PROOF OF INSURANCE (2002) CLOSEDACORD CERTIFICATE OF
LIABILITY INSURANCgSR DO DATE(MM/DDIYY)
AGIF -1 06/13/01
PRODUCER
Smith - Newman & Adamson
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Insurance Agency, Inc.
1800 E. Lambert Rd. Suite 215
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Brea CA 92821
�' COMPANIES AFFORDING COVERAGE
Suzanne Adams j(¢.j
2 1 JS`l1LtlY 5
PnoneNO. 714 - 257 -9644 FaxNo.714- 7- 3
i3 COMPANY
P11 2: 02 A St. Paul Fire & Marine
INSURED
COMPANY
B National Union Fire Ins. Co.
Pacific National Group
Pacific Building Interiors,
Inc.
COMPANY
C
COMPANY
D
5363 Alhambra Ave.
Los Angeles CA 90032
COVERAGES
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
COI E
LTR TYPE OF INSURANC
POLICY NUMBER
POLICY EFFECTIVE
DATE (MMIDD/YY)
POLICY EXPIRATION
DATE (MM/DD/YY)
LIMITS
GENERAL
LIABILITY
GENERAL AGGREGATE
s2000000
PRODUCTS - COMP /OPAGG
s2000000
r—,
A X
COMMERCIAL GENERAL LIABILITY
KK08301591
07/01/01
07/01/02
PERSONAL BADVINJURY
$1000000
CLAIMS MADE a OCCUR
EACH OCCURRENCE
$ 1000000
j�X j
X
OWNER'S & CONTRACTOR'S PROT
Per job aggregate
FIRE DAMAGE (Any one fire)
$ 100000
MED EXP (Any one person)
s5000
AUTOMOBILE
A Fkl
LIABILITY
ANY AUTO
KK08301591
07 /01/01
07/01/02
COMBINED SINGLE LIMIT
$ 1000000
BODILY INJURY
(Per person)
i
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident)
$
�X�
j{
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN AUTO ONLY:
ANY AUTO
EACH ACCIDENT
$
AGGREGATE
$
EXCESS LIABILITY
F X UMBRELLA FORM
BE8711744
07/01/01
07/01/02
EACH OCCURRENCE
$ 19000000
AGGREGATE
$ 19000000
$
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
X TORY LIMIT OTH-
S
EL EACH ACCIDENT
$ 1000000
EL DISEASE - POLICY LIMIT
$ 1000000
A THE PROPRIETOR/ }{ INCL
PARTNERS /EXECUTIVE
OFFICERS ARE: EXCL
WVK8300619
07/01/01
07/01/02
EL DISEASE - EA EMPLOYEE
$ 1000000
OTHER
A Install /Builders
CK08307756
07/01/01
07/01/02
Limit: 4000000
:Risk
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES /SPECIAL ITEMS
All operations. Its agreed the City of El Segundo are included as
additional insured and coverage is primary per the attached endorsement.
CERTIFICATE HOLDER
CANCELLATION
CYELSEG SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL MAIL
City of E1 Segundo
*30 DAYS WRITTEN NOTICE'T9 THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Bldg. & Safety Dept.
350 Main Street
E1 Segundo CA 90245
AUTHORIZED REPRESENTATIVE
7 �)
/
Suzanne Adams �' �� -/
ACORD 25 -S (1195)
" ACORD CORPORATION 1988