ nsuRe° 7rnA. C_ernini [nsur�nae Com an NSA CONSTRUCTION GROUP INC It—fi a. PROGRESSIVE INSURANCE _COMPAN 19562 VENTURA BLVD STE 219 1 Ir +suueo c TARZANA, CA 91366 f-- - -- - — -• -_- r•:E:riER. v IranJaeR E. COVERAGE6 TH- POLJC;ES Of- !a:ZUF:AtdCE LISTED oELO�N HAVE 6dL:r4 ISSULD Tr T11E Itl5URED NIWED AL'OVE FOR THE vOLICY PERIOD ItdDICG.TED t:0- /vriHSTANGNG l !�d'r RL'OuIRc''dcrll" TERM CR COt;DIPON OF ,VIY COr:TR;;CT OR :JTH6R DOCUfv1Et;T VRTH RESPE'f 1'0 4 ?riICN THIS CERTIFICATE MAY GE !S�U_D OR rrAY PER "i ir'I _; IC IWSURAFICE AFI'OP.DED BY THE rOLICIEC DEJCR15ED HFIREIN (fl 9UBJ_I;T TU ALL THE TERMS. Ek'CLUSIOr,S Al-10 CCINOI `)NJ 0'= SUCH POLICES AUGP.EOAYE LIMITS SH'OV)N MAY HAVIT PI(io'. PEDUCEC 0Y PAID CLt,IMS. I� ❑R 1YPE DF'f;5UAANCE _ R °OUCY NUMBER rQ trl'!rti.7lvL I NCiilc:PE %PI S1'16f:" 16+A+:ry. _ DATE Ir.1. " /�DMV) GG:'ER LLLANUT, i EL',r.0.;:o.,++c%c_- r. X CGId(::Ehi:nl GENEkAl. L_ IAUILIT - _1,000,0_0_0 ^E Dr. ".1F�E iAn. "rL Ili d; , SO.000 �/ !�f4a K I Ote.'_l ('� 1 � _ !PIED EiP !A!tf Ctp ✓2CJGiI 5,000 ` A ~ ` VCGP013631 12/12/2000 1211212007 a �ortgL:; Aov I;JJUIr Vr 1.000,000 ; EN •L.;GI;RL'rr,`c_UITAPPLILSTERj Gf:ODVCTS- _- A4P+OP,:r,,; 1 000,000 AUTOraOFILE LlwdluYr �I i COVL +!Piro 1114ZLC LR1'I 1,000,000 + +nur� I a JCUCY'lil ______i' __.._.. .,... 1 ' ,ti.:.':h[O aU`C.. �'DOLL'�II•111J ?Y— �Pvr X �: i,EDi! G /• L T03 g — 01807545 -9 2/1112001 I 8111/2007 X '. X r ;OrlLI +AJFD .r:.Trg i ;I +Ar ...mid :nti - - GARAGE U'ieJUT- j AU i 0 0:!LY . nCC _EMT OTHER -Hhr W'•. A!� AtrY A. IT`) EXCe:;S LIA91LIlY - � ;;r'CUt< •:Ll+Ihh rdr�GG I � i r�?G'NE :nT[, .. ... I -- -, -- -- i JFCU:TIl3LE -- re-EN rlor, :.CRKLRF MhIPGNSATIOk AND eMPLOY6RW LIARILITY c.l. enCH Ar,:;IJEt,,T i E,L, OISGhSE. EA EKIFLOYL+fa ; ry..... _. . C.,. uIdF.AyC- PC!_ICr Ljr)!T i r, 07rna I � — DESCRIPTION Oi O ?ERAiION$ ;LOCATIONS! \EHI.Ltaieu:LUSIOF;; ADOCO BY EIIDr_'raee4rNTrSP[CIAL PROV19iaWC 10 DAY NOTICE OF CANCELLATION FOR NON - PAYMENT OF PREMIUM, THE CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS, EMPLOYEES AND AGENTS CIO CITY OF EL SEGUNDO CITY CLERK ARE ADDITIONAL INSURED TO THE ABOVE POLICY PART "A ". PROJECT NAME, EL SEGUNDO GROUP 13 CERTIFICATE HOLDER 1 rpOITONALUaeuRCOIroJ ; uaw L4TTtr:. THE CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS, EMPLOYEES, AND AGENTS C/O CITY OF Ek SEGUNDO CITY CLERK 350 MAIN STREET ROOM 5 EL SEGUNDO CA 90245 -3813 ACORD 25S (7197) t' _ 1 a E c. , Jr T - tl e,% er vi0 1AIT U cA+v�tLLh nvr+ JIIDULO aN'i C'F YI•!E A80 +/E DEsCR10 ED PO1101w^ C3E CMICELLED 6E+'QAF_Tl-.E [.. ?IRAN 011 DATE TISFilI.iAi _TH= IS3Utr;C it.SVHGR v,9LL90=00� MAIL 3l� ua'YG 'l:r�nEra ryd'fh'f'f0 •ME GEf:;I,'ICATG HOLOP_R ruc +GO YO THE LEF1, LI'' LPi: r-' C! — - ', ':7 b, L- "TN.