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PROOF OF INSURANCE (2005) CLOSED
ACORA, CERTIFICATE OF LIABILITY INSURANCE -1 DATE 02/04/2 04) PRODUCER (310)328 -3622 FAX (310)328 -6054 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Post Insurance Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE License #0551220 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 2356 Torrance Blvd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Torrance, CA 90501 INSURERS AFFORDING COVERAGE NAIC # INSURED Xcel Mechanical Systems, Inc. INSURER A: Westport Insurance Company. 1614 139th Street INSURER B: Unitrin Specialty Lines Ins Gardena, CA 90249 INSURER a The St Paul Fire & Marine INSURER D: Arrowhead General Insurance INSURER E: fi�PI9 GIS1�73�� THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN 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 DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS 350 Main Street KKW4 (d0O(*lfi(xmxlxxKAl�lfXDt*kx)SKxwxm WfX�6��EXXXXXXXXX GENERAL LIABILITY RP1005673 02/04/2004 02/04/2005 EACH OCCURRENCE $ 1000000 1 X71 COMMERCIAL GENERAL LIABILITY CLAIMS MADE i A I OCCUR DAMAGE TO RENTED $ 5000 MED EXP (.Ary one person) 1000 A PERSONAL & ADV INJURY $ 100000 GENERAL AGGREGATE $ 200000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC JECT PRODUCTS - COMP /OP AGG $ 200000 AUTOMOBILE LIABILITY ANY AUTO C7674234 11/09/2003 11/09/2004 COMBINED SINGLE LIMIT (Ea accident) $ 100000 B ALL OWNED AUTOS X SCHEDULED AUTOS BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ _ AUTO ONLY: AGG $ EXCESS /UMBRELLA LIABILITY X OCCUR F] CLAIMS MADE QK06100034 02/04/2004 02/04/2005 EACH OCCURRENCE $ 3,000,000 AGGREGATE $ 3,000,000 C $ X DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND AHWC0014900 09/04/2003 09/04/2004 X I WC STATU- I OTH- 0 EMPLOYERS' LIABILITY E.L EACH .ACCIDENT $ 1,000,000 IAN'YrROPRIErorqF,AR-liJEP/EXECUliVE OFFICER/MEMBER EXCLUDED? If yes, describe under E.L. DISEASE - EA EMPLOYd Y $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1 $ 1,000,000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS s respects all California operations performed by named insured. ert holder is addl insured per attached CG2009 0 day cancellation notice except nonpay/non report i ng which is 10 days r P92TIFIf`ATF UnI IIFD f•A\If%M 1 ATIAAI AGURD 25 (2001/08) U ©ACORD CORPORATION 1988 '317,-7- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL NAMOOM MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, City of El Segundo KJ6K1( �X�G) fKl 6d( iKdJ( DQXd (€�4D(�61i�(i�fi6XXn1�)LiQrXXX 350 Main Street KKW4 (d0O(*lfi(xmxlxxKAl�lfXDt*kx)SKxwxm WfX�6��EXXXXXXXXX El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE W IV /P _ AGURD 25 (2001/08) U ©ACORD CORPORATION 1988 '317,-7- Policy Number: RP 10 0 5 6 7 — 3 CONtVIERCIAL GENERAL LIABILITY Named Insured: XCEL Mechanical Systems, Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 20 0910 93 ADDITIONAL INSURED - OWNERS, LESSEES or CONTRACTORS (Form A) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. Name of Person or Organization (Additional Insured): City of El Segundo 350 Main Street El Segundo, CA 90245 Bodily Injury and Property Damage Liability (If no entry avvears endorsement.) Premium Basis Cost 4it all 1i Location of Covered Operations All California operations Rates (Per $1000 of Cost) Total Advance Premium required to complete this endorsement 1. WHO IS AN INSURED (Section In is amended to include as an insured the person or organization (called "additional insured ") shown in the Schedule but only with respect to liability arising out of A. Your ongoing operations performed for the additional insured(s) at the location designated above, or B. Acts or omissions of the additional insured(s) in connection with their general supervision of such operations. 2. With respect to the insurance afforded these additional insureds, the following additional provisions apply. A. Exclusions b., c., g., b.(1), j., L, L and n. under COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE LIABILITY (Section I - Coverages) do not apply. B. Additional Exclusions. This insurance does not apply to: (1) "Bodily injury" or "property damage" for which the additional insured(s) are obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the additional insured(s) would have in the absence of the contract or agreement. (2) "Bodily injury" or "property damage" occurring after: (a) All work, including materials, parts or equipment famished in connection with such in Advance Premium $ INCLUDED $ INCLUDED as applicable to this work, on the project (other than service, maintenance, or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed; or (b) 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. (3) "Bodily injur -y' or "property damage" arising out of any act or omission of the additional insured(s) or any of their employees, other than the general supervision by the additional insured(s) of your ongoing operations performed for the additional insured(s). (4) "Property damage" to: (a) Property owned, used or occupied by or rented to the additional insured(s); (b) Property in the care, custody, or control of the additional insured(s) or over which the additional insured(s) are for any purpose exercising physical control; or (c) Any work, including materials, parts or equipment furnished in connection with such work, which is performed for the additional insured(s) by you. CG 20 09 10 93 Copyright, Insurance Services Office, Inc., 1992 Page I of 1