PROOF OF INSURANCE (2009) CLOSEDACORDL, CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDDrCM)
1 09/24/2008
DD'
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
PRODUCER
Woodruff - Sawyer & Co.
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
88 Rowland Way, Suite 180
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
LTR
B
NSR
Novato, CA 94945
(415) 878 -2460
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
INSURER A: Everest National Insurance Company
10120
INSURER B: Old Republic Insurance Company
24147
(dba) Republic ITS
37 r Be] Manh KE7r 5m
Novato, CA 94949 -5699
INSURER D:
COVERAGES
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
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SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
POLICY NUMBER
POLICY EFFECTIVE
POLICY EXPIRATION
LIMITS
LTR
B
NSR
TYPE OF INSURANCE
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE a OCCUR
AICG49560802
10/01/2008
10/01/2009
EACH OCC
$ 1,000,000
TO RENTED
DAMAGE RENTED
PREMISES Ea ocugence'
$ 300 OQO
P (Any one person)
$ 5,000
NAL & ADV INJURY
$ 1,000,000
AGGREGATE
$ 2,000,000
CTS - COMP /OP AGG
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY X PRO LOG
B
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
AICA49560802
10/01/2008
10/01/2009
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
X
BODILY INJURY
(Per person)
$
BODILY INJURY
(Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
AUTO ONLY: AGG
$
$
A
B
EXCESSIUMBRELLA LIABILITY
X1 OCCUR ❑CLAIMS MADE
DEDUCTIBLE
RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED?
H yes, describe under
SPECIAL PROVISIONS below
71C7000221081
A 1 C W49560803
10/01/2008
10/01/2008
10/01/2009
10/01/2009
EACH OCCURRENCE
$ 1 ,000,000
AGGREGATE
$ 1,000,000
WC 57ATU- OTH-
$
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,00
E.L. DISEASE -POLICY LIMIT
$ 1,000,000
OTHER
$
DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES/ 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
CERTIFICATE HULUEK
-
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of El Segundo
DATE THEREOF, THE ISSUING INSURER WILL &bE%UXM MAIL 30 DAYS WRITTEN
350 Main Street
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,)FX/ )W)P)0X* `}¢F*X)
El Segundo, CA 90245
c3�bib) bk�36XT7b> Y.0 IXfi3Ce )€XrNXcIYuXc3�l)ftXuXi#XcXrX
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AUTHORIZED REPRESENTATIVE
LOAN #:
n wrnon /`nDDARAT1AAl 9QRR
ACORD 26 (2001/08) ID #:
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(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)
POLICY NUMBER: AICG49560802 COMMERCIAL GENERAL LIABILITY
NAMED INSURED: Republic Intelligent Transportation Services, Inc. (dba) 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
350 Main Street
Address: 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
CG 20 10 11 85 Copyright, Insurance Service Office, Inc., 1984