PROOF OF INSURANCE (2007) CLOSED'ACOLAD CERTIFICATE OF
PRODUCER
Alliant Insurance Services Inc
Gaddy -Ward & Co. Lic. #OC36861
66 West Walnut Street
Lodi CA 95240 -3537
LIABILITY INSURANCE OP ID T DATE (MM /DD/YYYY)
TRONI 12 21 06
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
Phone: 209 - 333 -1136 Fax:209- 333 -1584
INSURERS AFFORDING COVERAGE NAIC #
INSURED
DATE MMIDD /YY
DATE ( EC Y)
INSURER A: Landmark American Insurance Cc
LIMITS
A
X
INSURER B:
LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE a OCCUR
Tron Construction Inc
P.O. Box 8 419
Fresno CA 93747
03/01/06
INSURERC:
EACH OCCURRENCE
INSURER D:
X
C(�VFRA�Fc
$ 50000
INSURER E:
MED EXP (Any one person)
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.
LTR
NSR
TYPE OF INSURANCE
POLICY NUMBER
DATE MMIDD /YY
DATE ( EC Y)
POLICY XPI A 10
DATE (MM1DDfYYJ
LIMITS
A
X
GENERAL
LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE a OCCUR
LHA129415
03/01/06
03/01/07
EACH OCCURRENCE
$ 1000000
X
PREMISES (Ea occuEence)
$ 50000
MED EXP (Any one person)
$ Excluded
PERSONAL BADVINJURY
$ 1000000
GENERAL AGGREGATE
$ 2000000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO-
JECT LOC
PRODUCTS - COMP /OPAGG
$ 2000000
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY (Per (Per person)
BODILY INJURY (Per (Per accident)
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
ANY AUTO
1.
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
AUTO ONLY: AGG
$
$
EXCESS /UMBRELLA LIABILITY
OCCUR ❑CLAIMS MADE
DEDUCTIBLE
RETENTION $
EACH OCCURRENCE
$
AGGREGATE
$
$
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER /EXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
OTHER
TORY LIMITS ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYE
$
E.L. DISEASE -POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
RE: Project #RS 106 -15- Residential Sound Insulation Program -Group 15. City
of E1 Segundo, its officers, agents, employees, boards & commissions are
named additional insured per the attached endorsement. Primary Wording
applies. *Subject to 10 days notice of cancellation for non - payment of
premium.
rI=PTICIf1ATC Unl nmo
CI TYELS
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL WX%) (jRXX MAIL *30 DAYS WRITTEN
City of E1 Segundo
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, XCfOGiQK XX)CNXKKX
350 Main Street
iGXi�X
El Segundo CA 90245
XP=XXUwMXXX
AUTHORIZED REPRESENTATIVE
P,y/I I
David Schna
Arnpn 25 t9nnimm
(0 ACORD CORPORATION 1
LANDMARK AMERICAN INSURANCE COMPANY
This Endorsement Changes The Policy. Please Read It Carefully.
ADDITIONAL INSURED
BLANKET - PRIMARY
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
SCHEDULE
Name of Person or Organization:
Any person or organization to whom or to which you are obligated by virtue of a written contract or by the
issuance or existence of a written permit, to provide insurance such as is afforded by this policy.
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement.)
SECTION= II - WHO IS AN INSURED 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.
If you are required by a written contract to provide primary insurance, this policy shall be primary as respects your
negligence and SECTION 1V — COMMERCIAL GENERAL LIABILITY CONDITIONS, 4. Other Insurance does
not apply, but only with respect to coverage provided by this policy.
This endorsement effective 03/01/2006
forms part of Policy Number LHA129415
Issued to TRON CONSTRUCTION INC.
by Landmark American Insurance Company
Endorsement No.: 01
RSG 15001 1005 Includes copyrighted material of Insurance Services Office, Inc. 1984
(CG 2010 1185) with its permission tC
k%
■ =■
Gaddy• Ward & Company
I N S U R A N C E B R O K E R S
December 22, 2006
To Whom It May Concern:
RE: Tron Construction, Inc.
As respects 30 days Notice of Cancellation except for 10 days notice of
cancellation for non - payment of premium, Gaddy Ward & Company takes
responsibility for notification to the certificate holder.
If you have any questions, please do not hesitate to give me a call.
Best regards
David Sc2app
Executive Vice - President
DS /rle
Post Office Box 1088 . Lodi, California 95241
66 West Walnut Street . Lodi, California 95240 -3537
209 -333 -1136 ♦ 800 - 416 -5626 . Fax 209 -333 -1584
Lic. No. OB84509
POLICYHOLDER COPY
STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142 -0807
COMPENSATION
INSURANCE
FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 01 -01 -2007 GROUP: 000046
POLICY NUMBER: 0010278 -2007
CERTIFICATE ID: 1
CERTIFICATE EXPIRES: 01 -01 -2008
01 -01- 2007/01 -01 -2008
CONTRACTORS STATE LICENSE BOARD NE LICENSE NUMBER: #433107
WORKERS COMPENSATION UNIT INCEPTION DATE:01 -01 -2007
PO BOX 26000 DONE
SACRAMENTO CA 95826 -0026
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.
tTHORI�ZED REPRESENTATI PRESIDENT
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE.
ENDORSEMENT #1600 - RON DONALDSON, PRESIDENT - EXCLUDED.
ENDORSEMENT #1600 - SHARYN DONALDSON, SECRETARY TREASURER - EXCLUDED.
ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 01 -01 -2001 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY.
EMPLOYER
TRON CONSTRUCTION INC
PO BOX 8419
FRESNO CA 93747
M0409
(REV. 2-0W PRINTED : 12 -15 -2006
NE