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PROOF OF INSURANCE (2008) CLOSEDACORD ' CERTIFICATE OF LIABILITY INSURANCE PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO Powers and Company ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Insurance Agents and Brokers u Box 619043 Lic Brokers 64 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOV P. Roseville CA 95661 -9043 Phone:916- 630 -8643 Fax:800- 783 -0083 DATE (MM /DDNYYY) S 8 03/13108 INSURED L� Seal Beach CA 90740 COVERAGES INSURERS AFFORDING COVERAGE NAIC # INSURER A: Navigators Insurance Co. 42307 INSURER B: Mt. Hawley Insurance ___ INSURER C: INSURER D: INSURER E: n AlnTnrITAJCTAAII'11A1(] THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED I o I rlt INbUntU rvwvlr =v mDw" ��.n 1,1� .�. • �• -• _._... __.. -_ _ _... - _ 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. LTR NSR -- TYPE OF INSURANCE GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR X Owner /Copt Prot. _— POLICY NUMBER 0410017716 OLICY EF ECTIVE DATE MM /DD/YY 06/17 /07 I POLICY EX (RATION DATE MM /DD/YY 06/17/08 LIMITS EACH OCCURRENCE $ 1,000,000 A X PREMISES(Eaoccurence) $ 50,000 MED EXP (Any one person) $ 5 , 000 PERSONAL & ADV INJURY $ 1 , 000 , 000 GENERAL AGGREGATE s2,000,000 — — PRODUCTS - COMP /OP AGG $ 1 , 00 0 , 000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X JPER& LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEDULED AUTOS HIRED AUTOS I BODILY INJURY (Per accident) $ NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ _ —_ LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ i GARAGE OTHER THAN EA ACC AUTO ONLY: AGG $ $ $ I g EXCESS /UMBRELLA LIABILITY $ OCCUR CLAIMSMADE EMX0308918 03/10/08 06/17/08 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 $ I DEDUCTIBLE RETENTION $ WC;bIA U_ $ iWORKERS COMPENSATION AND EMPLOYERS' LIABILITY TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? E.L. DISEASE - POLICY LIMIT $ If yes, describe under SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS *10 day NOC applies for non - payment of premium. The City of E1 Segundo, its officers, agents and employees is included as Additional Insured under Commercial General Liability policy per endorsement ANF -ES 160 (5/2006), subject to a written contract between Named Insured and Additional Insured. * *Endorsement to follow from company, xw (see attached notepad) CERTIFICATE HOLDER CANCELLATION CI TYOFE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIC City of El Segundo DATE THEREOF, THE ISSUING INSURER WILL dwAlwomOMM" 30* DAYS WRITTEN Public Works Dept. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, E1 Segundo City Hall 350 Main Street El Segundo CA 90245 - -- (200 A IVIZ 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 (2001/08) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED ENDORSEMENT (EXCLUDING RESIDENTIAL) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM B) CG 20 10 11 85 Policy Number: 04- 10017716 Endorsement Effective: 02/20/08- 06117/08 12:01 a.m. Named Insured Countersigned By: TONY PAINTING, INC. SCHEDULE Name of Person or Organization: PUBLIC WORKS DEPT.; EL SEGUNDO CITY HALL; THE CITY OF EL SEGUNDO, IT'S OFFICERS, AGENTS, AND EMPLOYEES 350 MAIN STREET EL SEGUNDO, CA 90245 Location: INTERIOR /EXTERIOR PAINTING NOT TO EXCEED 3 STORIES IN HEIGHT OF PUBLIC FACILITIES, A COMMERCIAL BUILDING, LOCATED THROUGHOUT EL SEGUNDO CA 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. The following additional provisions apply to any entity that is an insured by the terms of this endorsement: 1. Primary Wording If required by written contract or agreement: Such insurance as is afforded by this policy shall be primary insurance, and any insurance or self- insurance maintained by the above additional insured(s) shall be excess of the insurance afforded to the named insured and shall not contribute to it. 2. Waiver of Subrogation If required by written contract or agreement: We waive any right of recovery we may have against an entity that is an additional insured per the terms of this endorsement because of payments we make for injury or damage arising out of "your work" done under a contract with that person or organization. 3. Neither the coverages provided by this insurance policy nor the provisions of this endorsement shall apply to any claim arising out of the sole negligence of any additional insured or any of their agents /employees. 