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PROOF OF INSURANCE (2008) CLOSEDDATE (MMIDDIYYYI� ACORD, CERTIFICATE OF LIABILITY INSURANCE 02/26/2008 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION _. ONLY "AND' CONFERS -NO'-RIGHTS UPON THE CERTIFICATE Woodruff= Sawyer & Co. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 220 Bush St., 7th Floor ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. San Francisco CA 94104 (415) 391 -2141 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: National Union Fire Insurance Company of Pittsburgh, A 19445 Republic ITS INSURERS: Old Republic General Insurance Corporation 24139 371 Bel Marin Keys Blvd #200 INSURER C: Novato, CA 94949 -5699 INSURER D: OVERAGtS THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. QEwn OR CONDITION ES WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR —VAM TU=1I I FORDED BY THE POLICIES DESCRIBED HEREIN S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. INSR LTR ME AGGREGATE LIMITS SHOWN MAY Mlo� HAVE 13EtN KtLIUGtu 6T ri+iu POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS E 1 0000 10/01/2008 EACH OCCURRENCE LOAN #: ® ACORD CORPORATION 1988 rGENERAL Y L GENERAL LIABILITY MADE a OCCUR AICG49560701 10/01/200 7 I MED EXP An one raon E E PERSONAL 3 ADV INJURY E 1 OOO OOO GENERAL AGGREGATE $ 2,900.000 PRODUCTS - COMPIOP AGG E 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: B X POLICY X PRO LOC AUTOMOBILE LIABILITY X ANY AUTO AICA49560701 10/01/2007 10/01/2008 COMBIINderlt) INGLELimIT $ 1,000,000 ALL OWNED AUTOS BODILY INJURY (Per pereon) E SCHEDULED AUTOS HIREDAUTOS BODILY INJURY (Per accident) E X NON -OWNED AUTOS AMAGE ) E - EA ACCIDENT $ N � ACC : AGG R__ S GARAGE LIABILITY ANY AUTO S A EXCES &UMBRELLA LIABILITY X OCCUR CLAIMS MADE BE5691371 10/01 /2007 10/01/2008 RRENCE S 1 OO OLIO E $ 1000000 S S DEDUCTIBLE $ B RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISKNS below OTHER AlCW49560702 10/01/2007 10/01/2008 X WC STATU- OTH- E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE E 1,000,000 E.L. DISEASE • POLICY LIMIT $ 1,000,000 $ a $ DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Certificate Holder is included as additional insured per form CG 20 10 11 85, Project: Traffic Signal Maintenance Services GERTIFIGAIt riUL.u=R — — SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of El Segundo DATE THEREOF, THE ISSUING INSURER WILL 0@(*)MMAIL 30 DAYS WRITTEN 350 Main Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, El Segundo, CA 90245{¢Ci4 ►X€7't '[XIX3 AUTHORREDREPRESENTAnVE LOAN #: ® ACORD CORPORATION 1988 ACORD 25 (2001108) ID #: 38 1 9 ,'. IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the poiicy(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 The Certificate of Insurance on the reverse side of this form 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. ACORD 25 (2001108) ` ' �, • -i POLICY NUMBER: AICG49560701 COMMERCIAL GENERAL LIABILITY NAMED INSURED: Republic ITS THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES or CONTRACTORS [Form B] This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of person or organization: Any person or organization to which you are obligated by virtue of a written contract to provide insurance such is afforded by this policy, but with respects to (1) occurrence taking place after such written contract has been executed and (2) occurrences resulting from work preformed by you during the policy period. Coverage provided by this policy to the Additional Insured(s) shown in the Schedule shall be primary insurance and any other insurance maintained by the Additional Insured(s) shall be excess and non - contributory, but only as respects any claim or liability determined to be the result of the sole negligence or responsibility of the Named Insured and only if required of the Named Insured by written contract. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" for that insured by or for you. Name: City of El Segundo Address: 350 Main Street El Segundo, CA 90245 Certificate Holder is included as additional insured per form CG 2010 1185. Project: Traffic Signal Maintenance Services Additional Insured: City of El Segundo, its officials and employees CG 20 10 1185 Copyright, Insurance Service Office, Inc., 1984 38 19., „a OLD REPUBLIC GENERAL INSURANCE CORPORATION ADDITIONAL INSURANCE WHERE REQUIRED UNDER CONTRACT OR AGREEMENT THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: BUSINESS AUTO COVERAGE FORM The following is added to Section II - Liability Coverage, A. - Coverage, 1. Who Is An Insured: d. Any person or organization to whom you become obligated to Include as an additional Insured under this policy, as a result of any contract or agreement you enter into which required you to furnish insurance to that person or organization of the type provided by this policy, but only with respect to liability arising out of your operations or premises owned by. or rented to you. However, the insurance provided will not exceed the lessor of 1. The coverage or limits of this policy, or 2. The coverage or limits required by said contract or agreement. City of El Segundo 350 Main Street El Segundo, CA 90245 Certificate Holder is included as additional insured per form CG 20 10 11 85. Project: Traffic Signal Maintenance Services Additional Insured: City of El Segundo, its officials and employees Named Insured Republic ITS Policy Number AlCA49560701 Endorsement No. Policy Period to Endorsement Effective Date: 10/01/2007 Producer's Name: Producer Number: 02/26/2008 AUTHORIZED REPRESENTATIVE DATE CA EN GN 0020 09 06 3i. „ a a� OLD REPUBLIC GENERAL INSURANCE CORPORATION CHANGES ADDITIONAL INSURED PRIMARY WORDING SCHEDULE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Name of Additional Insured Person(s) Or Organization(s): City of El Segundo 350 Main Street El Segundo, CA 90245 As required by written contract: Location(s) of Covered Operations Certificate Holder is included as additional insured per form CG 20 10 11 85. Project: Traffic Signal Maintenance Services Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Insurance provided by this endorsement is primary insurance and we will not seek contribution from any other insurance of a like kind available to the person or organization shown in the schedule above unless the other insurance is provided by a contractor other than the person or organization shown in the schedule above for the same operation and job location. If so, we will share with that other insurance by the method described in paragraph 4.c. of Section IV — Commercial General Liability Conditions. All other terms and conditions remain unchanged. Named Insured I Republic ITS AlCG49560701 Endorsement No. Policy Period 01 2 to Endorsement Effective Date: 10/01/2008 Producer's Name: Producer Number: AUTHORIZED REPRESENTATIVE Additional Insured: City of El Segundo, its officials and employees CG EN GN 0029 09 06 02/26/2008 DATE ' � 4