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PROOF OF INSURANCE (2009) CLOSEDACORD. CERTIFICATE OF LIABILITY INSURANCE 9/1/2009 DATE (MM /DD/YYYY) 1 8/28/2008 PRODUCER LOCKTON COMPANIES, LLC THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 5847 SAN FELIPE, SUITE 320 HOUSTON TX 77057 866 - 260 -3538 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 350 Main Street, Room 5 vs� POLICY EFFECTIVE INSURERS AFFORDING COVERAGE NAIC # INSURED 1309407 , SUITE 200 VALENCIA CA 91355 INSURER A: Liberty Mutual Fire Insurance Company 23035 INSURER B Hartford Casualty Insurance Company 29424 INSURER C: St Paul Fire and Marine Insurance Co 24767 INSURER D: GENERAL LIABILITY INSURER E: EACH OCCURRENCE COVERAGES NIL THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INCII0012M AIITM11Q17Fn 0 .009COUTAT IP r1Q 00nnl 11`90 AIJn TN9 1`90TI91r`ATF Yt11 nFQ 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 ADD'L 350 Main Street, Room 5 vs� POLICY EFFECTIVE POLICY EXPIRATION El Segundo CA 90245-3813 LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MWDD/YY ) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1.000.000 B X COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR 61 UENI-IY9296 9/1/2008 9/1/2009 DAMAGE TO RENTED S 300,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE S 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG S 3,000,000 PRO- r-1 POLICY I I JECT X L 0 C A AUTOMOBILE LIABILITY ANY AUTO AS2- 691450294 -028 9/1/2008 9/1/2009 COMBINED SINGLE LIMIT (Ea accident) $ 1000,000 X BODILY INJURY (Per person) $ XXXXXXX ALL OWNED AUTOS SCHEDULED AUTOS X BODILY INJURY (Per accident) $ XXXXXXX HIRED AUTOS NON -OWNED AUTOS X PROPERTY DAMAGE (Per accident) S XXXXXXX GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ XXXXXXX ANY AUTO NOT APPLICABLE OTHER THAN EA ACC $ XXXXXXX $ XXXXXXX AUTO ONLY: AGG C EXCESS/UMBRELLA LIABILITY X OCCUR D CLAIMS MADE QK09101382 9/1/2008 9/1/2009 EACH OCCURRENCE $ 15,000,000 AGGREGATE S 15,000,000 $ XXXXXXX UMBRELLA $ XXXXXXX DEDUCTIBLE FORM $ XXXXXXX X RETENTION $ 10,000 A WORKERS COMPENSATION AND WA2-69D-450294 -018 9/1/2008 9/1/2009 X WC LIMIT ER EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERMEMBER EXCLUDED' E.L. EACH ACCIDENT $ 1 ,000,000 E.L. IiISEASE - EA EMPLOYEE $ 1,000,000 If yes. descnbe under * 10 SPECIAL PROVISIONS below I`I E.L. DISEASE - POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSfVEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECUIL PROVISIONS Re: Occupational Medicine Services for the City of El Segundo Additional Insured in favor of City of El Se do, its officers, officials, employees agents & certificated volunteers (on all policies except Workers' Compensation/EL) where and to the extent required by written r.iar e Insurance afforded to the Additional Insured as described in this certificate of insurance for work performed by the named insured is primary and non contributory to y sverage maintained by the additional insured where and to the extent required by contract. (iw CERTIFICATE HOLDER 1A' A/ dANCPLLAT)ON fD4497391 3733897 1 1� City of El Segundo ( v SHO D 1N�iOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION E T�t1EOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN City of El Segundo, City Clerk Ann: Administrative Services Director t TIC TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IM NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 350 Main Street, Room 5 vs� l/ El Segundo CA 90245-3813 R ESENTATNES. HORIZED REPRESENTAT—� )' ACORD 25 (2001/08) For questions regarding this certificate, contact the number listed in tM 7rcducsr' section strove. 0 ACORD CORPORATION 1988 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY 61 UENHY9296 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 Person(s) Or Or anization s : Locations Of Covered Operations Blanket where required in a written contract. 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) designated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment 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 intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 © ISO Properties, Inc., 2004 Attachment Code: D449739 Master ID: 1309407