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PROOF OF INSURANCE (2008) CLOSEDACORa, CERTIFICATE OF LIABILITY INSURANCE 4 DATE 1- 866 - 220 -4625 T THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION PRODUCER 1 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Holmes Murphy and Associates - Omaha O THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 2637 South 158th Plaza Suite 200 INSURERS AFFORDING COVERAGE Omaha, NE 68130 I — - - -- INSURER A: Zurich American. Insurance INSURED I Company 165 d /b /a PBS &J I INSURERC Steadfaat Insurance Company /H263.87 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE IN5UKLIJ NAmtu movvr: rvR r ". 1-1—, .— • • ­'_'1'__...__­.' - -_ - 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. _ .. ........... _._. __., . ..... ._._— __._...._. -. POLICY EFFECTIVE POLICY EXPIRATION LIMITS ITR INSR _ TYPE OF INSURANCE POLICY NUMBER A GENERAL OLD 9139458 -01 09/30/07 09/30/08 EACHOCCURRENCE _ - $_1,000, -000 . „_. 1,000,000 X COMMERCIAL GENERAL. LIABILITY FIRE DAMAGC (Any one fire) S _. ..._._. - CLAIMS MADE LX OCCUR MCD,FXP(Anyoneperson) $25,000 .. -.,._ _.._ - 1, 000 000 X Contractual Liability 2 , 000, 000 - GENERAL AGGflEGATE S - _ . _ ...... .... ......... . _.._..... . .— ... -._.. GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 2 , 000 - POLICY I X PRO- X LOC S AUTOMOBILE LIABILITY Sap 9139457 -01 09/30/07 09/30/08 COMBINED SINGLE LIMIT $2,000,000 (Ea auddent) X ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Per person) .. _.. SCHEDULED AUTOS _.........._._ -. ....,......_ __._..._. X HIREDAVTOS BODILY INJURY $ _._.. (Per accident) X NON -OWNED AUTOS ........ - - _.,......._ ....... __,...... - ...___._._ _ . . ........... % Contractual Liability PROPER TYDAMAUE $ _ --- --_----...-...,___ ._...._...__.- .-...._-- _-_----- (Porsoddent) AUTO ONLY -EA ACCIDENT $ -.. .._.._.- ..._.._ ...... . ... ._.._.. _GARAGE LIABILITY --__..-.__.... ........_-- _._._........__..... -- ANY AUTO OTHER THAN _.— .. S _ ....--- .-- _.__...___•_ -- -__ AUTO ONLY: AGG $ AUC 508762103 09/30/07 09/30/08 EACH OCCURRENCE _ —_- 5 25,000,000 C EXCESS LIABILITY .,.•_ - J OCCUR _ J CLAIMS MADE AGGREGATE _ _ , - - -... $ 25 000,000 _ $ -- DEDUCTIBLE _......... _. -...- - -- ......_...__ ..._- ... -..._. RETENTION $ 0 WC 8 A I jOTH- A WORKERS COMPENSATION AND WC 9139459 -01 09/30/07 09/30108 X 7oRY.iIMlTS..._..__, _EI3- ...__ .... .. ............__. ,- ..... -... EMPLOYERS' LIABILITY - E.L_EACH ACCIDENY $ 1, 000, 000 E.L. DISEASE EA EMPLOYEE ..S -1 000 000 . E.L. DISEASE POI.LCYLIMIT $ 1,000,000 OTHER 6 t 3 DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES !EXCLUSIONS ADDED BY ENOORSEMENTISPECiAL PROVISIONS The City of E1 Segundo, its officials and employees are Additional Insureds on the General Liability on a Primary and Non - Contributory basis with respect to the operations of the insured. SEE ATTACHED FOR ADDITIONAL WORDING REGARDING COVERAGES AND NOTICE OF CANCELLATION. GtKI11'fllAl M nV1-N1=rc I I nuun,vnnw mo.,,...., ,,.��•• -•• - _.._. -. -- - -- - __ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION El Segundo, City of DATE THEREOF, THE ISSUING INSURER WILL T XMKV4MAIL 90 DAYS WRITTEN Planning & Building Safety Dept. NOTICE TO THE CERTIFICATE MOLDER NAMED TO THE LEFT, dWX% [HUX5XV9D1tl{=K Attn: Mary Lewis Xap1yV$ j( Yes f�gf1E3WEI4GX8GKKK1tNdk�4ii114B74i6iWf >XaUWE><?IiEBKiit9<8i{X 350 Main Street IMW"g 1CXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXX E1 Segundo , CA 90295 -3813 AUTHORIZED REPRESENTATIVE �� USA ACORD 25-3 (7197) rflatowicz ®ACORD CORPORATION 1988 oaa, v,. GtKI11'fllAl M nV1-N1=rc I I nuun,vnnw mo.,,...., ,,.��•• -•• - _.._. -. -- - -- - __ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION El Segundo, City of DATE THEREOF, THE ISSUING INSURER WILL T XMKV4MAIL 90 DAYS WRITTEN Planning & Building Safety Dept. NOTICE TO THE CERTIFICATE MOLDER NAMED TO THE LEFT, dWX% [HUX5XV9D1tl{=K Attn: Mary Lewis Xap1yV$ j( Yes f�gf1E3WEI4GX8GKKK1tNdk�4ii114B74i6iWf >XaUWE><?IiEBKiit9<8i{X 350 Main Street IMW"g 1CXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXX E1 Segundo , CA 90295 -3813 AUTHORIZED REPRESENTATIVE �� USA ACORD 25-3 (7197) rflatowicz ®ACORD CORPORATION 1988 oaa, v,. IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(les) 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 -S Additional Insured — Automatic - Owners, Lessees Or Contractors - Broad Form Named Insured: Post Buckley, Schuh & Jernigan, Inc. d /b /a PBS &J Policy No. GL09139458 -01 0 ZURICH , L'ff. Date of Pol. rixp. Date of Pol. Gty. Date orI'nd. Producer Add'].Prem ttctumPrem. 