Loading...
PROOF OF INSURANCE (2008) CLOSEDPRODUCER MARSH USA, INC. 600 RENAISSANCE CENTER, SUITE 2100 DETROIT, MI 48243 Attn: RAFFLES Fax (313) 393 -6950 '.6067 - 00177- -07/08 INSURED SEMA CONSTRUCTION, INC. 7353 S. EAGLE STREET CENTENNIAL, CO 80112 -4223 CERTIFICATE OF INSURAMCE CERTIFICATE NUMBER CHI-001308939-11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE POLICY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES DESCRIBED HEREIN. COMPANIES AFFORDING COVERAGE COMPANY GL CANC A AMERICAN ZURICH INSURANCE CO. COMPANY B DISCOVER PROPERTY & CASUALTY INSURANCE COMPANY COMPANY RECEND C ZURICH AMERICAN INSURANCE C COMPANY D -� v„I j-V moly mJueu cerimcate Tar Me policy period noted1fe1&vvV %. 1UU0 THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PEER��IIO�O$$D},I�N4DIICCATED. PERTAIN, NH THE N INSURANCE CE AFFORDED BY THE POLICIES DESCRIBED NHE EIIN IBS SUBJECT TO ALL THE TERMS, CONDITIONS ONS ANDHEXCLUSIONSTOFCSUCH Ol IN64R MAY LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CID n LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE(MM /DD/YY) DATE(MM /DD /YY) LIMITS GENERAL LIABILITY _ C X COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE $ 2,000,000 GL03486335 04/01/07 04/01/08 PRODUCTS - COMP /OP AGG $ 2,000,000 CLAIMS MADE OCCUR PERSONAL & ADV INJURY $ 1,000,000 X OWNER'S & CONTRACTOR'S PROT X ER PROIFt^TA %AlFIFR XCU EACH OCCURRENCE $ 1,000,000 B A E EQUIRED BY CONTRACT AUTOMOBILE LIABILITY 238YO0404 Excess Auto Only 04/01/07 04/01/07 04/01/08 04/01/08 FIRE DAMAGE (Any one fire) $ 500,000 MED EXP Any one person) $ 10,000 COMBINED SINGLE LIMIT $ 1,000,000 C X ANY AUTO BAP3486333 04/01 /07 04/01/08 $ 1,000,000 ALL OWNED AUTOS 1,000,000 BODILY INJURY (Per person) $ SCHEDULED AUTOS X HIRED AUTOS X NON -OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ GARAGE LIABILITY $ ANY AUTO AUTO ONLY - EA ACCIDENT OTHER THAN AUTO ONLY B A EXCESS LIABILITY UMBRELLA FORM X OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EMPLOYERS' LIABILITY IWC3486331 THE PROPRIETOR/ X INCL PARTNERS /EXECUTIVE OFFICERS ARE: EXCL 238YO0404 Excess Auto Only 04/01/07 04/01/07 04/01/08 04/01/08 AGGREGATE EACH OCCURRENCE $ $ AGGREGATE $ CSL X TORY LIMITS ER $ $1,000,000 EL EACH ACCIDENT $ 1,000,000 EL DISEASE- POLICY LIMIT $ 1,000,000 EL DISEASE -EACH EMPLOYEE T$ 1,000,000 DESCRIPTION OF Of SEE ATTACHED ITEMS CITY OF EL SEGUNDO CITY HALL - PUBLIC WORK DEPARTMENT ATTN: STEVE FINTON 350 MAIN STREET EL SEGUNDO, CA 90245 SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE INSURER AFFORDING COVERAGE WLL EOOWAX4XW MAIL _ ) DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED HEREIN, E MARSH USA INC. BY: John C Hurley MM1(3/02) VAUD AS OF: 03/27/07 PRODUCER MARSH USA, INC. COMPANY 600 RENAISSANCE CENTER, SUITE 2100 E DETROIT, MI 48243 Attn: RAFFLES Fax (313) 393 -6950 COMPANY 26067 - 00177 - -07/08 GL CANC F INSURED SEMA CONSTRUCTION, INC. COMPANY 7353 S. EAGLE STREET G CENTENNIAL, CO 80112 -4223 COMPANY H DATE (MWDD/YY) CHI-001308939-11 03/27/07 COMPANIES AFFORDING COVERAGE RE: DOUGLAS STREET GAP CLOSURE / RAILROAD GRADE SEPARATION PROJECT, PROJECT NO. PW 05 -06. SCE, THE CITY OF EL SEGUNDO, ITS OFFICERS, AGENTS AND EMPLOYEES ARE NAMED AS ADDITIONAL INSUREDS FOR GENERAL LIABILITY AND AUTO LIABILITY ONLY BUT ONLY AS RESPECTS LIABILITY ARISING FROM THE OPERATIONS OF THE INSURED. WAIVER OF SUBROGATION APPLIES TO WORKERS' COMPENSATION IN FAVOR OF THE ADDITIONAL INSUREDS LISTED AND VOLUNTEERS. THE GENERAL LIABILITY POLICY INCLUDES THE ISO CG0001 12/04 FORM WITH THE SEPARATION OF INSUREDS CONDITION AND NO ADDED ENDORSEMENTS RESTRICTING XCU OR CONTRACTUAL LIABILITY. INSURANCE IS PRIMARY AND NON - CONTRIBUTORY FOR GENERAL LIABILITY. WORKERS' COMPENSATION DOES NOT APPLY TO MONOPOLISTIC STATES (ND, OH, WA, WV, AND WY), PUERTO RICO OR THE VIRGIN ISLANDS. CITY OF EL SEGUNDO CITY HALL - PUBLIC WORK DEPARTMENT ATTN: STEVE FINTON 350 MAIN STREET EL SEGUNDO, CA 90245 MARSH USA INC. BY John C Hurley Client #: 51914 8SEMACON ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DDNYYY) PRODUCER 03/29/07 HRH of Colorado THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 720 South Colorado Boulevard HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Suite 60ON ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 0246 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City Hall- Public Works Dept; INSURERS AFFORDING COVERAGE NAIC # n7353 INSURER A National Union Fire Insurance PA c of 19445 EMA Golf, LLC INSURER B: S. Eagle Street INSURER C: Centennial, CO 80112 INSURER D: COVERAGES INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID NSR CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER N DATEYMM DD /YYE PDATE GENERAL LIABILITY MM /DDS LIMITS EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED CLAIMS MADE OCCUR PR M S occurrenc $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ POLICY PRO- PRODUCTS - COMP /OPAGG $ JECT LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ (Ea accident) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: A AGG $ EXCESS /UMBRELLA LIABILITY BE7274907 04/01/07 04/01/08 X OCCUR F7 EACH OCCURRENCE $25 000 000 CLAIMS MADE AGGREGATE $25 000 000 DEDUCTIBLE X RETENTION $ 10000 WORKERS COMPENSATION AND _ WC S"fATU- $ OTH- EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER /MEMBER EXCLUDED? E.L. EACH ACCIDENT $ If yes, describe under E.L. DISEASE - EA EMPLOYEE $ SPECIAL PROVISIONS below OTHER E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Project Ref: Douglas Street Gap Closure /Railroad Grade Separation Project, Project No. PW 05 -06 * The following cancellation conditions always apply: (See Attached Descriptions) CERTIFICATE HOLDER f%A,,,f,=, , AT,,,,, City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City Hall- Public Works Dept; DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE Attn: Steve Finton TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 350 Main Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR El Segundo, CA 90245 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2001/08) 1 of 3 #M521856 8CMAR © ACORD CORPORATION 1988 .J49i 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 26-S (2001/08) 2 of 3 Amr91aaa