-m. )RD CORPORATION 19EE 0K-(- . �7i1 "" ,3 : _,0F0 r3'3: 5'3 818 - 34505,30 t !SA DD ISTPUCT I O1 l �aPP IMPORTANT If the cerri ic3?e holder ;3 an ADDITIONAL INSURED, the policy(io2) must be cndorsc(J . H estaiNment on this certificate does not confer rights to the certificate holder in lieu of such endo sement(s) If SUBRCGATIO14 IS V AIVED, subject to tha terms and conditions of the policy, certain policies n-3, reQore an endorsement. A atatement c!, This certir!cale does not confer ri•pts to the cert&catc- holder in lieu of such endursemr_nt(s) DISCLAIMER The Cortificmo of Insurance on the reverse side of this form does not constitute a contract t,enve n the Issuing irnsurer(s), authorized representative or producer, and the certificate holder, nor dos it aFfinr+aiivoly or negatively arncrd, ev.tcnd or alter the coverage o+fordod by the polici_s listed thgracn ACORD 25.3 (7197) Lf L;'\, ♦ �'.:� _l �,a31�:' r': N ,, 3 ^i - 1 v,':h P4GE 0 ,r �i'3 3`1 0 % 09: 59 Y 919 - 34505'30 t15 COt1STF'UCTIi]tl caRF FHi%E 0G,/09 VYll 11:0!GVIJ/ 1 "L d� ;fj5 Ay PAt,•_ 1,111�,i, F6UcY Nmnber: VCCP013631 1'F 0170 0.102 [rtrnrcd Names ?NSA CONSTRUCTION GROUT, fPr'C, Number: 37 1Y%rttve Datti 01112.,*2W TF'S E`'DORSF1\41\`1' CIUM3,FS 7TfF POLICY. PLEASi, READ Tx C- ApEnTLY. A1bE DIN-M."NT JAUSCELL.ANEOUS PRONISIUNS This endorsement modifies in3urar,cr: provid;d under t w f0110AdnF: COk1:�RCIAL CE*,NTP AL Lll,.BlLI'TY Cl)ti'ER AJ3E PART PRODUCTS /COACPLETED OP>; F_1,.TIONS LIABILITY CGvFRAGE RkRT It is au--ed for a D4 i11lly eunad mditicnal Premium of 5 j00 thF following, Additional Pro i,Van(s) is,+= added to yic policy a^ indicated by tha "p" chtu;ed in the box Wert to the applicable Flw l,Ysion(s ). of X "J�I-ly (30) days Wnttrn noti c exr -C:pt [rn (10) daye Written notice if the policy CaW -cls for nnrrp lj'mcnt of "tvmium to the cer u5cate h0lch r ,�dreed bolnti�; d) Other Sp8 i�I Pretiti�iocy 1\0?'7-CONTF J3UT1012Y ` QRN-- G ALSO AF'PLIZ S, Co of catc Holden `IA.pplicablu 77,ird Party (icy) tau hem this L•ndor rrttcnt appllev; THE CIT'rYr��OF L;,L7�SEC- T- J -NT>C, ITS OFFICTR -3. OFFiCM, CITY Or RT, 9EGLWD0 CITY CLERK AT"T: RBSIDFIMM, 80TT,,,lD L'�SLL,ATTOht prtiOGF_3 \c 350 :\0Q'i STREET ROO.Nf s EL sEGtTTDO CA 90245 -38 13 QL. MER T73. MS AND OF TM POLIC) f RPJ \,f U',t UN!-HPNGF.T). Pmmlum� g Slate Tax: $ VE 017o 0102 Stamping Fee: a . Total Due: $ S t (" . v P peso I of i X31:' 9 2 -100 7 X39:59 818 - 94505'30 HSA COtISTRUCTIOt! r-:3RP PAGE 09/09 Pol iry \Timber: V CGP011.875 AD (1l 16 0195 Insured Name: NSA CONSTRUCTION GROUP, INC. Number: 38 Effective Date. 1011 VU06 COMMERCIAL GENERAL LIABILITY COVEt3AGsE PART THTS E'NDORSEVIEN f C RA-NGES TW, POLICY. PLEASE READ IT CAREP`ULLY. l MENTMEENT This endorserrm ut modifies insurance pmlde:l under the follov jajg CONSfE.1ZML GENTRAL LIABU,ITY COVERAGE PART Tr L4 AGREED FOR A RETURN pRENiffTJ t OF �,:Oh.oO. 7I� �T ���ORSIril�LitiT 1dT fiIBEP. ?