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PROOF OF INSURANCE (2012) CLOSEDDATE (MM /DD/YYYY) C, "! CERTIFICATE OF LIABILITY INSURANCE 7/7/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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(s). PRODUCER CONTACT Jennifer Hoffa Rye PHONE � (FAAIX Tar et Financial & Insurance Services ��Ett)� ( ) (100)434-8053 6630 Flanders Drive ADMDRES&: License #0743582 PRODUCER 00000437 Tarr 1., . San Diego CA 92121 INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSU��gA:Interstate Fire & Casual CO y INSURER B :Everest National Ins Co Taylor Tennis Courts, Inc. INSURER C: 31441 Santa Margarita Pkwy INSURER D : Rcho Snta Margarita CA 92688 1 INSURER F; COVERAGES CERTIFICATE NUMBER GL, WC 2011 -2012 REVISION NUMBER: " THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ��, INS R ;,4t)t L' I�('i' POLICY EFF POLICY EXP ......... ......... L7F). INSURANCE ...�.� ...". ..—.�.. TYPE OF INSU � ..... � .�.......��...�.....�........._ ... POLICY NUMBER ...... (MMID,DIYVYY) . (M,)IA /DDIYYYYJ, LIMITS .. . ..............ew,,,�,- ...6..... GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY P AEIu �NL EMI��S (Ea occrcrroncm) $ 100,000 A CLAIMS -MADE X I OCCUR X 1000009 6/15/2011 6/15 201 2 000 MED EX (Any one person) $ 5,000 ®. ®,.... ® , �. . ° °, . ° °, . ° °, PERSONAL &ADV INJURY $ 1 , 000 , 000 .......... .... ..........,.,,. ,°... _ m.... , GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 --- PRC7• $ X..� POLICY J4"T`-------� LOG AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO ,,,......... BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE I HIRED AUTOS $ (Per accident) NON -OWNED AUTOS $ ----------- ---- _ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ .. $ B WORKERS COMPENSATION OETRH- WOC�Y d AND EMPLOYERS' LIABILITY Y / N IMTIITS ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $ 000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) ❑ NIA 7600004896111 2/12/2011 /12/2012 - ,1, E.L. DISEASE - EA EMPLOYE $ 1� 000, 000 ... If es, describe under ERATIONS below DESCRIPTION OP OP..�.._ .. ] .... —._.. ...... ........ _ ______ w E.L, DISEASE - POLICY LIMIT $ 1 000 000 c_ —, _90 DESCRIPTION ............ —.11111-111111 .... . ....... ­­­ . . . . .. ... ... ........ OF OPERATIONS / LOCATIONS /VEHICLES ... . . ............ (A ttach ACORD 101, Additional Remarks Schedule, ........... If more space is required) City of E1 Segundo, its officers, officials, employees, agents, and volunteers are Named as Additional Insured per the Attached Endorsement. *10 Days Notice of Cancellation for Non - Payment of Premium /30 Days All Others. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of E1 Segundo ACCORDANCE WITH THE POLICY PROVISIONS. Attn: City Clerk _.........n.. ..,......_.. °.....,..,. ry ............... rv............................................................................................................................................................................... ............................... y 350 Main Street AUTHORIZED REPRESENTATIVE E1 Segundo, CA 90245 Carl Savoia /JH�ea� -- ACORD 25 (2009/09) ©1988 -2009 ACORD CORPORATION. All rights reserved, INS025 (200909) The ACORD name and logo are registered marks of ACORD Fireman's Fund THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CHANGE ENDORSEMENT In consideration of no change in premium, it is hereby agreed and understood that the following is named as additional insured per the attached CG 2010 11/85, City of El Segundo, It's officers, Officials, Employees, Agents and volunteers Attn: City Clerk 350 Main Street El Segundo, CA 90245 RE: Commercial Project located @ 401 Sheldon, El Segundo, CA ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. The premium for this endorsement is included in the premium shown on the declarations unless a specific amount is shown here: Premium: $ NIL ENDORSEMENT NO: 02 Effective: 07/07/2011 is attached to and forms part of your policy number., AMW 1000004 Issued by: Interstate Fire & Casualty Company Executive Offices: 33 W. Monroe Street Chicago, Illinois 60603 Insured Taylor Tennis Courts, Inc. Date 6/21/11 Authorized Representative: Issued MSE -8001 (11/91) (Ed. 08/05) POLICY NUMBER: AMW 1000004 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - (FORM B) This endorsement modifies insurance provided under the following:. COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization: RE Co M6 "al Project located @ 401 Sheldon, El City of El Segundo, It's officers, Officials, Employees,Seg o, C Agents and volunteers Attn: City Clerk 350 Main Street El Segundo, CA 90245 "Any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement (signed prior to a commencing work for such person or organi- zation) that such person or organization be added as an additional insured on your policy." (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) 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. ** *THIS ENDORSEMENT IS APPLICABLE TO COMMERCIAL AND /OR INDUSTRIAL OPERATIONS ONLY * ** CG 20 10 11 85 Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1 ❑ ACORD CERTIFICATE OF LIABILITY INSURANCE oiii3 /2011 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 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, 2356 Torrance Blvd. Torrance, CA 90501 INSURERS AFFORDING COVERAGE NAIC # INSURED _ INSURER A: Mercury Casualty Company 11 908 INSURER B: Taylor Tennis Courts Inc INSURER C: 1250 N. Lal oma Circle INSURER D; Anaheim, CA 92806 INSURER e r vFRAr c 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 DD.L �- POLICY EFFECTL.... ................ ..... .......................... PIRATTIION TYPE OF INSURANCE POLICY NUMBER EFFECTIVE POLICY EXPIRATION LIMITS m mmm GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ - PBEd�AISES, CLAIMS MADE OCCUR M E D EXP (Any one person) $ PERSONAL & ADV INJURY $ m,,,,,, ��..... ......_ ............._---- - - - - - . ... ............. GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: ... . ........ .. ...... ...........-- ..---- PRODUCTS - COMP /OP AGG $ . PRO POLICY JECT LOC AUTOMOBILE LIABILITY CCA0007728 02/21/2011 021211201 COMBINED SINGLE LIMIT $ X ANY AUTO (Ea accident) 1,000,000 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) A -. ... ............................... X HIRED AUTOS BODILY INJURY X NON -OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE $ . I OCCUR CLAIMS MADE AGGREGATE $ .. W WWWW DEDUCTIBLE $ �.. RETENTION $ $ WORKERS COMPENSATION AND WC STATU- OTH- EM P LOYERS' LIABILITY "' "'" 'TO'Y.L1 ANY PROPRIETOR /PARTNER/EXECUTIVE EACH ACCIDENT El, .w.. $ OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYE $ If yes, describe under - ° ° ° ° °— ° ° ° ° ° ° ° ° °° SPECIAL PROVISIONS below EL. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIQNS / VEHICLES / EXCLUSIONS ADDED BY ENDOR s EMENT / SPECIAL PROVISIONS s respects to all California operations performed by the Named Insured. 0 day cancellation notice except nonpay /nonreporting which is 10 days. "Revised 7/13/2011 CD ** SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL &Mdf%IaJ M MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, City of El Segundo XIXIr�4XiIXx�E�IX� (Y11b)(X�II�Xrl614XXil(X�IXJ(XX: 350 Main Street dfX*X)10i YJX*XANUNNAWAdD X)OOM) MXWMVMXXXXXXXX,. El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE — Dan Post, CIC /CASSIE ACORD 25 (2001/08) © ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) 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(s). 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 (2001/08)