PROOF OF INSURANCE (2007) CLOSED (2)miewi w VCK 1 IrIlt..A I C Ur LIA131LI 1 T INOUMAMOM 02/15/200
PRODIi:ER (973)812 -9855 FAX (973)812 -9860 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
C&H Agency, Inc . ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
PO Box 324 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
783 North Riverview Drive
Totowa, N] 07512 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A: American Home Assurance Co. (AIG 19380
S & L Specialty Contracting, Inc. INSURERS: Arch Insurance Company (Hartan) 11150
31S South Franklin Street INSURER C:
Syracuse, NY 13202 INSURER D:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN(
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
D'
TYPE OF INSURANCE
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE FX I OCCUR
POLICY NUMBER
GL1793345
POLICY EFFECTIVE
DATE IUM100rintf
12/01/2006
POLICY EXPIRATION
12/01/2007
LIMITS
EACH OCCURRENCE $ 2, 000, OO
A
DAMAGE TO RENTED
ISES (Ea rcw_^
$ 50, 00
MED EXP (Any one person)
$
PERSONAL 8 ADV INJURY
$ 2,000.00
GENERAL AGGREGATE
$ 4,000 ,00
PRODUCTS - COMP/OP AGG
$ 4,000 , OO
GENL AGGREGATE LIMIT APPLIES PER:
POLICY X JECT LOC
AUTOMOBILE LIABILITY
X ANY AUTO
CA8262 5 5 5
12/01/2006
12/01/2007
COMBINED SINGLE LIMIT
(Ea accident)
$
1,000,000
A
X ALL OWNED AUTOS
X SCHEDULED AUTOS
X HIRED AUTOS
X NON-OWNED AUTOS
BODILY INJURY
(Per person)
$
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
AUTO ONLY: AGG
$
$
B
EXCESSIUMBRELLA LIABILITY
X OCCUR FI CLAIMS MADE
ULP001921600
12/14/2006
12/01/2007
EACH OCCURRENCE
$ 10, 000, 00
AGGREGATE
$ 10,000,00(
$ --
DEDUCTIBLE
X RETENTION $ 10,00
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
WC7180651
CALIFORNIA
12/01/2006
12/01/2007
X wcsTATU- oR
$
E.L. EACH ACCIDENT
$ 1,000,000
A
ANY PROPRIETOR/PARTNERIEXECUTIVE
OFFICERIMEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - EA EMPLOYE
$ 11000,000
E.L. DISEASE - POLICY LIMIT
_
$ 1,000,000
OTHER
DESCRIPTION OF OP RA IONS / LOCATIONS I VEHI SIONS ADD D BY ENDORSEMENT I SPECIAL PROVISIONS
E: City - E� Segundo, ResidEent i Sound Insulation Program 04 -11, GROUP 17, Contract No. 3685
G2010 (11/85) Additional Insured - Owners, Lessees or Contractors (Form B) (attached)
ity of E1 Segundo, its officers, officials, employees, agents & certified volunteers are included as
dditional Insureds with respect to this project. **See attached for cancellation clause &
dditional Wording" Primary Insurance End. attached. REVISED - Replaces certificate issued 02/12/2007.
City of E1 Segundo
Attn: Residential Sound Insulation Program
350 Main Street
Room 5
E1 Segundo, CA 90245 -3813
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL 1(ol(3foXlldfft MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
KMAKMNXKX*MKKKOMUOUWIXXMUK)(KMKVMM)bXXKWMXX
AUTHORIZED REPRESENTATIVE
Michael Culnen /LOI
w wAwnA��T�A�1 Anee
ACORD 25 (2001108) .- .. -•-- -• _...___
City of E1 Segundo
:rtificate issued to City of E1 Segundo 02/15/2007
BFI Agency, Inc .
/15/2007
This insurance will be deemed "primary" such that any other insurance that may be carried by City of E1
gundo will be excess thereto. This insurance will be on an "occurrence ", not a "claims made," basis or
uivalent.
It is agreed that this insurance will not be canceled, not renewed or the limits of coverage in any way
duced without at least (30) days advance written notice ten (10) days for non - payment of premium sent
certified mail, return receipt requested to the Certificate Holder.
POLICY NUMBER: GL 179 -33 -45
COMMERCIAL GENERAL LIABILITY
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:
CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS, EMPLOYEES, AGENTS & CERTIFIED VOLUNTEERS
THE FOLLOWING PROJECT ONLY:
PROJECT: RESIDENTIAL SOUND INSULATION, PROGRAM 04 -11 -GROUP 17, CONTRACT NO 3685
(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.
CG 20 10 11 85 Copyright, Insurance Services Office, Inc., 1984
Page 1 of 1 O
ENDORSEMENT
This endorsement, effective 12:01 A.M. 12/01/2006
Forms apart of policy no.: GL 179 -33 -45
Issued to A. SERVIDONE, INC/S &L SPECIALTY ,CONTRACTING, INC.
By AMERICAN HOME ASSURANCE COMPANY
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY.
AMENDMENT OF OTHER INSURANCE
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
Section IV - Commercial General Liability Conditions, 4. - Other Insurance, b.- Excess
Insurance, is amended to read:
b. Excess Insurance
This insurance is excess over any of the other insurance whether primary, excess,
contingent or. on any other basis:
(1) Unless such insurance is specifically purchased to apply as excess of this policy, or
** (2) you are obligated by contract to provide primary insurance.
When this insurance is excess, we will have no duty under Coverage A or B to defend
any claim or "suit' that any other insurer has a duty to defend. If no other insurer
defends, we will undertake to do so, but we will be entitled to the insured's rights
against all those other insurers.
When this insurance is excess over other insurance, we will pay only our share of the
amount of the loss, if any, that exceeds the sum of:
(1) The total amount that all such other insurance would pay for the loss in the
absence of this insurance; and
(2) The total of all deductible and self - insured amounts under all that other insurance.
We will share the remaining loss, if any, with any other insurance that is not described in
this Excess Insurance provision and was not bought specifically to apply in excess of the
limits of Insurance shown in the Declarations of this Coverage Part.
67265 (3/97)
AUTHORIZED REPRESENTATIVE