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PROOF OF INSURANCE (2010) CLOSEDFrom: 7603798722 Page: 1/3 Date: 9/2/200910:38:07 AM ACQRP. CERTIFIQlidE OF LIABILITY INSURANCE DATE(MlAfDDfY" PRODUCER 08/24/2009 (760)379 -4651 FAX (760)379 -8722 THIS CERTIFICATE IS ISSUED ADA-MATTER OF INFORMATION Walter Mortensen Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE License #2663 4 HOLDER. RTHE COCERTIFICATE RAA FRDED NOT THE POLICIES BELOW. P.O. Box 2663 Lake Isabella, CA 93240 INSURERS AFFORDING COVERAGE NAIC # INSURED Rite, Inc. INSURERA; ^Endurance American Specialty DBA: The Perfect Field & INSURER B: ^' 5355 Avenida Encinas INSURER C: - -- Unit #109 INSURER Oz Carll sbad, CA 92008 INSURER E THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDINC3 MAY PERTAIN THE INSURANCE AFFORDED I Y THE POLICES DESCRIBED HEREIN IS SUBJECT TOPALL THE 1TYRMS. EXCLUSIONS AND MAY EO OR POLICIES. ACCREGATE LIMITS SHOWN MAY HAVF RFFN 149:1`11 u^.f:n RV DAIn ni eu.re LTR NSRI: TYPE OF INSURANCE POLICY NUMBER - POLICY EFFECTFJE DATE MMI00 POLICY EXPIRATION DATE MMIDD —` "'" LIMITS � ox a��> a aaaxoenmpa��xlx y� qLe c/o City Clerk GENERAL LIABILITY CMC10000682601 0412312009 04/2312010 EACH OCCURRENCE s 11000,0005 , 004 00 X COMMERCIAL GENERAL LIABILITY PREMIfil Eacnxrmee S 100 , QQ MED EXP (Any one person) - _ $ 1,000 A CLAIMS MADE FX] OCCUR PERSONAL & ADV INJURY $ 11000,00 GENERAL AGGREGATE s GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGO $ 21000 100 X POLICY JECT LOC AUTOMOBILE LIA9ILITY ANY AUTO COMBINED SINGLE LIMIT (Eeaccident) § ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Perpereon) 3 HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per ecddent) $ PROPERTY DAMAGE $ °.'° - (Per wddenl} GARAGE LIABILITY AUTO ONLY. EA ACCIDENT 5 ANY AUTO OTHERTHAN EA ACC S — ; AUTO ONLY: AGG EXCESS 1 UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR n CLAIMS MADE AGGREGATE 3 DEDUCTIBLE RETENTION S g. WORKERS COMPENSATION 'ER.. AND EMPLOYERS' LIABILITY YIN TORY LIMITS I E.L ,_.. EACH ACCIDENT S ANY PROPRIETORIPARTNERMXECt nVED pFFICERlMEMBER EEXCLUDED'? E,L DISEASE . EA EMPLOYEE _ S - - -,.,- -- - ,mandakory in NH) N veS. describe under E.L. DISEASE - POLICY LIMIT S SPECIAL PROVISIONS below OTHER PESCRIPTK)N OF OPERATIONS I LOCATIONS I VEHICLE; I EXCLUSIONS ADDED BY ENPORSEAIENT I SPECIAL PROVISIONS he City of El Segundo, its officers, officials, employees, agents & volunteers are added to the eneral Liability policy as Additional Insureds, per form CG 2026 7/04 attached, subject to the erms, Conditions and exclusions of the policy. Insurance is primary. A written contract is equired for the additional insured to be valid. 10 day notice of cancellation applies for non Payment of gremium. • -- - - -, • W 1999 -LVY9 A4vr Li bvr[r'vr%A 1 Ivry. All 119OLS TOSerVed. The ACCORD name and logo are registered marks of ACORD This fax was received by GFI FAXmaker fax server. For more information, visit: hfp: /Iwww.gfi.com SHOULD ANY OF THE A90VE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE MUING INSURER WILL &k1Q C11WJ6 MAIL 30 DAYS wRrr -rFN City of El Segundo NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, 90K&Ad(@=MXKXM C its officials & employees � ox a��> a aaaxoenmpa��xlx y� qLe c/o City Clerk 350 Main Street, Room #5 ' A TH R NTAnvE El Segundo, CA 90245.381 ,3 A Trion 9C Mr1Ae7M\ IJudy Dempsey/3D "'`'` • -- - - -, • W 1999 -LVY9 A4vr Li bvr[r'vr%A 1 Ivry. All 119OLS TOSerVed. The ACCORD name and logo are registered marks of ACORD This fax was received by GFI FAXmaker fax server. For more information, visit: hfp: /Iwww.gfi.com From: 7603798722 Page: 2/3 Date: 9/2/2009 10:38:07 AM POLICY NUMBER: CMC 10000682601 COMMERCIAL. GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANCES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifiers insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional ured Persons Or Or enixation s ANY PERSON OR ORGANIZATION FOR WHOM YOU ARE PERFORMING OPERATIONS, WHEN YOU AND SUCH PERSON OR ORGANIZATION HAVE AGREED IN WRITING IN A CONTRACT OR AGREEMENT THAT SUCH PERSON OR ORGANIZATION BE ADDED AS AN ADDITIONAL INSURED ON YOUR POLICY, PROVIDED THE CONTRACT OR AGREEMENT IS EXECUTED PRIOR TO THE DATE OF LOSS. Information required to