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PROOF OF INSURANCE (2012) CLOSEDPOIicy Number: 0400700650 ACORV uate tntereo: 1/25/2011 I� CERTIFICATE OF LIABILITY INSURANCE DATE(MMrD°IYY" THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDE THIS 1/25/2011 R. CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the Certificate certificate holder is an ADDITIONAL INSURED, the policypes) must be endorsed. 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 endorsemen s . PRODUCER Mary Barnard Insurance 2190 Stokes Street Suite 201 San Jose CA 95128 INSURED Range Maintenance Services, L.L. John and Donna Foggiato P. O. Box 2270 Arnold, CA 95223 arl M. Cama; (408)286 -1334 408)286 -6425 INSURER {S) AFFORDING COYERACiE NAIC N INSURERA;CATLIN SPECIALTY INSURANCE COMPANY 15989 INSURER a INSURERC: INSURER D INSURER E INSURERF: THIS IS TO CERTIFY THAT THE POLICIES INSURANCE REVISION NUMBER: 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 @Y IFIE POLiC��S. Q SC�IBg4 R_ ..SUB C1LKL_THF_ffflM$,�Cj-U� S q�q O� LIMIT$ $HQWN Mgy.NAVl 9ESN. iZEDUC R QY PAID CLAIMS SMI LTR r TYPE OF INSURANCE TAD R POLICY NUMBER S EFF POLICY E%P IP_OLICIES GEnIERALUAmu7Y j A COMMERCIAL GENERAL LwBILITY 0400700650 1/20/2011 1/20/2012 CLANS-MADE x OCCUR EACH OCCURRENCE 51,000,000 DAMAGE 7oRN7ED f 100,000 PRE► SIEa aa'arrenoe), + 5... r i MED EXP (Any o_ rr-penml S 5,000 PERSONAL E ADV INJURY [ $ l' 000 , 000 NLAOGREGATEL88RAPPUES PER- GENERAL AGGREGATE $2,000,000 PRODUCTS COMPIOPAGG `S2,000,000 POLICY � ,PRO• LOC - ._ ALIT AUTOMOBILE LIANUTY $ COMBINED SINGLE LIMIT 5 ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY (Per person) , $ SCHEDULED AUTOS BODILY INJURY (Per soodsrs) I $ HIRED AUTOS PROPERTY DAMAGE $ (Per ooddent) NON -OWNED AUTOS 5 BRE UMLLA UAB OCCUR _ $ j EXCESS LIAR CLAIMS EACH OCCURRENCE S -MADE AGGREGATE : DEDUCTIBLE F RETENTION s 5 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN WC TATU- I TH- 1 ERT ANY PROPRIETORIPARTNEMEXECUTIVE OFFICERIMEMBEREXCLUDED? NIA { _T.OBYJ.IMITS. E.L EACH ACCIDENT S (ory InNH) Kyss describe under DaRIPTION OF OPERATIONS below E.L DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ � P S °130 MW 50F MM ON APPLIES 'MrifbN —PAa� 01� pREM UM DAYS FOR ALL OTHER. ALL CALIFORNIA OPERATIONS. CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED AS PER ADDITIONAL INSURED ENDORSEMENT FORM NO. CG 20 10 07 04 ATTACHED. CERTIFICATE HOLDER CITY OF EL SEGUNDO, CITY CLERK ATTENTION: BRIAN EVANSKI 350 MAIN STREET EL SEGUNDO, CA 90245 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN AUTHORIZED 1 88 -2009 ACORD CORPOOfION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered ma of ACORD Produced using Forms Boss Plus software, wwwTormsBoss.00m Impressive Publishing 800.208.1977 t= POLICY NUMBER: 0400700650 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 I Name Of Additional Insured Person(s) I . nr hman:waflo% iel. CITY OF EL SEGUNDO, CIT ERK 350 MAIN STREET EL SEGUNDO, CA 9024 ALL OF INSURED'S OPERATIONS 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, 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 in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 2010 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 NOV, 302010 12:20PIA„ CENTURYNATIONAtINSUR NO. 3757 P. 4 i;C:Py I UKYT W -QWMAL irvauRANCE COMPANY %%-� �: POLICY NO.: BAP0165200 BUSINESS AUTO POLICY - ENDORSEMENT 9tYCi� & 00"Ah rms MOXIM MO. @ 122000 90WOr 1E1=2 POliay MVW8 FEW 12tOi All = S /24/20XO TO 11 /241101& nfA09. DAD SO„ 22 INIOZI&C ll fAlCTM AUft t 11/24 /1010 FAW 12t01 alt INSMMDI BROKER& RANGE MAINTENANCE SVCS LLC CHhIX & ASSOC INS BROKERS INC JOHN A DONNA 7000IATO DBA PO BOX 2270 41 