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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