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PROOF OF INSURANCE (2009) CLOSEDACORD- CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
PRODUCER 01/07/09
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Meadowbrook, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Southfield Commercial Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
26255 American Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Southfield, MI 48034 -6112 INSURERS AFFORDING COVERAGE
INSURED NAIC #
ROSSETTI ASSOCIATES INC. INSURER a Travelers Property Casualty Co. of A 25674
TWO TOWNE SQUARE, STE. 200 INSURER B:
SOUTHFIELD, MI 48076 INSURER C:
INSURER D:
E:
COVERAGES INSURER
ANY REQUIREMENT, TERM OR CONDITION OF —= 1NbUHFU ANY CONTRACT OR OTHER DOCUME ITH ABOVE
PECT TO WHICCHLTHIS CERTIFICATE MADY BE ISSUED OR ITHSTANDING
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.
km
on
TYPE OF INSURANCE
POLICY NUMBER
POLICY EF;j2T
POLICY EXPIRATION
DATE (111111111MON V1
LwTS
A
GENERAL
X
LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE OCCUR
168062931-871TIL08
11/05/08
11/05/09
EACH OCCURRENCE
$2000.00
DAM RENTED
MED EXP (Any one person)
$300 000
$5.000
PERSONAL & ADV INJURY
$2,000,000
GENL AGGREGATE LIMIT APPLIES PER:
POLICY PRO- CT LOC
GENERAL AGGREGATE
S4 000 000
PRODUCTS - COMPFDP AGG
$4,000,000
A
AUTOMOBILELIAMurr
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
16806293L871TIL08
11/05/08
11/05/09
COMBINED SINGLE LIMIT
(Ea accident)
$2,000,000
BODILY INJURY (Per
(Per Peon)
$
X
BODILY INJURY (Per (Per accident)
X
PROPERTY DAMAGE
(Per accident)
$
12X
GARAGE LIABILITY
ANY AUTO
ESSIUMBRELLA LIABILITY
OCCUR FI CLAIMS MADE
DEDUCTIBLE
RETENTION $5000
ISFCUP773OY859TILO
11/05/08
11/05/09
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
AUTO ONLY: AGG
EACH OCCURRENCE
S
$
$5,000,000
AGGREGATE
$5 000 000
S
i
E
WORKERS COMPENSATION AND
ENPLOYEW LUUNLm
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED?
SPEC AL PROM under E�elow
OTHER
WC STATU- OTH-
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE - POLICY LIMIT S
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Named Insured Schedule
Rossetti Associates Architects dba Louis A Rossetti Architects PC
Rossetti Associates Inc.
Rossetti Jorgensen
(See Attached Descriptions)
CERTIFICATE HOLDER CANCELLATION
City of El Segundo Attn: Dan
Garcia, Assistant City Engineer
350 Main Street
El Segundo, CA 90245
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILLMAIL An DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, M sum
mawowmx
AUTH D REPRESENTATIVE
`4�i i
..vvfV �J tLUU UYO) I of 2 #5109487/M107944 CXK a ACORD CORPORATION 1988
DESCRIPTIONS (Continued from Page 1 )
City of El Segundo, its officials and employees are additional insured as
respects El Segundo Pool Atemative Study per Blaket Additional Insured
Form CG D2 52 08 05 attached.
J%Mo c;2.0 kAUVUUD) 2 OT L W:b7UV4811M1U1V44
ROSSETTI & ASSOCIATES
POLICY 0168062931871TILOS
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
BLANKET ADDITIONAL INSURED
(CONTRACTORS OPERATIONS)
This endorsement modifies insurance provided under the fb%Wng:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
t. WHO IS AN INSURED — (Section 11) It 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 Injuy , and
b) if, and only to the extent that, the injury or
damage Is caused by acts or omisslons of
you or your subcontractor In the performance
of -your work" to which the "written contract
requiring insurance" applies. The person or
organizaton does not qualify as on additional
Insured with respect to the independent ads
or omissions of such person or organizction.
2. The insurance provided to the additional insured
by this endorsement Is limited as follows:
a) in the event that the Limits of ho"nee of
this Coverage Part shown in the Decieratlons
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-
surar}ce", This endorsement shall not lr -
crease the limits of Msuranoe described In
section 111— 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 fallure to rander, any
professional architectural, engineering orsur-
veying services, Including;
1. Tine 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 falling to prepare or ap.
prove, drawings and specifications; and
fl. 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".
d) The insurance provided to the additional In-
sured does not apply to 'bodily injury' or
*property damage" that occurs, or `personal
injury* arising out of an offense committed,
while any separate liability Insurance that you
have procured for that person or organization
rs in effect, NOW= of whether the scope
or limits of insurance In this Coverage Part
exceed those of that separate Kobigty Insur-
ance or whether that separate liability insur-
ance is valid and collectible.