complete this Schedule if not shown above will be shown in the Declarations Section 11 — Who Is An Insured is amended to in- clude as an additional insured the person(s) or or- ganizations) shown in the Schedule, but only with respect to liability for "bodily Injury", "property dam- age" or "personal and advertising injury" caused, in whole or In part, by your acts or omissions or the acts or omissions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07.04 iii 150 Properties, Inc., 2004 Page 1 of 9 This fax was received by GFI FAXmaker fax server. For more information, visit: http: //www.gfi.com 7 rrom: IbWt98122 Page: 3/3 Date: 9/2/2009 10:38:07 AM 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 This Certificate of Insurance does not constitute a Contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively emend, extend or after the coverage afforded by the policies listed thereon, ACORD 25 (2009101) This fax was received by GFI FAXmaker fax server. For more information, visit: http: / /www.gfi.com L2:39 CST RITE INC 5355 AVENIDA ENCINAS STE 109 CARLSBAD CA 92008 Infinity Property & Casualty Corporation Infinity Commercial Auto 11700 Great Oaks Way, Suite 300 Alpharetta, GA 30022 COMMERCIAL AUTO DECLARATION # Yr Make -Model Serial Number 4 07 GMC SIERRA C2500 HD SIE 1GTHC24K37E541350 500 / 500 / N/A 6 100 TOYOTA TUNDRA C EWM,5TFE 5F1XAX077012 500 / 500 / N/A COVERAGES - LIMITS OF LIABILITY THE COVERAGE IS APPLICABLE ONLY IF A PREMIUM IS INDICA Bodily Injury Liability $1,000,000 CSL Property Damage Liability $1,000,000C L Medical Benefits $2,000 Limit Uninsured Motorist - BI Comprehensive $25,000 each person $50,000 each accide Collision Rental $30 /day $900 per occurrence MCP /PUC: No POLICY NUMBER: 504-61001-1138-001 POLICY PERIOD: 03/16/2009 To 03/16/2010 This policy incepts on the date and time that the application for insurance is executed and shall expire at 12:01 a.m. on the last day of the Policy period. The following coverages and limits apply to each described vehicle as shown below. Coverages are defined in the policy and are subject to the terms and conditions contained in the Policy, including amendments and endorsements. No changes will be effective prior to the time changes are requested. # Driver Name DOB Excl SR2 1 Tim Pellegrino 2 Jess Becker 02/22/1967 No No 3 Nicholas Hetherington 02/07/1985 08/06/1985 No No No No 4 Michael Mueller 5 Tim Casinelli 07/10/1974 No No 6 Mike Casinelli 06/14/1967 02/22/1967 No No No No PREMIUMS FOR VEHICLES PREMIUM BY VEHICLE: 1621 1507 1507 1056 SEE REVERSE FOR ADDITIONAL INFORMATION ENDORSEMENTS MADE A PART OF THIS POLICY: 50461LPE01 ;50461POL01;50461SEE01 INSURED COPY TOTAL VEHICLE PREMIUM POLICY FEES TOTAL POLICY PREMIUM $ 6125.00 $ 6125.00 Form 50461 DEC01 Page 1 of 2 AMEND DATE: 07/22/09 ENDORSEMENT: 1 -8 vr=n v with 5 VEH 6 642 679 679 388 304 323 323 184 22 22 22 16 53 53 53 35 125 83 83 90 425 297 297 311 50 50 50 32 PREMIUM BY VEHICLE: 1621 1507 1507 1056 SEE REVERSE FOR ADDITIONAL INFORMATION ENDORSEMENTS MADE A PART OF THIS POLICY: 50461LPE01 ;50461POL01;50461SEE01 INSURED COPY TOTAL VEHICLE PREMIUM POLICY FEES TOTAL POLICY PREMIUM $ 6125.00 $ 6125.00 Form 50461 DEC01 Page 1 of 2 AMEND DATE: 07/22/09 ENDORSEMENT: 1 -8 CERTHOLDER COPY STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142 -0807 SD COMPENSATION INSURANCE FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 08 -28 -2009 GROUP: POLICY NUMBER: 1874098 -2009 CERTIFICATE ID: 8 CERTIFICATE EXPIRES: 03 -01 -2010 03 -01- 2009/03 -01 -2010 CITY OF EL SEGUNDO SD DEPT OF BUILDING & SAFETY 350 MAIN ST EL SEGUNDO CA 90245 -3895 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 10 days advance written notice to the employer. We will also give you 10 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 affordedpbytthe policy described s herein insurance subject to all he terms exclusions, Ia daconditionsthof insurance policy. 1 policy. THORIZED REPRESENTATI PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,00 0 RRENCE. ENDORSEMENT #1600 - DANNY SWAIM SECRETARY - EXCLUDED. ENDORSEMENT #1800 - TIM PELLEGRINO PRESIDENT,TREASURER - EXC EMPLOYER RITE, INC SD 5355 AVENIDA ENCINAS STE 108 CARLSBAD CA 92008 [JRL,CNj (REV.2 -05) PRINTED : 08 -26 -2009