� ��IVD? A.R$ �'i�Zt Bc 11OlI7• Premium: wpb StWo Tax: Total Due,, $ s 1 3�.. R P AD 66 16 0195 Cop }aght, Iriy4rancc Scnric�s 4fTice InU., 1997 Pale Y of 1 [I Policy Number: VCGP013631 VE01700102 Insured Name: NSA CONSTRUCTION GROUP, INC. Effective Date: 01 /1 2/2007 Number: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART A. Section II — Who is An insured is amended to include as ari insured any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured but only with respect to liability caused by your ongoing operations performed for that insured. A person's or organization's status as an insured under this endorsement ends when your operations for that insured are completed. This insurance does not apply to liability caused by the sole negligence of any additional insured. B: With respect to the insurance. afforded io these ad"cftional }nsureds, the follovng additional exclusions applies: This insuranoefji s tApply to: 1. The prepanng approving, or failing to prepare and approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and 2. Supervisory, inspection, architectural or engineering activities. VE01820304 Page IofI Policy Number. VCGP013631 VE 0170 0102 Insured Name: NSA CONSTRUCTION GROUP, INC. Number: 37 Effective Date: 01/1212007 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT MISCELLANEOUS PROVISIONS This endorsement modifies insurance provided under the following: CON% ERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART It is agreed for a flat; fully earned Additional Premium of S 500 the following Additional Provision(s) is/are added to the policy as indicated by the "x" checked in the box next to the applicable Provision(s). a) ❑X Thirty (30) days written notice except ten (10) days written notice if the policy cancels for non - payment of Premium to the certificate holder named below; d) IX Other Special Provisions NON-CONTRIBUTORY WORDING ALSO APPLIES. Certificate Holders /Applicable Third Party(its) to whom this Endorsement applies: THE CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS EMPLOYEES AND AGENTS. C/O CITY OF EL SEGUNDO CITY CLERK ATT: RESIDENTIAL SOUND INSULATION PROGRAM 350 MAIN STREET ROOM 5 EL SEGUNDO CA 90245 -3813 ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. Premium: $ Ste. State Tax: $ fr. VE 0170 0102 Stamping Fee: $ a • Yl< Peat 1 of 1 Total Due: $ .r( r. p8 0 (( � MISAL C1lDMSV1WL5CV®1lDH cw-moufa�r Inc. General Bullding Contractors Lic, #714457 December 18, 2006 Mr. James O'Neill Program Manager City of El Segundo 350 Main Street EL Segundo, CA 90245 Re: Required Contract Documents Residential Sound Insulation Project — Group 12 Project No. RSI 06 -12, Contract No. 3676 Residential Sound Insulation Project — Group 13 Project No. RSI 06 -13, Contract No. 3677 Dear James: Via Messenger Service 35 pages Attached please find signed Contract Agreements for Residential Insulation Projects Group 12 & 13, along with required documents, as follows: — 2 sets of Faithful Performance Bond — 2 sets of Labor and Materials Bond — General and Auto Liability Insurance Certificate — Workers' Compensation Insurance Certificate. If you have any questions please call this office. Thank you for your immediate attention to this matter. Z: \Projects \EI Segundo Group 12\ Correspondence \Letters \Cover_Notice to Award Docs.doc 19562 Ventura Blvd., Suite 219, Tarzana, CA 91356 • Telephone: (818) 345-1153 Fax: (818) 345 -0590 www,nsoconstruction.com AGENCY ONE INS SRVCS 2052 W AVE K LANCASTER, CA 93536 661. 