PROOF OF INSURANCE (2009) CLOSED (2)04/09/2008 15:01 4158747199 EQUITY RISK PARTNERS PAGE 02/04
ACCORD,- CERTIFICATE OF LIABILITY INSURANCE
4 T9` zo""' oe
PRODUCER (41S) 874 -7100 FAX: (415) 874 -7199
Squat Risk Partners, Inc.
y
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
License No. OD21146
ALTER THE COVERAGE AFF RDEO BY THE POLICIES BELOW.
101 Montgomery Street, 14th Fl
San Francisco CA 94104
INSURERS AFFORDING COVERAGE
NAIC LR
INSURED
INSURE A:Americ,an Home Assurance
19380
IN ERB:Hartford Fire Ins. Co.
19682
LTS Holdings DBAe Wyle Laboratories, Inc.
INSURER c: National Union Fire Ins.
19445
1960 8. grand Avenue, Ste. 900
INSRE •ins. Co. of the State of
19429
INSURER E: Illinois National Las.
81 Segundo CA 90245
GES
THE POLICIES F INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY
REOUIREMENT, 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.
E 4 REDUrra BY PAID
spy
INSR L TYPE OF INSURANCE POLICY NUMBER D IEYNIM OD/Y+(E pATTfE �N LIMITS
GENERAL LIABILITY
3 1,000,000
A TO REN D u
MW FAI; OA6 Per6cn,
$ 1,000,000
A
X COMMERCIAL GENERAL LIABILITY
CLANSMADE FX OC,CUR
GL4572600
1/1/2008
1/1/2009
f 10,000
PFR$QML&ADVINLIURY
$ l . 000, 000
AENFRAL AGGREGAM
5 2,000 000
_
GEML AGGREGATE LIMIT APPLIES PER:
2,000,000
POLICY X LOC
AUTOMOBILE LIABILITY
X ANY AUTO
COMBINED SINGLE LIMIT
(EaaeddW0
5 11000,000
BODILY INJURY
(Pal Pam")
>
H
ALL OWNED AUTOS
SCHEDULED AUTOS
57yENTL1134
1/1/2008
1/1/2009
BODILY INJURY
(Peraceldenq
5
R HIRED AUTOS
K NON -OWNED AUTOS
PROPERTYDAMAGF.
(Per Mideno
X CWT. Ded• $1,000
X
coil. pod. $1.000
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
S
OTHER THAN
ANYAUTO
$
AUTO ONLY;
EXCESSIUMBRELLA LIAa1LRY
x OCCUR ❑ CI AIMS MPOE
EACH OCCUBBENCF
S 25,000,000
S 25,000,000
S
S
C
DEDUCTIBLE
nx
885685915
1/1/2008
1/1/7009
R E ON it 10,090
D
E PYEAND
LOYERS? COMPENSATION
ANY PROPMETORIPARTNERIEXECUTIVE
NC9909a41 (A08)
TATU-
F.L. &A-QH ACCIDENT
1,000,000
.L. DISEASE - EAEMPL YE
S Ir00a,000
A
OFFICERIMEMBEREXCLUDED?
If yes, dese ee under
-SPECIAL P
MC9909242 (CA)
1/113008
1/1/2009
P.L. OIS - POLICY
3 1,000,000
8
OTHER Workers Cmv- (FL)
WC9909243 (Fl)
1/1/2008
1/1/2009
Each accident 11000, 000
8
Workers Coup. (TX)
MCOOD9244 (TX)
1/1/2008
1/1/3009
Inch bioesse -SA Sep. 11000,000
Dioaana vollay LLx%tt 1,000,000
DESCRWRON OF OPERATION944CATWMSAMf4lCLfi MCLUMONB ADDED BY BNOORSEMENTMPECIAL PROVISIONS
Certificate bolder is included as additional insured as required by written contract per attached policy fora 61712,
subject to all policy terms and conditions.
640 -0489
City of 181 Segundo
Public Works Departmat
Attn: Jeff Stewart
350 main Street
31 Segundo, CA 90245 -3895
25120011981
IN8025 (0100)."a
SHOULD ANY OF THE ABOVE 093CRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL *)fiXtV4WM MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. ax
Kr X)�(7KI>K)fA6�LYdWiirdC
AUTHORIZED REPRESENTATIVE
font Marcon /PADILL
0
1988
Pape I of 2
04/09/2008 15:01 4158747199 EQUITY RISK PARTNERS PAGE 03/04
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(iss) 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($).
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 12001108)
INS025 toioapes Pae4 a d a
04/09/2008 15:01 4158747199 EQUITY RISK PARTNERS
~ ENDORSEMENT
This endorsement, dffscti: •7! 12:01 A.M. 01/01/2009 forms a part of
policyNo.GL g57z6*00 isauedto OBA: WYLZ LABORATOVESLT5NCO1.pINGS, 1NC.
by AMERI CAN HOME ASSLIRANCE COMPANY
THIS ENDORSEMENT CHANGES THE POLICY: PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - WHERE REWIRED UNDER CONTRACT OR. AGREEMENT
This endorsement modin"es insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
PAGE 04/04
section it - Who Is an Insured, I., is amended to add:
f) Any person or organizafion to whom you become obligated to include as an additional insured
under this policy, as a result of any contract or agreement You eneinto which
his policy, but
to furnish insurance to that person or organization of the type P r vi
only with respect to liabillty arising out of your operations or premises owned by or rented -to
you, However, the insurance provided will not exceed the lesser of:
1. The coverage and /or limits of this policy, or
2. The coverage and/or limits required by said contract or agreement.
M
Autho zed Reprebentatfve or
Counterslgnature (In States Where
Applicable)
61712 (9/01)