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PROOF OF INSURANCE (2011) CLOSEDDATE (MM /DD/YY)
ACORD�, CERTIFICATE OF LIABILITY INSURANCE 4
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Dealey, Renton &Associates
P. 0. Box 10550
ALL ERTHEHCOVERAGE AFFORDED BYO THE POLICIES BELOW.
Santa Ana CA 92711 -0550
�,onsulting d
Pweolx 57057
Irvine CA 92619 -7057
CAVERAGES
INSURERS AFFORDING COVERAGE
C INSURERA: Travelez
INSURER B: Underwri
INSURER c: Fireman'
INSURER D:
INSURER E:
HE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TV 'IM6 iivz�uxnu ivea•,nu - .- _ - -_
OTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
ERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE
ERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGA POLICY EFFEC I HOWPOLICY EXPIRATION BEEN REDUCED BY PAID CLAIMS.
LIMITS
INSR TYPE OF INSURANCE POLICY NUMBER DATE (M
LTR A GENERAL LIABILITY 6 3 0 5 0 0 D4 0 9 2 11/30/2010 11/30/2011 EACH OCCURRENCE $1. 0 0 0 0 0 0
FIRE DAMAGE (Any one fire) $1 000, 000
X COMMERCIAL GENERAL LIABILITY
CLAIt .SS MADE
X ontractual
MED EXP (Any one person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
$10 000
$1,000, 000
$
X BFPD XCU
PRODUCTS - COMP /OP AGG
$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRO
POLICY LOC
8109496B499
11/30/2010
11/30/2011
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
A
AUTOMOBILE
LIABILITY
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
$
LIABILITY
ANY AUTO
OTHER THAN _� ACC
AUTO ONLY: AGG
$
(RAGE
$
SSE00048285639
11/30/2010
11/30/2011
EACH OCCURRENCE
$10,000,000
C
EXCESS LIABILITY
}{ OCCUR EI CLAIMS MADE
AGGREGATE
$10 O 00, 000
Professional
$
Liability is
$
DEDUCTIBLE
RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
Excluded
WC STATU- OTH-
$
E.L. EACH ACCIDENT_
$ _ __ __ ___ __
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE - POLICY LIMIT
$
OTHER
Professional Liability
PI109400
11/30/2010
11/30/2011
Per Claim
Annl Aggr.
$1,000,000
$2,000,000
B
Claims Made
DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS
General Liability policy excludes claims arising out of the performance of professional services.
General Liability includes coverage for Independent Contractors.
Re: Raytheon Specific Plan EIR; RBF JN 10- 107917
City of E1 Segundo, its officials and employees are additional insured as respects to General Liability as required by
written contract. Primary and Non - Contributing coverage applies to GL as required by written contract.
Ly_7
City of E1 Segundo
Attn: Masa Alkire
350 Main Street
E1 Segundo, CA 90245
ACORD 25 -S (7197)
ULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
ORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER TO
L 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED
THE LEFT.
AUTHORIZED
Q
N 1988
DATE (MMIDDIYY)
ACORQ. CERTIFICATE OF LIABILITY INSURANCE 3/24Z2011
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Pealey, Renton &Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
?. 0. Box 10550 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Santa Ana CA 92711 -0550
INSURERS AFFORDING COVERAGE
INSURED
RBF Consulting
PO Box 57057
Irvine CA 92619 -7057
A:Travelex
B: Fireman'
c:Underwri
D:
COVERAGES
HE
OTWITHSTANDING
ERTIFICATE
TERMS,
INSR
POLICIES OF INSURANCE LISTED
ANY REQUIREMENT,
MAY BE ISSUED OR MAY
EXCLUSIONS AND CONDITIONS
TYPE OF INSURANCE
BELOW HAVE BEEN ISSUED TO
TERM OR CONDITION OF ANY
PERTAIN, THE INSURANCE AFFORDED
OF SUCH POLICIES. AGGREGATE
POLICY NUMBER
THE INSURED NAMED
CONTRACT OR OTHER
BY THE
LCYEFFECTIHO
ABOVE FOR
DOCUMENT WITH
POLICIES DESCRIBED
OLIO EXPIRATION BEEN
DATE fMMIDDIYYI
THE POLICY PERIOD
RESPECT TO WHICH
HEREIN IS SUBJECT
REDUCED BY PAID
LIMITS
INDICATED.
THIS
TO ALL THE
CLAIMS.