723 -0404 Certificate of Insurance Certificate Holder Insured CITY OF EL SEGUNDO NSA CONST GROUP 350 MAIN STREET ROOM 5 19562 VENTURABLVD219 EL SEGUNDO, CA 90245 TARZANA, CA 91356 drivw *30kµ« „oM nvasemW Policy number: 01807545 -9 Underwritten by: UNITED FINANCIAL CASUALTY COMPANY January 29, 2007 Page 1 of 2 Agent ............................... . AGENCY ONE INS SRVCS 2052 W AVE K LANCASTER, CA 93536 This document certifies that insurance policies identified below have been issued by the designated insurer to the insured named above for the period(s) indicated. This Certificate is issued for information purposes only. It confers no rights upon the certificate holder and does not change, alter, modify, or extend the coverages afforded by the policies listed below. The coverages afforded by the policies listed below are subject to all the terms, exclusions, limitations, endorsements, and conditions of these policies. ................................................ .............................. Policy Effective Date: Feb 11, 2007 .... ..................... ............................. ............................... Polic y Expiration Date: Au g .... 11, 2007 Insurance coverage(s) Limits EMPLO"YER"S NON -OWNED AUTO BIPD $1,000,000 COMBINED SINGLE LIMIT BODILY INJURY /PROPERTY DAMAGE $1,000,000 COMBINED SINGLE LIMIT HIRED AUTO BODILY INJURY /PROPERTY DAMAGE $1,000,000 COMBINED SINGLE LIMIT ......_........................ ................. ......................................................................................................................... UNINSURED /UNDERINSURED MOTORIST $1,000,000 COMBINED SINGLE LIMIT Description of LocationNehicles /Special Items Scheduled autos only ............................... ........................................................................................................................................... 1992 FORD PICKUP 1 FTEX15Y2NKA68446 Stated Amount $5,000 COMPREHENSIVE $1,000 DED COLLISION $1,000 DED ............................... .................................................................................................................... 1995 DODGE RAM VAN 82500 2B7HB21X5SK569626 Stated Amount $10,000 COMPREHENSIVE $1,000 DED COLLISION $1,000 DED ............. ....... . ................................................ ............................... ... ...................................................... ............. 2005 GMC YUKON 1 GKEC1 3T25R1 70795 Stated Amount $46,000 COMPREHENSIVE $1,000 DED COLLISION $1, DED ................................ ....... .... ................ ....... .............................................................................000 1997 FORD ECONOLINE El 50 1 FTEE1 426VHA58230 ............................. Stated Amount $10,000 COMPREHENSIVE $1,000 DED COLLISION $1,000 DED N Continued o tL® Policy number: 01807545 -9 Page 2 of 2 Certificate number 02907NET545 Please be advised that the certificate holder will not be notified in the event of a mid -term cancellation. Form 5241 (10/02)