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PROOF OF INSURANCE (2007) CLOSEDMar 22 2007 3:05PM ROWLEY INTERNRTIONRL INC 310 -377 -8890 P.2 ACORD„ CERTIFICATE OF LIABILITY INSURANCE CSR ,TL DATS4NINUDDMYVY) ROWLE -1 1 03/14/07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION InsPro- Jim Lohmann 7005- (ACE) ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Insurance Services HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 4010 Moorpark Avenue, #112 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. San Jose CA 95117 Phone:408 -241 -0014 Fax:408- 241 -0037 INSURERS AFFORDING COVERAGE NAIC# INBURED INSURER A. Continental CanuaLty Co. INSURER 8: Rowleeyy International, Inc. INSURER C. los 2325 s Eas CA 90274 esttes2 INSURER D: Palos p Verde INSURER E: COVERAGES _ -_ THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITH51ANUINU ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRAC- OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SJ8JECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH LTR NSR TYPE Of INSURANCE GENERAL LIABLITV COMMERCIAL GENERAL LIABILITY CLAIMS MADE L OCCUR POLICY NUMBER POLICY DATE MM/OD/YY DATE M/DDlYY LIMIT'S EACH OCCURRENCE $ PREMISES (Es occursncel S _ M E D EXP (Ary one Person) S S PERSONAL 3 ADV INJURY GENERAL AGGREGATE _ E DATE THEREOF, THE ISSUING INSURER WILL' MAIL 30 DAYS WRITTEN City of E1 PRODUCTS • COMPIOP AGG S GEN1 AGGREGATE LIMIT APPLIES PER: PRO POLICY - LOC JECT Attn: Mona i j AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS REPRESENTATIVES, El Segundo CA 90245 COMBINED SINGLE LIMIT (E a ac0dont) S BODILY INJURY S (Perperson) James Lohmann BODILY INJURY (Per ecdHant) S T arnRn rnRPnRATION ISES PROPERTY DAMAGE (Per eccident) _ GARAGE LIABILITY ANY AIfTD AUTO ONLY - EA ACCIDENT S _ OTHER THAN EA ACC AUTO ONLY: AGG S S EXCESMMBRELLA LLABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION S EACH OCCURRENCE - b AGGREGATE ~ 5 S ' - -_ WC STATU- s WORKERSCOMPEN5ATIONAND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER /MENBER EXCLUDED? tiyee,de&cn6eunder SPECIAL PROVISIONS below I , 70RV LIMITS I I ER EL EACH ACCIDENT S El DISEASE - EAEMPLOYEE b - - -- E.L, DISEASE - POLICY LIMIT S A 1 OTHER PROFESSIONAL LIABILITY AEA 11- 377 -67 -79 11/30/06 11/30/07 PER CLAIM $1,000,000 AGGREGATE $2,000,000 DESCRIPTION OP OPERATON9I LOCATIONS! VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROV1310N8 All professional services of the insured including but not limited to the following project: El Segundo Indoor Swim Center pool Equipment Rehabilitation CERTIFICATE HOLDER - SHOULD ANY OF THE ABOVE DESCRIBED 1POLJClE3 BE CANCELLED BEFORE THE EXPIRATION ELSEG -2 DATE THEREOF, THE ISSUING INSURER WILL' MAIL 30 DAYS WRITTEN City of E1 Segundo NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Attn: Mona Tobiason IMPOSE NO OBLIOATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 350 Main street REPRESENTATIVES, El Segundo CA 90245 AUTHORIZEDREPRESENTATVE James Lohmann T arnRn rnRPnRATION ISES ACORD 25 (2001106) Mar 22 2007 3:05PM ROWLEY INTERNRTIONRL INC 310 - 377 -8890 Rowley International Inc Aquatic Consulting Engineering TO FAX No 310. 322 -2756 NAME: RICHARD HOGATE FIRM: City of El Segundo P.1 2325 Palos Verdes Drive West, Suite 312 Palos Verdes Estates, California 90274 -2755 310 - 377 -6724 FAX: 310-377-9890 FAX TRANSMITTAL DATE: TIME: March 22, 2007 4:00 PM SUBJECT: PROFESSIONAL LIABILITY - El Segundo Indoor Swim Center Pool Equipment REMARKS: Attached is copy of our Professional Liability — note that the original was sent to the attention of Mona Tobiason. I hope this helps. TOTAL PAGES SUBMITTED INCLUDING COVER SHEET: Two (2) PLEASE CALL IF YOU DO NOT RECEIVE ALL PAGES INDICATED (310- 377 -6724) TRANSMITTED BY: Ruth Ann Rowley for William N. Rowley ROWLEY INTERNATIONAL INC CERTIFICATE OF INSURANCE ,..,,,... This certifies that ❑ STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois ® STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois IMl Y,.M,L ❑ STATE FARM FIRE AND CASUALTY COMPANY, Scarborough, Ontario ❑ STATE FARM FLORIDA INSURANCE COMPANY, Winter Haven, Florida ❑ STATE FARM LLOYDS, Dallas, Texas insures the following policyholder for the coverages indicated below: Policyholder Address of policyholder Location of operations Description of operations ROWLEY INTERNATIONAL, INC. 2325 PALOS VERDES DRIVE WEST, SUITE 312, PALOS VERDES ESTATES, CA 90274 2325 PALOS VERDES DRIVE WEST, SUITE 312, PALOS VERDES ESTATES, CA 90274 POOL DESIGN, RENOVATION AND IMPROVEMENTS The policies listed below have been issued to the policyholder for the policy periods shown. The insurance described in these policies is — -,* +n nil +ha 4armc aYCli minnc nnri conditions of those policies. The limits of liability shown may have been reduced by any paid claims. AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN. Name and Address of Certificate Holder CITY OF EL SEGUNDO DEPARTMENT OF PUBLIC WORKS 350 MAIN STREET EL SEGUNDO, CA 90245 556 -994 a.5 Rev. 11 -08 -2004 Printed in U.S.A. If any of the described policies are canceled before their expiration date, State Farm will try to mail a written notice to the certificate holder 3o days before cancellation. If however, we fail to mail such notice, no obligation or liability will be imposed on State Fq/r or its ag is or representatives. Signature of Authorized Representative AGENT 03/14/07 Title Date ELENA MEROTH Agent Name Telephone Number (310) 541 -4893 Agent's Code Stamp Agent Code E, Merot 75 -3231 AFO Code RRE 71 Southem California AFO F788 0 b� �l POLICY PERIOD LIMITS OF LIABILITY POLICY NUMBER TYPE OF INSURANCE Effective Date Expiration Date (at beginning of policy period) 92 -BS- 0020 -8 G Comprehensive 08 -01 -06 08 -01 -07 Busi-ness Liability ----------------------------- BODILY INJURY AND PROPERTY DAMAGE ----------------------- - - - - -- This insurance includes: - ® Products - Completed Operations ® Contractual Liability Each Occurrence $ 1, 000, o00 ® Personal Injury ® Advertising Injury General Aggregate $ 2,000,000 ❑ Explosion Hazard Coverage [:]Collapse Hazard Coverage Products - Completed $ 2,000,000 ❑ Operations Aggregate POLICY PERIOD BODILY INJURY AND PROPERTY DAMAGE EXCESS LIABILITY Effective Date Expiration Date (Combined Single Limit) ❑Umbrella ❑ Other Each Occurrence $ Aggregate $ POLICY PERIOD Part I - Workers Compensation - Statutory Effective Date Expiration Date 92- D3- 8099 -6 F Workers' Compensation and Employers Liability 11 -01 -06 11 -01 -07 Part II - Employers Liability Each Accident $ 1,000,000 Disease - Each Employee $ Disease - Policy Limit $ POLICY PERIOD LIMITS OF LIABILITY POLICY NUMBER TYPE OF INSURANCE Effective Date ; Expiration Date (at beginning of policy period) THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN. Name and Address of Certificate Holder CITY OF EL SEGUNDO DEPARTMENT OF PUBLIC WORKS 350 MAIN STREET EL SEGUNDO, CA 90245 556 -994 a.5 Rev. 11 -08 -2004 Printed in U.S.A. If any of the described policies are canceled before their expiration date, State Farm will try to mail a written notice to the certificate holder 3o days before cancellation. If however, we fail to mail such notice, no obligation or liability will be imposed on State Fq/r or its ag is or representatives. Signature of Authorized Representative AGENT 03/14/07 Title Date ELENA MEROTH Agent Name Telephone Number (310) 541 -4893 Agent's Code Stamp Agent Code E, Merot 75 -3231 AFO Code RRE 71 Southem California AFO F788 0 b� �l 04/18/07 WED 18:28 FAX 805 883 2089 N.COAST UW 002 FE AM LW Policy No. 92 -BS -002 -6 SECTION II ADDITIONAL INSURED ENDORSEMENT , Policy No.: 92 -BS -002 -8 Named Insured: ROWLEY INTERNATIONAL INC Additional insured (include address): THE CITY OF EL SEGUNDO DEPT OF PUBLIC WORKS, ITS OFFICERS, OFFICIALS, M4pLOYSES & AGit11TS 350 NAIN ST STE S EL SECiUNDO CA 90245 -3513 WHO IS AN INSURED, under SECTION 11 DESIGNATION OF INSURED, is amended to include as an insured the Additional Insured shown above, but only to the extent that liability is imposed on that Additional Insured solely because of your work performed for that Additional Insured shown above. Any insurance provided to the Additional Insured shall only apply with respect to a claim made or a suit brought for damages for which you are provided coverage. The Primary Insurance coverage below applies only when there is an "X" in the box. ❑ Primary Insurance. The insurance provided to the Additional Insured shown above shall be primary t ll insurance. Any Insurance carried by the Additional Insured shall be noncontributory Pe coverage provided to you, All other policy provisions apply- 0 K-Zo;zj�- Minted In U -SA FE-WQ9 .3 Z, q—/ Elena Meroth, Agent Lic. # 0D6W 2325 Palos Verdes Drive W, Suite 218 Palos Verdes Estates, CA 90274 -2782 Bus 310 5414893 fax 310 5419436 elena.meroth.pkjwGstatefarm.com April 04, 2007 Mr. Richard Hogate & Or Ms. Mona Tobiason City of El Segundo Department of Public Works West Garden Area 350 Main Stmt El Segundo, CA 90245 -3813 Dear Richard: As you requested attached please find a certificate of insurance evidencing the Certificate of Insurance. The carrier is unwilling to allow any modification to the standard certificate of insurance, to amend their standard cancellation clause. However, we as the agent are willing to accept the change of 30 days written notification, via US certified mail of the carrier's intent to non -renew and or any other policy modifications. Cancellation notice is 10 days in the event of non - payment of premium. Sincerely, Elena F. Meroth �&'e � vw—� Signature Elena F. Meroth, Agent Printed name and title Rowley - 30 Day Noft for city of El Segundo 044)407 ADDL INFO ON NEXT PAGE PAGE 11 + UNITED SERVICES AUTOMOBILE ASSOCIATION (A RECIPROCAL INTERINSURANCE EXCHANGE) State 14 15 USAA® 9800 Fredericksburg Road - San Antonio, Texas 78288 POLICY PERIO CALIFORNIA AUTO POLICY EFFECTIVE RENEWAL DECLARATIONS_ - I Insured and Address WILLIAM N ROWLEY MAJ GEN USAFR RET 225 ROCKY POINT RD PALOS VERDES ESTATES CA 90274 -2621 VEH YEAR TRADE NAME 14 VO 31 L E X U S 151031 COOPER Veh rULIU T I1UMUL ;' i LA, 00041 59 51 U 7102 12:01 A.M. standard time) VEH USE* WORK /SCHL BODY TYPE ANN L IDENTIFICATION NUMBER srM Wiles Da MODEL MILER E — — — — — n I.r n .1 30001 WMWRE33433TD66434 17 1W 1 01 � ? The Vehicle(s) described herein is rincipall ara ed at the above address unless otherwise statedl■W /C= Work /School• B= Business; r= rarm;r= rieasure VEH 14 PALOS VERDES MAT C-A VEH 15 PALOS VERDES ESTATES CA This ppolicy provides policy tprosvisionsraand may not pbemcombinedhregardless . ofhthei numbero of Mal be reduced by p y p. vehicles for which a remium is listed rD=�DED ificall authorized elsewhere in this Policy. COVERAGES LIMITS OF LIABILITY MONTH 15 6 -MONTH ( "'ACV" MEANS ACTUAL CASH VALUE) REMIUM D =DED PREMIUM D=DED PREMIUM D =DED PREMIUM S MOUN $ AMOUNT $ AMOUNT S BODILY INJURY EA PER $ 300900 EA ACC $ 500,00 90 80 7� PROPERTY DAMAGE EA ACC $ 100,00 PART B - MEDICAL PAYMENTS $ 5,00 PART C - UNINSURED MOTORISTS BODILY INJURY EA PER CC $ 60,00 WAIVER OF COLL DEDUCTIBLE PART D - PHYSICAL DAMAGE COVERAGE COMPREHENSIVE LOSS ACV LESS COLLISION LOSS ACV LESS VEHICLE TOTAL PREM 6 MONTH PREMIUM $ 2041.01 138. 84.18 50.1 12.821 1 7.5 24.921 1 12.4 6.38 3.1 500 65.51p 5001 29.1 50 241.11 500 113.1 573.8 .3 ADDITIONAL MESSAGE(S) - SEE FOLLOWING PAGE(S) LOSS PAYEE VEH 14 USAA FEDERAL SAVINGS BANK, SAN ANTONIO TX vGU I� Ikon FFDERAL SAVINGS BANK, SAN ANTONIO TX In WITNESS WHEREOF, the Subscribers at UN11tu a[nviur-o mu their Attorney -in -Fact on this date JANUARY 13, 2007 5000 U Y" Ise, presents .�to� be signed 01 Robert G. / Davis ��1 Attorney —in —Fact 0 � l