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PROOF OF INSURANCE (2010) CLOSEDDATE (MMIDDIYY) AMM. CERTIFICATE OF LIABILITY INSURANCE PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dealey, Renton & Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P. . 0 . Box 10550 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Santa Ana CA 92711 -0550 INSURERS AFFORDING COVERAGE INSURED RBF Consulting P0 Box 57057 Irvine CA 92619 -7057 COVERAGES E OTWDING ERT ERMUSIONS To — z S OF INSURANCE LISTED ANY REQUIREMENT, MAY BE ISSUED OR MAY AND CONDITIONS YPE OFINSURANCE LIABILITY ERCIAL GENERAL LIABILITY LAIMS MADE © OCCUR RACTUAL BELOW HAVE BEEN ISSUED TO TERM OR CONDITION OF ANY PERTAIN, THE INSURANCE AFFORDED OF SUCH POLICIES. AGGREGATE POLICY NUMBER 6 3 0 5 0 0 D 4 0 9 2 THE INSURED NAMED CONTRACT OR OTHER BY THE LIMITS SHOWN POLICY EFFECTIVE POLICY 11/30/2009 ABOVE FOR DOCUMENT POLICIES DESCRIBED MAY HAVE BEEN POLICY EXPIRATION 11 / 3 0/ 2 010 THE POLICY PERIOD INDICATED. WITH RESPECT TO WHICH THIS HEREIN IS SUBJECT TO ALL THE REDUCED BY PAID CLAIMS- LIMBS EACH OCCURRENCE S 009 0 0 _ FIRE DAMAGE (Any one fire $1,000,009 MED EXP An one non $10,090 PERSONAL & ADV INJURY O GENERALAGGREGATE $ AUTHORIZED REPRESENTA PRODUCTS - COMP/OP AGG S O O D XCU REGATE LIMIT APPLIES PER: A Y PRO LOC AUTOMOBILE LIABILITY 81094968499 11/30/2009 11/30/2010 COMBINED SINGLE LIMIT (Ea accident) $1 r 000,000 X ANY AUTO ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (Per accident) $ NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) : AUTO ONLY - EA ACCIDENT_ $ GARAGE LIABILITY ANY AUTO OTHER THAN EA ACC AUTO ONLY: AGG $ $ C EXCESS LIABILITY X OCCUR CLAIMS MADE SSE71722276 11/30/2009 11/30/2010 EACH OCCURRENCE $10,000,000 AGGREGATE $ Profe si nal s Li bi it i8 $ DEDUCTIBLE RETENTION S Ad WC STA. OTH- TORY LIMITS ER S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ E.L. DISEASE • EA EMPLOYEE S E.L. DISEASE - POLICY LIMIT $ B OTHER Professional Liability PI099400 11/30/2009 11/30/2010 Per Claim $1,000,000 Annl Aggr. $2,000,000 DESCRIPTION OF OPERATION $nM"TIONSNEHICLEWEXCLUSIONS ADDED BY ENDORSEMENUSPECIAL PROWSIONS General Liability policy excludes claims arising out of the performance of professional services. Independent Contractors Included Re: Hampton Inn & Suites Project; REIF JN 10- 106715 City of E1 Segundo, its officials and employees are additional insured as respects to General and Auto Liability as required by written contract. Primary and Non - Contributing overage applies to GL as required by written contract. CERTIFICATE HOLDER ADDITIONAL INSURED' INSURER LETMK: I .- HOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER City of E1 Segundo KILL MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER Planning & Building Department, Kimberly 1AMED To THE LEFT. Christens 350 Main Street E1 Segundo CA 90245 AUTHORIZED REPRESENTA ra A non rnRPAR TION 1988 ACORD 25-S (7197) COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED — (Section II) is amended to Include any person or organization that you agree in a "written contract requiring insurance" to include as an additional insured on this Cover- age Part, but: a) Only with respect to liability for "bodily injury", "property damage" or "personal injury"; and b) If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the "written contract requiring insurance" applies. The person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organization. 2. The insurance provided to the additional insured by this endorsement is limited as follows: a) In the event that the Limits of Insurance of this Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance ", the in- surance provided to the additional insured shall be limited to the limits of liability re- quired by that "written contract requiring in- surance". This endorsement shall not in- crease the limits of insurance described in Section III — Limits Of Insurance. b) The insurance provided to the additional in- sured does not apply to "bodily injury", "prop- erty damage" or "personal injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or sur- veying services, including: 1. The preparing, approving, or failing to prepare or approve, maps, shop draw- ings, opinions, reports, surveys, field or- ders or change orders, or the preparing, approving, or failing to prepare or ap- prove, drawings and specifications; and it. Supervisory, inspection, architectural or engineering activities. c) The Insurance provided to the additional in- sured does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products - completed op- erations hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that additional insured, and then the insurance provided to the additional insured applies only to such "bodily injury" or "property damage" that oc- curs before the and of the period of time for which the "written contract requiring insur- ance" requires you to provide such coverage or the and of the policy period, whichever is earlier. 