PROOF OF INSURANCE (2010) CLOSEDAv d CERTIFICATE OF LIABILITY INSURANCE 071291 MIDD/YYYY)
07/29/2009
PRODUCER THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION
Marsh USA Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
TWO LOGAN SQUARE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
PHILADELPHIA, PA 19103 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Attn: Philadelphia.Certs@Marsh.com Fax: 212 - 948 -0360
J19623- PSI- GAWUP -09 -10 gawupr yes
INSURED
PROFESSIONAL SERVICE INDUSTRIES, INC.
3960 GILMAN STREET
LONG BEACH, CA 90815
INSURERS AFFORDING COVERAGE
NAIC 8
INSURER A: Zurich American Insurance CO
16535
INSURER B: St. Paul Fire & Marine Ins Co
24767
INSURER C. Continental Casualty Company
20443
INSURER D: American Zurich Insurance Company
40142
INSURER E:
A
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.
NS
LTR
ADD'
INSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MM/DD/YYYY)
POLICY EXPIRATION
DATE (MMMD/YYYY)
LIMITS
A
X
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE X OCCUR
GLO 6580471 -18
03/01/2009
03/01/2010
EA HOCCURRENCE
1,000,000
_
DAMAGE TO RENTED
PREMISES Ea nn.)
$ 1'000,000
MED EXP (Any one person)
$ 5,000
PERSONAL & ADV INJURY
$ 1,000,000
PRnr) / COMPLETEr) nPS_
X
CONTRACTUAL
GENERAL AGGREGATE
$ 2,000,000
GENERAL AGGREGATE LIMIT APPLIES PER
X POLICY 1Eo LOC
PRODUCTS - COMP /OP AG
2,000,000
A
X
AUTOMOBILE
X
LIABILITY
ANY AUTO
BAP 6580472 -18
03/01/2009
03/01/2010
COMBINED SINGLE LIMIT
(Ea accident)
$ 2,000,000
ALL OWNED AUTOS
BODILY INJURY
$
SCHEDULED AUTOS
(Per person)
BODILY INJURY
$
HIREDAUTOS
NON -OWNED AUTOS
(Per accident)
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
ANY AUTO
OTHER THAN EA ACC
AUTO ONLY
AGG
$
$
B
EXCESS /UMBRELLA LIABILITY
X OCCUR F-1 CLAIMS MADE
QK 06401044
03/01/2009
03/01/2010
EACH OCCURRENCE
$ 2,000,000
AGGREGATE
$ 2,000,000
DEDUCTIBLE
RETENTION $
D
A
WORKERS COMPENSATION AND
EMPLOYERS'LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N
WC 6580421 -18 (ADS)
WC 9302890 -07 (MA, WI, HI)
03/01/2009
03/01/2009
03/01/2010
03/01/2010
X ZSTATU- OTH-
E.L. EACH ACCIDENT
1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
OFFICER/MEMBER EXCLUDED? FN I
.L. DISEASE - POLICY LIMIT
$ 1,000,000
MsrWatory in NH) If yes, describe under
PECIAL PROVISIONS below
OTHER
C
PROFESSIONAL LIABILITY
AEH 25 409 7107
03/01/2009
03/01/2010
EACH CLAIM 1,000,000
AGGREGATE 1,000,000
DEDUCTIBLE 750,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS
THE CITY OF EL SEGUNDO, ITS OFFICERS, AGENTS AND EMPLOYEES ARE INCLUDED AS ADDITIONAL INSUREDS WHERE REQUIRED BY
WRITTEN CONTRACT, BUT ONLY TO THE EXTENT OF THEIR LIABILITY RESULTING FROM THE NEGLIGENCE OF THE INSURED AND WITH
RESPECT TO SERVICES PROVIDED BY THE INSURED FOR THE ADDITIONAL INSURED, EXCEPT FOR WORKERS COMPENSATION AND
PROFESSIONAL LIABILITY. THE ABOVE GENERAL LIABILITY POLICY IS PRIMARY AND NON - CONTRIBUTORY WHERE REQUIRED BY WRITTEN
CONTRACT.
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CITY OF EL SEGUNDO
ATTN: LOUIS MORALES, PROJECT CONSULTANT
PLANNING & BUILDING SAWV
350 MAIN STREET
EL SEGUNDO, CA 90245 (�
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SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL 99Q1j00VM MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Mary Radaszewski
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The ACORD name and logo are registered marks of ACORD
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
This Certificate of Insurance 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.
POLICY NUMBER: GLO 6580471 -18
COMMERCIAL GENERAL LIABILITY
CG 20 10 07 04
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
Or Or anization s :
Locations Of Covered Operations
Only those persons or organizations where
required by written contract. This coverage
is primary and non - contributing with any other
Insurance available to such person or organi-
zati
Information required to complete this Schedule if not shown above will be shown in the Declarations.
A. Section II — Who Is An Insured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
with respect to liability for "bodily injury", "property
damage" or "personal and advertising injury"
caused, in whole or in part, by:
1. Your acts or omissions; or
2. The acts or omissions of those acting on your
behalf;
in the performance of your ongoing operations for
the additional insured(s) at the location(s) desig-
nated above.
B. With respect to the insurance afforded to these
additional insureds, the following additional exclu-
sions apply:
This insurance does not apply to "bodily injury" or
"property damage" occurring after:
1. All work, including materials, parts or equip-
ment furnished in connection with such work,
on the project (other than service, mainte-
nance or repairs) to be performed by or on
behalf of the additional insured(s) at the loca-
tion of the covered operations has been com-
pleted; or
2. That portion of "your work" out of which the
injury or damage arises has been put to its
intended use by any person or organization
other than another contractor or subcontractor
engaged in performing operations for a
principal as a part of the same project.
CG 20 10 07 04 Copyright, ISO Properties, Inc., 2004 Page 1 of 1
UNIFORM
POLICY NUMBER: GLO 6580471 -18
COMMERCIAL GENERAL LIABILITY
CG 20 37 07 04
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
Or Organ ization s :
Location And Description Of Completed Operations
Only those persons or organizations where
required by written contract. This coverage is
primary and non - contributing with any other
inuu a available to such person or organization.
Information required to complete this Schedule if not shown above will be shown in the Declarations.
Section II — Who Is An Insured is amended to in- at the location designated and described in the
clude as an additional insured the person(s) or or- schedule of this endorsement performed for that ad-
ganization(s) shown in the Schedule, but only with ditional insured and included in the "products -com-
respect to liability for "bodily injury" or "property pleted operations hazard ".
damage" caused, in whole or in part, by 'your work"
CG 20 37 07 04 Copyright, ISO Properties, Inc., 2004 Page 1 of 1
UNIFORM