09/30/07 09/30/08 09 /30 /07 $ THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 'this endorsement modifies insurance provided under the: Commercial General Liability Coverage Part A. WHO IS AN INSURED (Section 11) is amended to include as an insured any person or organization whom you are required to add as an additional insured on this policy under a written contract or written agreement. B. The insurance provided to additional insureds applies only to "bodily injury ", "property damage" or "personal and advertis- ing injury" covered under Section 1, Coverage A, BODILY INJURY AND PROPERTY DAMAGE LIABILITY and Coverage B, PERSONAL AND ADVERTISING INJURY LIABILITY, but only if: 1. The "bodily injury" or "property damage" results from your negligence; and 2. The "bodily injury ", "property damage" or "personal and advertising injury" results directly from: a. Your ongoing operations; or b. "Your work" completed as included in the " products - completed operations hazard ", performed for the additional insured, which is the subject of the written contract or written agreement. C. However, regardless of the provisions ofparagraphs A. and B. above: 1. We will not extend any insurance coverage to any additional insured person or organization: a. That is not provided to you in this policy; or b. That is any broader coverage than you are required to provide to the additional insured person or organization in the written contract or written agreement; and 2. We will not provide Limits of Insurance to any additional insured person or organization that exceed the lower of: a. 'f'lte Limits of Insurance provided to you in this policy; or b. The Limits of Insurance you are required to provide in the written contract or written agreement. D. The insurance provided to the additional insured person or organization does not apply to: "Bodily injury ", "property damage" or "personal and advertising injury" that results solely from negligence of the addi- tional insured; or 2. "Bodily injury ", "property damage" or "personal and advertising injury arising out of the rendering or failure to render any professional architectural, engineering or surveying services including: a. The preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and U- 0I.- 1175 -A Cw (9103) Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc. with its permission. b. Supervisory, inspection, architectural or engineering activities. E. The additional insured must see to it that: 1. We are notified as soon as practicable of an "occurrence" or offense that may result in a claim: 2. We receive written notice of a claim or "suit" as soon as practicable; and 3. A request for defense and indemnity of the claim or "suit" will promptly be brought against any policy issued by an- other insurer under which the additional insured also has rights as an insured or additional insured. F. The insurance provided by this endorsement is primary insurance and we will not seek contribution from any other in- surance available to any additional insured person or organization unless the other insurance is provided by a contractor other than you for the same operations and job location. "Then we will share with that other insurance by the method de- scribed in paragraph 4.c. of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS. Any provisions in this Coverage Part not changed by the terms and conditions of this endorsement continue to apply as writ- ten. Name of Person or Organization: City of El Segundo, its officals and employees Planning & Building Safety Dept. 350 Main Street E1 Segundo, CA 90245 -3813 U -c;L- 1175 -A Cw (9/03) Page 2 of 2 DATE (MM /DD/YYYY) AC -RPM CERTIFICATE OF LIABILITY INSURANCE 1 04/18/2008 PRODUCER (305)822 -7800 FAX (305)362 -2443 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Collinsworth Alter Fowler Dowling & French Group ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P. 0. Box 9315 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Miami Lakes, FL 33014 -9315 Attn : Anna Ramirez, ext 120; aramirez@cafdf.com INSURERS AFFORDING COVERAGE NAIC # INSURED Post, Buckley, Schuh, & Jernigan, Inc. INSURERA: Lloyds of London A XV d /b /a PBS &J INSURER B: 2001 NW 107 Avenue INSURER C: Miami, FL 33172 -2507 INSURER D: 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. INSR DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION IT, LIMITS LTA NSR GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY El Segundo, CA 90245 -3813 Meade Collinsworth ANNA`' `� ""'" - --- EACH OCCURRENCE $ DAMAGE TO RENTED $ MED EXP (Any one person) $ CLAIMS MADE ❑ OCCUR PERSONAL & ADV INJURY $ GENERALAGGREGATE $ PRODUCTS - COMP /OP AGG $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (Per accident) $ NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ ANY AUTO $ EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE $ OCCUR CLAIMS MADE $ DEDUCTIBLE $ RETENTION $ WC STATU- OTH- WORKERS COMPENSATION AND E.L. EACH ACCIDENT $ EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT 1 $ $1,000,000 Ea Claim $2,000,000 Policy Aggregate 11/11/1961 Retrodate A It yes, describe under SPECIAL PROVISIONS below OTH rXessional/ ollution Liability LDUSA0700811 CLAIMS -MADE FORM 09/30/2007 09/30/2008 1 DESCRIPTION OF OPERATIONS / LOCATIONS VEHICLES EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS E: IN 10- 106141, Aloft ssuing company will provide 30 days written notice of cancellation; 10 days for non - payment. ACORD 25 (2001/08) © ACORD CORPORATION 1988 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, EL Segundo, City of Attn : Mary Lewis BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 350 Main Street OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE fr s` El Segundo, CA 90245 -3813 Meade Collinsworth ANNA`' `� ""'" - --- ACORD 25 (2001/08) © ACORD CORPORATION 1988 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 (2001/08)