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PROOF OF INSURANCE (2009) CLOSEDACORDM CERTIFICATE OF LIABILITY INSURANCE 0/19/2009 DATE 1 /26/2DDl/YYVY) PRODUCER 1 ockbon Insurance Brokers. LI.0 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 725 S. Figueroa Street. 35th FI, CA License #OF 15767 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Los Angeles 90017 POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/YY ( 213) 089 -(X)65 LIMITS INSURERS AFFORDING COVERAGE NAIC # INSURED Piosum. Inc. INSURER A One Beacon America Insurance Company 20621 1303364 John Petri. CFO INSURER 8 Twin City Fire Insurance Company 29459 3321 kosecrans Avenuc. Ste. 422 1 {I Segundo CA 90245 INSURER C. AXIS Surplus Insurance Company 26620 INSURER D. 6/ 19/2008 6/ 19/2009 INSURER E. CLAIMS MADE ❑X OCCUR cOVFRA(;FS PRnCU_I Ix ., X. �: 11:;T Z7 -. 1.?.. 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 LTR DD' INSRi TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/YY POLICY EXPIRATION DATE MWDD/VY LIMITS GENERAL LIABILITY EACH OCCURRENCE 1.000,(XX) DAMAGE TO RENTED PREMISES E occurence $ 10)( M0 A X COMMERCIAL GENERAL LIABILITY 71 10082470002 6/ 19/2008 6/ 19/2009 CLAIMS MADE ❑X OCCUR MED EXP (Any one person) S I (IJI(H) PERSONAL 8 ADV INJURY $ I09),000 GENERAL AGGREGATE $ 2.000.0(X) PRODUCTS - COMP /OP AGG S 2.000.0IH) GEN'L AGGREGATE LIMIT APPLIES PER: POLICY M PRO. JECT LOC A AUTOMOBILE LIABILITY ANY AUTO 711 (HIS 2470002 6/19/2008 6/19/2009 COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) S XXXXXXX ALL OWNED AUTOS X SCHEDULED AUTOS HIRED AUTOS X NON,OWNED AUTOS BODILYINJURY (Per accident) $ XXXXXXX X Comp Ded. $1,000 X COIL Ded. S1,(XX) R PROPERTY DAMAGE (Per accident) $ XXXXXXX GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S XXXXXXX ANY AUTO NOT APPLICABLE OTHER THAN EA ACC $ XXXXXXX AUTO ONLY: AGG $ XXXXXXX EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 5,000,0(X1 AGGREGATE $ 5,()(X).000 A X OCCUR CLAIMS MADE 711(X)82470002 6/19/2108 6/19/2009 $ XXXXXXX A UMBRELLA Incl. WC Coverage B $ XXXXXXX .A DEDUCTIBLE X FORM FXC1Ulleti Prof. 1.1:111. S XXXXXXX RETENTION $ K WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 72WF.FY5995 12/31/2(H)S 12/31/2(H)9 X WC STATU- OTH. TORY LIMITS ER E.L. EACH ACCIDENT S I0H),(X)0 ANY PROPRIEIOH /PARTNER /EXECUTIVE E L. DISEASE - EA EMPLOYEE I'$ L000,(XXI OFFICf.H ;M[.MH[ H EXCLUDED9 NO Ii yes. describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT S I.1fHH1,000 C OTHER I•.CN636586(PL) 6/19/2008 6/19/2(X)9 S2.000JO) Va Wroughil Ac[ Profesmonal Ltahiln" - S'_[I00.000'lolal Limit {. Iaitll,10,kj • k DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL 1wgA n 1f 2911178 Cite of F:I Segundo City Clerk Ann: Administrative Services 3S) Main Street. Room 5 EI Segundo CA 90235 1113♦, —iAl ACORD 25 (2001/08) For questions regsrdingttus prtdkete , contact the number listed Inthe Producr'w sbe— nd M.ei cod. PROSUt. t Ar nPn (_A97PA92ATIAIJ 101tA SHOU►0 ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION •\'V DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. ACORD 25 (2001/08) For questions regsrdingttus prtdkete , contact the number listed Inthe Producr'w sbe— nd M.ei cod. PROSUt. t Ar nPn (_A97PA92ATIAIJ 101tA POLICY NUMBER: 7110082470002 COMMERCIAL GENERAL LIABILITY CG 2010 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) Location(s) Of Covered Operations: Or Organization(s): The City, its officers, officials, employees, agents, and volunteers. 