CORPORATE PARK STR 310 ARNOLD CA 9,5223 IRVINE CA 92606 -5181 ADDITT=AL INSURED WDORSXMENT CN613 5/99 IT IS AGREED TRAT INSVRMCB "FO nAt BY THE ABOVE POLICY SIMLL ApFLY TO T118 PARTY(S) NAMSD UNLOA1, AS THEIR INTBRBST MAY APPSAR BUT SHALL NOT OPERATE TO INCRX4663 THE LIMITS OF THE COMPANY IS LIABILITY. ANY ADDITZOML YNSU M LANGUAGE ON A CHRTXTZCATB OF IXSURANCB IS VOID. The additional insured named below is only an insured fox liability Which is the result of an act or omission of the "NAvxD IN9V=,i of the policy and &hall have no coverage wader this endorsement or the policy for its aaa acts or omissions, t one of its agents or 0 gploy�es, or thosra of any other person or entity for whioll it is vicaricus],yy liable, cave for acts of omissions of the "MANED INSURED° of the policy. P'urther, any insurance provided by this endorsement shall be excess insurance to all other insurance available to any person or entity who becomes an insured by reason of this andorstement whether the other insurance be primary or excess and whether or ant the other insurance be collectible. in the event the other insurer has a duty to defend any person or entity added to our policy by reason of this endorsement, we will have no duty to defend that person or entity however, we may elect to do so, and, if �y�e do, we will be entitled to the rights of my person or entity we ��d¢f�dd against the other insurer, I—y/ Authorised Representative ADDITIONAL 33ROM ED CITY OF EL SBGUIWO CITY CLERK ATTN% BRIAN BVANSKI 350 14UN SMxT 8L SEGUNDO CA 90243 Date Printed : 11/29/2010 LYDIA ZAMOAA NOV.30.2010 12:20PM CENTURYNATIONAIINSUR NO. 3757 P. 5 t-&INl I UN 4UP- 1192MA4 INSURANCE COMPANY POLICY NO.: 8AP03.65200 BUSMOS AUTO POLICY - ENDORSEMENT RAW t 1 cwrrxucsves DRUM m. r 142800 "%4CY F10Ps WILY oowra MW 12,81 AN W 11/24/2010 PTO 11/24/9011 19p10RllN<H7 810.1 11 MORUMM UTMIU MIM r 11/26/2010 wXft 12101 AN INS ED: BROKER: RAWA MAINTENANCE SVCS LLC CHAIX 6 ASSOC INS BROKERS INC JOHN A DONNA FOGGIATO DBA PO BOX 2270 41 CORPORATE PARK STS 31,0 ARNOLD CA 95223 IRVINE CA 92606 -5161 - ALTHBD C9RTIPYCATB BNDORSffidffiNT I11 CONBXDRV" [ON OV TRZ AMMONAL PREMIUM LISTED BELOW, CENTURY- VATI0NAL INSCRANCH COMPANY AGREES TO ISSUE A CRATIPYCATE, 211MR391) by AN =TITY DOING BUSINESS WITH THE INSURED THAT 18 NOT A STANDARD CERTIFICATE FORK* (OR AGREES TO ISSUE AN ACORD CERTIFICATE WXTH ITS STANDARD LANGUAGE DZLWSD OR ALTERED). TO THE HPTTTY LISTED BELOW. BeCAIISB THU IS NOT A STANDARD CZRTYFICATZ AND GENZZATZB AMIX"TONAL PROCESSING TXXR, THERE I8 A FIE ?OR TXXS CERTIFICATE AS SET OUT BELOW. CN604 (1 /01) CERTIFICATB HOLDER /PRE aUX $30 czTY OF im swumDo CITY CLBRR ATTNs BRIAN BVANsXl 350 XUX STRUT EL SEGO CA OD245 -3813 ALL OTRER TERMS AM CONDITID245 OF TNXa POLICY REMAIN UNCHANGED. ADTHOR12RD RZPRESZNTAT 1TS Data Printed a 11/29/2010 LYDIA ZAKORA / T L�J CERTHOLDER COPY P.O. BOX 420807, SAN FRANCISCO,CA 94142 -0807 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 11 -01 -2010 GROUP: POLICY NUMBER: 1760432 -2010 CERTIFICATE ID: 20 CERTIFICATE EXPIRES: 11 -01 -2011 11- 01- 2010/11 -01 -2011 CITY OF EL SEGUNDO CITY CLERK NG 350 MAIN ST EL SEGUNDO CA 90245 -3813 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. t thor&Q�JG� Y , ized Representative Interim President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE ENDORSEMENT #1901 - JOHN FOGGIATO, MGR -MEM - EXCLUDED. ENDORSEMENT #1901 - DONNA RAE FOGGIATO, NGR -MEM - EXCLUDED. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 11 -01 -2004 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER . RANGE MAINTENANCE SERVICES, LLC t/G PO BOX 2270 ARNOLD CA 95223 M0408 IREV.1 -20101 PRINTED : 10 -15 -2010 me