11/30/2011
$1 000,000
GENERAL LIABILITY
6 3 0 5 0 0 D4 0 9 2
11/30/2010
EACH OCCURRENCE
FIRE DAMAGE (Any one fire)
$1 000 000
MED EXP (Any one person)
$10 000
• COMMERCIAL GENERAL LIABILITY
CLAIMS MADE � OCCUR
PERSONAL & ADV INJURY
$1,000 000
GENERAL AGGREGATE
$
• ontractual
•
BFPD XCU
PRODUCTS - COMP /OP AGG
$ 2 000 O O O
GEN'L AGGREGATE LIMIT APPLIES PER:
LlPOLICY j{ PRO- LOC
8109496B499
11/3 0/2010
11/30/2011
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
A
AUTOMOBILE
LIABILITY
X
ANY AUTO
ALL OWNED AUTOS
BODILY INJURY
(Per person)
$
SCHEDULED AUTOS
HIRED AUTOS
BODILY INJURY
(Per accident)
$
X
NON -OWNED AUTOS
PROPERTY DAMAGE
(Per accident)
$
AUTO ONLY - EA ACCIDENT
$
GARAGE
LIABILITY
ANY AUTO
OTHER THAN EA ACC
AUTO ONLY: AGG
$
$
SSE00048285639
11/30/2010
11/30/2011
EACH OCCURRENCE
$10,000,000
B
EXCESS LIABILITY
AGGREGATE
$10.0 0 0,000
Professional
$
}{ OCCUR CLAIMS MADE
Liabilit is
$
DEDUCTIBLE
$
RETENTION $
EX 1 ed
WC STAT U- OTH-
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
I
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE - POLICY LIMIT
$
OTHER
Professional Liability
PI109400
11/30/2010
11/30/2011
Per Claim $1,000,000
Annl Aggr. $2,000,000
C
Claims Made
DESCRIPTION OF OPERATIONS /LOCATIONS/VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
eneral Liability policy excludes claims arising out of the performance of professional services.
eneral Liability includes coverage for Independent Contractors.
Re: Raytheon Specific Plan EIR; RBF JN 10- 107917
city of E1 Segundo, its officials and employees are additional insured as respects to General Liability as required by
written contract. Primary and Non - Contributing coverage applies to GL as required by written contract.
CERTIFICATE HOLDER ADDITIONAL IN ED; I SURER LETTER: CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER
City of E1 Segundo 9ILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE
Attn: Masa Alkire ERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO
350 Main Street HALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON
E1 Segundo, CA 90245 HE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIV
O ACORD CORPO TION 1988
ACORD 25-S (7/97)
IR
COMMERCIAL GENERAL LIABILITY
63050OD4092
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
BLANKET ADDITIONAL INSURED
(CONTRACTORS)
This endorsement modifies Insurance provided under the following:
COMMERCIAL GENERAL LIA131LiTY COVERAGE PART
c) The Insurance provided to the addltional in-
sured does not apply to " bodily tnjury" 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 end 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 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:
1, WHO IS AN INSURED — (Section 11) 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 warlc" 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 architectures, engineering or sur-
veying services, including:
1. The preparing, approving, or falling 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
II. Supervisory, inspection, architectural or
engineering activities.
CGD246O1305
V 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2
COMMERCIAL GENERAL LIABILITY
1. How, when and where the "occurrence"
or offense took place:
ii. 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:
i. 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 "sult and
otherwise comply with ail 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. Whiie that part of the contract or
agreement is in effect; and
c. Before the end of the policy period.
iillliowe Page 2 of 2 0 2005 The St. Paul Travelers Companies, Inc. CG D2 46 08 05
RBFCO -1 OP ID: KH
A� R DATE (MM0D /YVYY)
CERTIFICATE OF LIABILITY INSURANCE 06/30111
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY EXTEND OR ALTER THE COVERAGE AFFORDED ATE
THE POLIC EIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,
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 holder is an ADDITIONAL INSURED, the policy(ies) 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 endorsement(s). — T —T
PRODUCER 714 -708 -4
United Captive Ins. Brokers 714 -708 -2
17151 Newhope St., Ste 211
Fountain Valley, CA 92708
Mark Barrie
United States Fidelity &
INSURED RBF Consulting INSURER B: Guaranty Corn
14725 Alton Parkway INSURER C : _.
Irvine, CA 92618 INSURER D :
INSURER E :
NAIC #
5887
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES O F 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
POLICY EFIR POLICY EXP LIMITS
INSR TYPE OF INSURANCE POLICY NUMBER MMIDD /YYYY MM /DD /YYYY
LTR
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE � OCCUR
EACH OCCURRENCE
$
AMA R NT D
PREMISES Ea occurrence
$
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$
GENERAL AGGREGATE
$ _
PRODUCTS - COMP /OPAGG
$
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO LOC
$
COMBINED SINGLE LIMIT
Ea accident
AUTOMOBILE LIABILITY
BODILY INJURY (Per person)
$
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
$
HIRED AUTOS AUTOS
UMBRELLA LIAB OCCUR
EXCESS LIAB CLAIMS -MADE
EACH OCCURRENCE $
AGGREGATE $
DED RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
A ANY PROPRIETOR /PARTNER /EXECUTIVE D1 23W00213 07/01111 07101112
N A
OFFICERIMEMBER EXCLUDED? /
X WC STATU- OTH-
E.L. EACH ACCIDENT $ 1,000,00
E.L. DISEASE - EA EMPLOYEE $ 1,000,00
(Mandatory In NH)
If yes, describe under
UESCRIPI ION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
Re: Raytheon Specific Plan EIR: RBF JN 10- 107917
ceurtt =l I eTIAN
CITYELS
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of El Segundo
Attn: Masa Aikire AUTHORIZED REPRESENTATIVE
350 Main Street
El Segundo, CA 902 - 798
©1988 -2010 ACORD CORPORATION. All rights reserved.
ACORD 26 (2010105) The ACORD name and logo are registered marks of ACORD