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 of the the additional insured(s) at the location(s) designated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work including materials parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; 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 2010 07 04 ® ISO Properties, Inc., 2004 Page 1 of 1 Attachment Code: D452802 Certificate ID: 2911178 WA-IR %O1.1i March 3, 2009 City of El Segundo City Clerk; Attn: Administrative Services; 350 Main Street, Room 5 El Segundo, CA 90245 Re: Notice of Cancellation Clause To Whom It May Concern: Please be advised that we cannot fulfill the request to alter the cancellation clause of the certificate. The insurance carriers have advised that they will not allow us to do this, as it is impossible for them to guarantee compliance with this request given the large number of certificate holders. However, the certificate will contain the standard "endeavor to" wording. Thank you for your understanding. Regards, 4�X2�� David Burgos Assistant Vice President Lockton Insurance Brokers Attachment Code: D447908 Certificate ID: 2911178 ACORD. CERTIFICATE OF LIABILITY INSURANCE 6/19209 °"3/3/2009 ORODUC431 Lockton Insurance Brokers, LLC 725 S. Figueroa Street, 35th Fl. CA License # OF 15767 Los Angeles OF 90017 76 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. MLTR NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL (213) 689 -0065 INSURERS AFFORDING COVERAGE NAIC 0 MMIIRED Prosum, Inc. INSURER A: OneBeacon America Insurance Company 20621 1303364 Jahn Petri, CFO INSURER 8: Twin City Fire Insurance Company 29459 2321 Rosecrans Avenue, Ste. 422 El Segundo CA 9024$ INSURER C: AXIS Surplus Insurance Company 26620 INSURER D INSURER E. A TM CWTIFICATE OF wrarAMNCE DOES NOT COMMUTE A CONTRACT BETION" THE IINKWW COVERAGES PROSU- I UC awurRnem. AUMOrmO AMPRrlENTAMP OR PROM "A A ANn TNF CLYTWMCATF �Lw.. 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. MLTR NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL TYPE OF INSURANCE POLICY NUMBER DATE EFFECTIVE POLICY EXPIRATION LIMITS AUTMWANMIWMSBUWA X GENERAL LIABILITY Effi#WW 3 ! S 1 000 000 A X COMMERCIAL GENERAL LIABILITY 7110082470002 6/192008 6/192009 CLAIMS MADE nX OCCUR MED EXP (Any one S )0,000 PERSONAL d ADV INJURY f 1000,000 GENERAL AGGREGATE f 2,000 000 PRODUCTS - COMPA0P A0G f 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY JECT LOC AUTOMOBILE LIABILITY A ANY AUTO 7110082470002 6/192008 6/192009 (Es scdderx) BODILY INJURY ALL OWNED AUTOS X SCHEDULED AUTOS (Per person) f XXXXXXX X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per ) f XXXXXXX X Comp Ded. $1,000 X Coll. Ded. $1,000 N (Par d'AMACE s XXXXXXX GARAGE LIABILITY AUTO ONLY - EA ACCIDENT f XXXXXXX ANY AUTO NOT APPLICABLE OTHER THAN EA ACC f XXXXXXX AUTO ONLY: AGG f XXX EXCES11AIABRELLA WUSLftY EACH OCCURRENCE f 5,000,000 A X OCCUR FI CLAIMS MADE 7110082470002 6/192008 6/192009 AGGREGATE $ 5.000.000 f XXXXXXX A U�� ❑ Incl. WC Coverage B f XYIXXXXX A DEDUCTIBLE X FORM Excludes Prof Liab. X XX RETENTION C WORKERS OMPENSATION AND 72WEFY5995 12/312008 12/312009 X WC SLIM'T orH- E . EACH ACCIDENT Is 1,000,000 ANY PROPRIETORIPARTNERIEXECUTWE E L. DISEASE - EA EMPLOYE f 1,000,000 OFFICERIMEMBER EXCLUDED? NO Use. describe under E.L. DISEASE - POLICY LIMIT 1 f 1,000,000 SPECIAL PROVISIONS below C OTHER ECN636586(PL) 6/192008 61192009 $2,000,000 Ea Wrongful Act Professional Liability - $2,000,000 Total Limit Claims Made DESCRpT10N OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS The City, its officers, officials, employees, agents, and volunteers are an Additional Insured to the extent provided by the policy language or endorsement issued or approved by the insurance carrier. This certificate supersedes all previously issued certificates. CERTIFICATE HOLDER cANCFI I ATInlM rna79osl rba52e021 2911178 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of El Segundo City Clerk DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS wRrrmN Attn: Administrative Services NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 350 Main Street, Room 5 IMPOSE NO OBLIGATM OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR El Segundo CA 90245 REPRESENTATIVES. AUTMWANMIWMSBUWA ACORU 25 (2001109) For qustbm nyad%g Ihis cwWkar, co~ the wime.r hftd in to vmduce ' it;.ro 0 ACORD CORPORATION 1988