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PROOF OF INSURANCE (2009) CLOSED.. 00p� A ORD CERTIFICATE OF LIABILITY OP IQ DATE (MMIOOIYYYY) INSURANCE Slown1 01/26/09 ABOVE FOR THE POLICY RESPECT TO WHICH THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION PRODUCER BOSWELL INS AGENCY (#OA96080) ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Agents & Brokers, Inc. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 4648 OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE --... ....... ...._ ...................... Mission Viejo CA 92690 Phone : 949 - 855 -0430 Fax : 949 -837 -5528 INSURERS AFFORDING COVERAGE _ NAIC # INSURER A: Golden ea 10 Ineuten00 conpany -- .... ......... INSURED ....................... INSURER B: 6mplyy ra Ca " --tlen Ins Co .., ,,.__..... CBP6446383 ....... _ ....... ___-- _.._...... INSURER C, -- Si source, Inc. CLAIMS MADE , X OCCUR QQ Mearns ��1 6 O i. Maffadd I�1 — INSURER E: ' Santa Ana CA 2705 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN tSSUED TO THE INSURED NAMED OTHER DOCUMENT WITH ABOVE FOR THE POLICY RESPECT TO WHICH PERIOD INDICATED. THIS CERTIFICATE MAYBE NOTWITHSTANDING ISSUED OR ANY REQUIREMENT, TERM OR CONDITION OF ANY MAY PERTAIN, THE INSURANCE AFFORDED BY THE CONTRACTOR 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. ...... ....--- DA DATE MMI - LIMITS EACH OCCURRENCE $1,000,000 .. INSR1ADB'{q__ LTR )NSRD TYPE OF INSURANCE POLICYNUMBER GENERAL LIABILITY I....._. A; IX�COMMERCIALGENERALLIABILITY CBP6446383 06/01/08 'DAN7iGET`0'RERTE 06/01/09 -'-- PREMISES.(Esoccurence).,.,. s 100j000 CLAIMS MADE , X OCCUR MED EXP (Arty one peroon) S 10,000 — PERSONALBADVINJURY $ 1,000,000 GENERAL AGGREGATE $2,000,000 °-' -- - -- - - ........._ ............. .. PRODUCTS-COMPIOPAGG 3_2,00 0,000 GEN'L AGGREGATE LIMIT APPLIES PER: - .. -• - -- °° '' "' —' - - -- ( POLICY JECT r I L� f ' I I COMBINED SINGLE LIMIT I AUTOMOBILE LIABILITY CBP8446383 06/01/0$ 06/01/09 i !$1,000,000 (Eeaccident) - - -- _— BODILY INJURY A ! ANY AUTO j j ALL OWNED AUTOS 1 i s (Per p ""- - --' - "� SCHEDULED AUTOS I X HIRED AUTOS BODILY INJURY (Per 11ccldent) s $ : WON-OWNED AUTOS — -_.� PROPERTY DAMAGE (Per accldenl) S AUTO ONLY -EA ACCIDENT S GARAGE LIABILITY i $ E A ACC ANY AUTO i I OTHER THAN AUTO ONLY: — AGG 1 g EXCESSIUMBRELIA LIABILITY I i 06/01/09 EACH OCCURRENCE f 5 1 000 LOOO , ^ !S1,000,000 AGGREGATE A X ; OCCUR CLAIMSMADE CBP8446383 06/01/08 s I �^ DEDUCTIBLE s X RETENTION $10,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY EIG106301301 (CA) 12/30/08 j 1 12/30/09 X TORY LIMITS ER ...... _. I $ 11000,000__ i E.L. EACH ACCIDENT -EA EMPLOYE B : ANYCERIMEMB R/PARLUDED? CUTIVE B `ANyYICER/MEETORE%CLNERIE BIG107091401 (OR) 12/30/08 12 /30 /09!E.L.DISEASE S_1t000,O_OO SPECIALPROVI Or below E.L. DISEASE - POLICY LIMIT; s1 000 000 OTHER A !Property Section iCBP8446383 06/01/08 06/01/09 DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS for non - payment. The City of El Segundo,its *10 Days notice of cancellation officers, officials, employees, agents and volunteers are included as Additional Insured, but only as respects to operations of the insured under written contract with the insured per Additional Insured forms CG2010(7/04) and CG2037(07/04) attached. Insurance is Primary and Non - Contributory per w�a.wrl 1 �TIA \1 City of E1 Segundo Attn: Louis Morales, Project Consultant 350 Main Street El Segundo CA 90245 25 (2001 CITYO -5 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL B0VV%Q=MAIL 30* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, W0- FAII.UR54GGG4G4HAI-L- REPItl:SBNT'A"M. I 3900 . ., s . POLICY NUMBER: CBP8446383 3900 , _ COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS --SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Panson(s) Or Organization(s): Locations Of Covered Operations The City of E1 Segundo, Its Re: Wayfinding Signage Officers, officials, employees, per attached contract documentc agents and volunteers Information required to complete this Schedule if not shown above will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; In the performance of your ongoing operations for the additional insured(s) at the location(s) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This Insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the Injury or damage arises has been put to its in- tended use by any person or organization other then another contractor or subcontractor en- gaged In performing operations for a principal as a part of the same project. CG 20 10 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 ❑ POLICY NUMBER: CBP8446383 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations The City of E1 Segundo, Its Re: Wayfinding Signage officers, Officials, employees, agents and volunteers Per attached contract documents Information required to complete this Schedule if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to include as an additional Insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property dam- age" caused, In whole or in part, by "your work' at the location designated and described In the sched- ule of this endorsement performed for that additional insured and Included in the "products- completed operations hazard ". CG 20 37 07 04 C ISO Properties, Inc., 2004 Page 1 of 1 ❑ PRIMARY INSURANCE ENDORSEMENT Policy No. Cnp 8aa61383 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. This endorsement modifies the following policy coverage forms: COMMERCIAL GENERAL LIABILITY COVERAGE FORM PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE FORNI Endorsement No. (If Issued after the effective date): Endorsement Effective: (At 12A111 Aid. &WMrd Tire) Named Insured: Signsouce Inc. The insurance provided by this policy for the benefit of the Additional Insured showy in the Schedule shall be primary insurance as specifically described in: COMMERCIAL GENERAL LIABILITY COVERAGE FORM CG 0009 Saction IV Commerciet General Liability Conditions, 4. Other insurance a. Primary Insurance SCHEDULE Name of Person or Organization: The City of F1 Segundo, Its officers, officials, employees, agents and volunteers GE CO 427A(11-97) Re: Wayfinding Signage Per attached contract documents ENDORSEMENT 0k Golden. Eagle hi gurarice. Forming a part of Policy Number: CBP8446383 _ Coverage Is Provided In PEERLESS INSURANCE COMPANY - A STOCK COMPANY Named Insured: ^— Agent; BOSWELL INSURANCE AGENCY AGENT Signsouce Inc. Agent Code: 4295039 Agent Phone: (949) -855 -0430 THIS ENDORSEMENT CHANGES THE POLIO'. PLEASE READ IT CAREFULLY THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: COMMERCIAL GENERAL LIABILITY COVERAGE PART NONCONTRIBUTORY CLAUSE OTHER INSURANCE MAINTAINED BY THE ADDITIONAL INSURED SHOWN IN THE SCHEDULE SHALL BE EXCESS AND NONCONTRIBUTORY WITH THE INSURANCE PROVIDED BY THIS POLICY, BUT ONLY AS RESPECTS ANY CLAIM, LOSS OR LIABILITY ARISING OUT OF THE ONGOING OPERATIONS OF THE NAMED INSURED OR ITS SUBCONTRACTORS; AND ONLY IF SUCH CLAIM, LOSS OR LIABILITY IS DETERMINED TO BE SOLELY THE NEGLIGENCE OR RESPONSIBILITY OF THE NAMED INSURED, SCHEDULE NAME OF PERSON OR ORGANIZATION: The City of E1 Segundo, Its officers, officials, employees, agents and volunteers RE: Wayfinding Signage Per attached contract documents 17 -59 (08/94) 8387802 NEUSXCOC1812 PGDMO500 J14640 0C'AFPPN 00008703 Page