PROOF OF INSURANCE (2005) CLOSEDDATE
ACORD CERTIFICATE OF LIABILITY INSURANCE Page 1 of 2 1 04106/2004
PRODUCER 877- 945 -7378 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Willis North America, Inc. - Regional Cert Center HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
26 Century Blvd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P. O. Box 305191
Nashville, TN 372305191 INSURERS AFFORDING COVERAGE
INSURED SCS Engineers INSURERA:Zurich American Insurance Company 27855 -700
SCS Field Services INSURERB:Zurich American Insurance Company 27855 -001
SCS Energy
3711 Long Beach Blvd., 9th Floor INSURERC:Granite State Insurance Company 23809 -900
Long Beach, CA 90807 INSURERD:Steadfast Insurance Company 26387 -001
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 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
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
POLICY EXPIRATION
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE OCCUR
GL0804440410
4/1/2004
4/1/2005
EACH OCCURRENCE
$ 11 000, 000
FIRE DAMAGE (Any one fire)
$ 1,000,000
MED EXP (Any one person)
$ 10,000
PERSONAL & ADV INJURY
$ 1 OOO O00
GENERALAGGREGATE
$ 1,000,000
PRODUCTS- COMP /OPAGG
$ 1 OOO OOO
GEN'IAGGREGATELIMITAPPLIESPER:
POLICY ]( PRO- LOC
71
B
B
AUTOMOBILE
LIABILITY
ANYAUTO
AIDS BAP804440510
TX TAP523004603
4/1/2004
4/1/2004
4/1/2005
4/1/2005
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
X
B
ALLOWNEDAUTOS
VA BAP804555710
4/1/2004
4/1/2005
BODILY INJURY
(Per person)
$
SCHEDULED AUTOS
HIRED AUTOS
BODILY INJURY
(Per accident)
$
NON -OWNED AUTOS
PROPERTYDAMAGE
(Per accident)
$
GARAGE
LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
OTHERTHAN EAACC
AUTO ONLY: AGG
$
$
EXCESS LIABILITY
OCCUR CLAIMS MADE
EACH OCCURRENCE
$
AGGREGATE
$
DEDUCTIBLE
WC STATU- CER
X Rvll
C
C
D
RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
The Proprietor /
Partners /Executive
Officers are Include
OTHER
Professional /Environment
AIDS 3281830
CA 3281831
PEC793000010
10/1/2003
10/1/2003
4/l/20 4
10/1/2004
10/1/2004
4 1 2005
E.L. EACH ACCIDENT
$ 11000,000
E.L. DISEASE - EA EMPLOYEE
$ 1 OOO OOO
E.L. DISEASE - POLICY LIMIT $ 1 000 000
$5,000,000 Each Occurrence
$5,000,000 Aggregate
1$50,000 Deductible
DESCRIPTION OF OPERATIONS /LOCATIONS(VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
The certificate holder is named as additional insured under the General Liability coverage
per the attached endorsement. The insurance is primary per the policy form.
SCS Job No. 01203014.00 - Review Documents - Location: El Segundo, CA
Additional Insured to Include: The City of E1 Segundo, its officials, and employees
CERTIFIGA I t HULL)LK ADDITIONAL INSUMU; mbuNcn Lc I i
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL XLNWU XK MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFQ=XM L
City of E1 Segundo
Q� X
Attn: Patti Right
AUTH ESENT/,TIVE
350 Main Street
El Segundo, CA 90245 -3895
4
_ - ----- _ _
.. ,. ArnQn _nRPf1ROT1AN IORR
ACORD 25-S (7197) c011:y0jyia rp.L:a»ujj f'\ J — -- -- -
3163
Page 2 of 2
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-S (7/97) C011:963911 Tp1:ZZJV55 Uerr.:YL8Y130
POLICY NUMBER: GL0804440410
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ CAREFULLY.
ADDITIONAL INSURED- OWNERS, LESSEES OR
CONTRACTORS- SCHEDULED PERSON OR ORGANIIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL. LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
(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 ongoing operations performed for that insured.
CG 20 10 03 97 Copyright, Insurance Services Office, Inc., 1996