4. This endorsement does not apply to any work involving or related to properties intended for permanent residential or habitational occupancy (other than apartments). The words "you" and "your" refer to the Named Insured shown in the Declarations. "Your work" means work or operations performed by you or on your behalf; and materials, parts or equipment furnished in connection with such work or operations. ANF -ES 160 (5/2006) CERTIFICATE OF INSURANCE ® ALLSTATE INSURANCE COMPANY ❑ ALLSTATE INDEMNITY COMPANY S*k015 S THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO ATE HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR ALTER THE COVERAGE AFFORDED BY TH�1+ E. CERTIFICATE HOLDER I NAMED INSURED Public Works Department Ante Manjanovic ut3A i onys Fainting El Segudo City Hall 4817 Elder Ave 350 Main St El Segundo, Ca 90245 Seal Beach, CA 90740 r This is to certffy that policies of Insurance listed below have been issued to the insured named above subject to the e3WratiUM date 410dicated below, 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 Dolicies described herein is subject to all the terms, exclusions and conditions of such policies. TYPE OF INSURANCE AND LIMITS COMMERCIAL GENERAL LIABILITY Policy Effective Expiration Number Date Date Limit Amount GENERAL AGGREGATE LIMIT (Other than Products - Completed Operations) PRODUCTS - COMPLETED OPERATIONS AGGREGATE LIMIT PERSONAL AND ADVERTISING INJURY LIMIT EACH OCCURRENCE LIMIT PHYSICAL DAMAGE LIMIT ANY ONE LOSS MEDICAL EXPENSE LIMIT ANY ONE PERSON WORKERS' COMPENSATION & Policy Effective Expiration EMPLOYERS` LIABILITY Number Date Date Coverage Limits WORKERS' COMPENSATION STATUTORY - applies only in the following states: BODILY INJURY BY ACCIDENT EACH ACCIDENT EMPLOYERS' BODILY INJURY BE DISEASE EACH EMPLOYEE LIABILITY BODILY INJURY BY DISEASE POLICY LIMIT AUTOMOBILE LIABILITY Policy 048728943 Effective 06/0412007 Expiration 06/0412008 Number Date Date Coverage Basis Limits ANY AUTO OWNED AUTOS HIRED AUTOS Combined Single Limit of Liability BODILY INJURY & PROPERTY DAMAGE 1,000,000 EACH ACCIDENT ❑ SPECIFIED AUTO ❑ NON -OWNED AUTOS Split Liability Limits Bodily Injury Property Damage Each OWNED PRIVATE PASSENGER AUTOS :r... PERSON OWNED AUTOS OTHER THAN PRIVATE PASSENGER ACCIDENT UMBRELLA LIABILITY Policy Effective Expiration Number Date Date EACH OCCURRENCE GENERAL AGGREGATE PRODUCTS - COMPLETED OPERATIONS AGGREGATE OTHER (Show Policy Effective Expiration type of Policy) Number Date Date DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES /RESTRICTIONS /SPECIAL ITEMS CANCELLATION Number of days notice 30 JOHN MURPHY February 19, 2008 AuMmIrad Representative Date Should any of the above described policies be cancelled before the expiration date, the issuing company will endeavor to mail within thw numhPr of nays entered above, written notice to the certificate holder named above. But failure to mail such notice shall impose no obligation or liability of any kind upon the company, its agents or representatives W4PJ23 -2 2008 -02- 1912:57 ALLSTATE INSURA Page 2 CERTHOLDER COPY SP STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142 -0807 COMPENSATION INSURANCE FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 02-11 -2008 GROUP: POLICY NUMBER: 0818834 -2007 CERTIFICATE ID: 123 CERTIFICATE EXPIRES: 08 -28 -2008 06-28- 2007/08 -28 -2008 CITY OF EL SEGUNDO SP JOB:PW 07 -12 PUBLIC WORKS DEPARTMENT, CITY HALL 350 MAIN ST COPY EL SEGUNDO CA 90245-3813 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. THORIZED REPRESENTATI PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT H2O65 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 07-17 -2007 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER TONY PAINTING INC SP 4817 ELDER AVE SEAL BEACH CA 80740 (RDG,CNj PRINTED : 02 -11 -2008 (REV.2 -05) POLICYHOLDER COPY SP STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142 -0807 COMPENSATION INSURANCE FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 02-11-2008 GROUP: POLICY NUMBER: 0616634 -2007 CERTIFICATE ID: 123 CERTIFICATE EXPIRES: 06 -28 -2008 06 -28- 2007/06 - 28-2008 CITY OF EL SEGUNDO SP JOB:PW 07-12 PUBLIC WORKS DEPARTMENT, CITY HALL 350 MAIN ST EL SEGUNDO CA 80245 -3813 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. 'Z:/ THORIZED REPRESENTATI PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 07 -17 -2007 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER TONY PAINTING INC SP 4817 ELDER AVE SEAL BEACH CA 80740 [RDG,CNj PRINTED : 02 -11 -2008 (R E V.2-05)