3. The Insurance provided to the additional insured
by this endorsement Is excess over any valid and
colleollpte "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.
4. As a condition of coverage provided to the
additional insured by this endorsement.,
it) The addltlonai 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 Police
should Include:
L How, when and where the 'occurrence
or offense took plaoe;
ii. The names and addresses of any Injured
Pam= and witnesses; and
iii. The nature and location of any Injury or
damage arising out of the •Murrence" or
offense.
b) If a claim Is made or auk* 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
CG DI 52 09 06 0 2005 The St. Paul Travelers Companies, Inm Page t of 2
ROSSETTI 6 ASSOCIATIV.
POLICY # 16806293L871TIL07
COMMERCIAL GENERAL UABIUTY
It. Notify us as soon as practicable.
The additional Insured must see to It that we
receive written notice of the claim or "aud' as
soon as practicable.
c) The additional Insured must immedielely
send us copies of all legal papers received in
connection with the claim or 0suir, cooperate
with us in the investigation or settlement of
the claim or defense a0ainst the "suit ", and
otherwise comply with all policy conditions.
d) The additional Insured must tender the de-
fense and lndenv*y of any claim or "suir to
any provider of "other Insurance" which would
cover the additional insured for a loss we
cover under this endorsement.
S. 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 Us Coverape 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
conlrad 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 ® 2005 The SL Paul ?revelers Companies, Inc. CG 02 52 08 05
01481
ACORD n, CERTIFICATE OF
LIABILITY INSURANCE
DATE
2/18/2008Y)
PRODUCER Serial # 102869
DESIGNPRO INSURANCE GROUP
P.O. BOX 511106
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
LIVONIA, MI 48151
(734) 425 -9710
INSURERS AFFORDING COVERAGE
NAIC*
INSURED
ROSSETTI ASSOC, INC. - (CA)
999 SEPULVEDA BLVD., SUITE #100
EL SEGUNDO, CA 90245
HOME OFFICE: SOUTHFIELD, MICHIGAN
INSURER A: TRAVELERS INDEMNITY COMPANY
INSURER B: LEXINGTON INSURANCE COMPANY
INSURER C:
INSURER D:
INSURER E:
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 POLICES DESCRIBED
HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF INSURANCE
POLICY NUMBER
P FF
MN
P8&fVP6
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE M OCCUR
AMAG TO RENTED
$
MED EXP (Any one on
$
PERSONAL & ADV INJURY
$
GENERAL AGGREGATE
$
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP /OP AGG
$
POLICY M PRO- LOC
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident)
$
HIREDAUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
EXCESSIUMBRELLA LIABILITY
OCCUR CLAIMS MADE
EACH OCCURRENCE
$
AGGREGATE
$
a
DEDUCTIBLE
$
RETENTION $
A
WORKER'S COMPENSATION AND
EMPLOYERS LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
UB- 5982Y80
05 -01 -08
05 -01 -09
C S u
X T RY LIMIT O R
EL EACH ACCIDENT
$ 1,000,000
EL DISEASE - EA EMPLOYEE
$ 1,000,000
OFFICERIMEMBER EXCLUDED?
n describe under
SPECIAL PROVISIONS below
EL DISEASE - POLICY LIMIT
$ 1,000,000
OTHER
PER CLAIM LIMIT $5,000,000
B
ARCHITECTS /ENGINEERS
#0867224
08 -16-08
08 -16-09
AGGREGATE LIMIT $5,000,000
PROFESSIONAL LIABILITY
DEDUCTIBLE $ 50,000
DESCRIPTION OF OPERATIONS /LOCATIONSNEMCLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
RE: EL SEGUNDO POOL ALTERNATIVE STUDY.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITY OF EL SEGUNDO
ATTN: MR. DAN GARCIA
DATE THEREOF, THE ISSUING INSURER WILL XIKI XAMAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, IK.XAXaMA&eKXX
Ar041(xx0i4xxb0m 1(D CXXX
ASSIST. CITY ENGINEER
KfivK4 ExA"XXX
350 MAIN STREET
AUTHOR17ED REPRESENTATIVE OF INDEPENDENT INSURANCE AGENCY
EL SEGUNDO, CA 90245
ACORD 25 (2001108) © ACORD CORPORATION 1988
C:\FMPRO\CERTPROS.FP5