PROOF OF INSURANCE (2007) CLOSEDOP ID QQ
AGO CERTIFICATE OF LIABILITY INSURANCE 90OP1
DATE (MM1DD/YYYY)
03 /26/07
PRODUCER
Hays Companies of WI
1200 N, Mayfair Road Suite 100
Milwaukee WI 53226
Phone : 414- 443 -0000 Fax : 414- 259 -8448
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 #
INSURED
Pierce Manufacturing Inc
P O Box 2017
Appleton WI 54912 -2017
INSURER A: Scottsdale Insurance Company
-
INSURER B: Lexington Insurance Co.
_
INSURER C: travelers Propcas cc ofAme_ri_ca_ t
25674
__
INSURER D: Charter oak Fire Insurance Co. t
25615
-
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.
INS 0
LTR NSRE TYPE OF INSURANCE POLICY NUMBER DATE MMIDD(YY ) DATE (MM/DDtYYI (MM/DD/Y! LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$1,000 , 000
PREMISES_(Eaoccurence)
$500,000
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE n OCCUR
RBS0001157
04/01/06
04/01/07
MED EXP (Any one person)
S
PERSONAL & ADV INJURY
$1r000(000
GENERAL AGGREGATE
S 5 OOO OOO
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMPIOPAGG
52 {000,000
— -
X POLICY PRO- - LOC
JECT
C
AUTOMOBILE
X
LIABILITY
ANY AUTO
TJCAP118D2004TIL06
10/01/06
10/01/07
COMBINED SINGLE LIMIT
(Ea accident)
$1000 OOO OOO
+ +
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE
(Per accident)
S
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
S 1_,0_00,000 _
C
X ANY AUTO
TJCAP11BD2004TIL06
10/01/06
10/01/07
OTHER THAN EAACC
AUTO ONLY: AGG
S
-- __
S
EXCESS/UMBRELLALIABILITY
EACH OCCURRENCE
S 25 000, 000_
B
X1 OCCUR I CLAIMSMADE
4585354
04/01/06
04/01/07
AGGREGATE.^
525,000,000
S
DEDUCTIBLE
-�
$
RETENTION $
C
D
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PR
ANY PROPRIETORlPARTNEILEXECUTIVE
OFFICERIMEMBEREXCLUDED?
TRJUB117D757706
TC20UB117D756506
10101106
10/01/06
10/01/07
10/01/07
TORY LIMITS ER
_X
E.L. EACH ACCIDENT
$1,000,000_
E.L. DISEASE - EA EMPLOYEE
- - _
S1,000,000
It yes, desu be under
SPECIAL PROVISIONS below
- - - --
E.L. DISEASE - POLICY LIMIT
- -
^
$1,000,000
OTHER
C
GarageKeepers
TJCAP11BD2004TIL06
10/01/06
10/01/07
Comp Ded $50,000
$1,000,000 Limit
(SYMBOL 30)
Coll Ded $50,000
DESCRIPTION OF OPERATIONS! LOCATIONS! VEHICLES! EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS
The Certificate Holder will be included as Additional Insured for General
Liability per attached endorsement as respects to the contract for One (1)
Pierce (TM) Quantum(R) Pumper.
CERTIFICATE HOLDER CANCELLATION
9ELSEGU SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO
DATE THEREOF, THE ISSUING INSURER WILL 0990 MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
City of El Segundo
314 Main Street
E1 Segundo CA 90245
12001!081 0 ACORD CORPORATION 1988
1 �
ENDORSEMENT
SCOT TSPALE. iNSL RANC'E COMM" NO.
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:
COMMERCIALI.GENERAL LIABiLPY COVERAGE PART.
SCHEDULE'
Name of Person e r Organization: THE CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS, EMPLOYEES,
AGENTS & CERTI. =IED VOLUNTEERS, AS RESPECTS TO THE PURCHASE OF ONE PIERCE (TM) QUAN-
TUM (R) PUMPEF
(If no entry app=;= above, information required to complete this endorsement will be shown in the Declarations as appli-
cable to this endorsement.)
WHO IS AN INSU: -ZED (Section II) Is Amended to include as an insured the person or organization shown in the Sched-
ule, but only with n )spect to liability arising out of "your work" for that insured by or for you,
This insurance will be deemed "primary" such that any other insurance that may be carried by City of El Segundo will be
excess thereto. Tt is insurance will be m an "occurrence ", not a "claims made ", basis or equivalent.
It is agreed that th s Insurance will not be cancelled, not renewed or the limits of coverage in any way reduced without at
least thirty (30) d;,/s advance written notice ten (10) days for non-payment of premium sent by certified mail, return re-
ceipt requested to:
CITY OF EL SEGIINDO CITY CLERK
ATTN: FIRE CH1E
314 MAIN STREE
EL SEGUNDO, Cr 90245
AUTHORIZED REPRESI•NTATIVE DATE
UTS -3g -17 (3.42)
ATTACHED YO AND SNDORSIMINT ZOTECTIVI: DAY!
FORMING A►ART Oi
NAMED INBURID
AAEHY NO.
(11:01 A.M. ST/WDARDTIME)
POUCYNUMDDR
RBS0001157 2/19107
OSHKOSH TRUCK CORPORATION
12719
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:
COMMERCIALI.GENERAL LIABiLPY COVERAGE PART.
SCHEDULE'
Name of Person e r Organization: THE CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS, EMPLOYEES,
AGENTS & CERTI. =IED VOLUNTEERS, AS RESPECTS TO THE PURCHASE OF ONE PIERCE (TM) QUAN-
TUM (R) PUMPEF
(If no entry app=;= above, information required to complete this endorsement will be shown in the Declarations as appli-
cable to this endorsement.)
WHO IS AN INSU: -ZED (Section II) Is Amended to include as an insured the person or organization shown in the Sched-
ule, but only with n )spect to liability arising out of "your work" for that insured by or for you,
This insurance will be deemed "primary" such that any other insurance that may be carried by City of El Segundo will be
excess thereto. Tt is insurance will be m an "occurrence ", not a "claims made ", basis or equivalent.
It is agreed that th s Insurance will not be cancelled, not renewed or the limits of coverage in any way reduced without at
least thirty (30) d;,/s advance written notice ten (10) days for non-payment of premium sent by certified mail, return re-
ceipt requested to:
CITY OF EL SEGIINDO CITY CLERK
ATTN: FIRE CH1E
314 MAIN STREE
EL SEGUNDO, Cr 90245
AUTHORIZED REPRESI•NTATIVE DATE
UTS -3g -17 (3.42)