3. The insurance provided to the additional insured by this endorsement is excess over any valid and collectible "other insurance% whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover under this endorsement. However, if the "written contract requiring insurance" specifically requires that this insurance apply on a primary basis or a primary and non - contributory basis, this insurance is primary to "other insurance" available to the additional insured which covers that person or organization as a named insured for such loss, and we will not share with that "other other insurance . But the insurance provided to the additional insured by this endorsement still is excess over any valid and collectible "other in- surance", whether primary, excess, contingent or on any other basis, that is available to the addi- tional insured when that person or organization is an additional insured under such "other insur- ance". 4. As a condition of coverage provided to the additional insured by this endorsement: a) The additional insured must give us written notice as soon as practicable of an "occur- rence" or an offense which may result in a claim. To the extent possible, such notice should include: CG D2 46 08 05 ® 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 COMMERCIAL GENERAL LIABILITY I. How, when and where the "occurrence" or offense took place; Il. The names and addresses of any injured persons and witnesses; and Ill. The nature and location of any injury or damage arising out of the "occurrence" or offense. b) if a claim is made or "suit" is brought against the additional insured, the additional insured must: 1. immediately record the specifics of the claim or "suit" and the date received; and II. Notify us as soon as practicable. The additional insured must see to it that we receive written notice of the claim or "suit" as soon as practicable. c) The additional insured must immediately send us copies of all legal papers received in connection with the claim or "suit ", cooperate with us in the investigation or settlement of the claim or defense against the "suit ", and otherwise comply with all policy conditions. d) The additional insured must tender the de- fense and indemnity of any claim or "suit" to any provider of other insurance which would cover the additional insured for a loss we cover under this endorsement. However, this condition does not affect whether the insur- ance provided to the additional insured by this endorsement is primary to "other insur- ance" available to the additional insured which covers that person or organization as a named insured as described in paragraph 3. above. 5. The following definition is added to SECTION V. — DEFINITIONS: "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or organization as an additional in- sured on this Coverage Part, provided that the "bodily injury" and "property damage" oc- curs and the "personal injury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you; b. While that part of the contract or agreement is in effect; and c. Before the and of the policy period. Page 2 of 2 0 2005 The St. Paul Travelers Companies, Inc. CG D2 46 08 05 POLICY #:8109496B499 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions ofthe Coverage Form apply unless modi- fied by this endorsement. This endorsement identifies person(s) or organization(s)who are "insureds" under the Who Is An Insured Provi- sion of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective: 11 / 19 / 2 0 0 9 Countersigned By: Named Insured: RBF consulting SCHEDULE Name of Person(s) or Organization(s): Any person or organization for whom you have agreed in a written contract or agreement to provide insurance but only for damages which are covered by this insurance and which you have agreed to provide in such (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. CA 20 46 02 99 Copyright, Insurance Services office, Inc., 1998 OP II Acow). CERTIFICATE OF LIABILITY IiNSURANCEISS�ED Ts PRODUCER ONLY AND CONFERS NO RIGH HOLDER. United Captive Ins. Brokers AL ER TE THIS AFFORDS 17151 Neahope St., Ste 211 Fountain Valley CA 92705 INSURERS AFFORDING COVERAGE Phone: 714- 708 -4370 Fax:714- 708 -2300 INSURER u,9. ridelity and GuasantY INSURED INSURER B: INSURER C: � NSURER D: jrvine CA 92618 ay INSURER E: THE DATE (MMIDDIYYYY) NAIC 0 25887 OVERAGES ANY REQUIREMENTgTERM ORLCONDITION OF ANY CON TACT OR OTHER OCUMENT WITH RESPECTT O WN CM THIS CERDTIFICATE MAY BE SSUED ORDING 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 CLAIMSi - -__- � � umn,w� LIMITS POLICY NUMBER GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE D OCCUR GENL AGGREGATE LIMIT APPLIES PER: POLICY n PJEC LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED ALTOS NON -OWNED AUTOS GARAGE LIABILITY �I I ANY ALTO EXCESSIUMBRELLA LIABILITY 7 OCCUR 1:1 CLAIMS MADE DEDUCTIBLE RETENTION $ JAAW ORKERS COMPENSATION AND MPLOYERS' LIABILITY D123WO0187 FFICEPJMEMBERPF- XCLUDED9 ECUTIVE ws, describe under -- " EACH OCCURRENCE $ PREMISES Me —Mcs S MED EXP (Arty one person) S PERSONAL & ADV INJURY S GENERAL AGGREGATE $ PRODUCTS . COMPIOP AGG S COMBINED SINGLE LIMIT $ (En accident) BODILY INJURY S (Per Person) BODILY INJURY S (Per accident) PROPERTY DAMAGE S (Per accident) AUTO ONLY • EA ACCIDENT E OTHER THAN EA ACC S AUTO ONLY: AGG S EACH OCCURRENCE S AGGREGATE S S 5 S 0.7/01/09 I 0.7/01/10 E. L. 51000 E.L. DISEASE - EA EMPLOYE $1000 E.L. DISEASE - pOLICV LIMIT S 1000 )ESORIPTION OF OPERATIONS I LOCATIONS I VENlcL-es r u. *10 days notice of cancellation for non - payment of premium. [X Re: Hampton Inn S Suites Project; RBF JN 10- 106715 City of El Segundo Planning t Building Department Kimberly Christensen 350 Main Street E1 Segundo CA 90245 -3813 SHOULD OULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATI01 DATE THEREOF, THE ISSUING INSURER WILL BRCERTMW MAIL *30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.