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PROOF OF INSURANCE (2013) CLOSEDACCOREP DATE (MM/ Y) CERTIFICATE OF LIABILITY INSURANCE os/2o/2012 2012 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 Richard Don Agent PHONE Chr . N A 9' 9 We �� Etta. .(949)855-1310 1A( , Not (949)855 0217 27772 Vista Del La o, Suite 20 EMAIL ......... 9 ADDRESs,� chnsta.m.smith.itbd stalefarm,com A Mission Viejo, CA 92692 - _ .. ..�...... 0.11 R( MARra ��rb�ew�� rrw R. COVERAGES CERTIFICATE NUMBER: 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. ILTR TYPE OF INSURANCE ADDL dVD POLLCY NUMBER 'M�VPOVRMkO MY Y I (MMtDDrrYYYJ LIMITS A GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X,,,, COMMERCIAL GENERAL (ABILITY 92- BQ- F064 -9 06/19/2012 06/19/2013 m mm $ 3D CLAIMS-MADE OCCUR MED EXP (Amy one person) 5000,m, DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER City Of El Segundo ,„.-°" SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXP RATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE 350 Main Street POLICY PROVISIONS. El Segundo, CA 90245 I AUTHORIZED REPRESENTATIVE Richard Dong ©1988- 2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD 1001486 132849.4 02 -11 -2010 PERSONAL & ADV INJURY $ 1,000,000 ''.. ............ . ............................... ..... ................... .................... ............................... GENERAL AGGREGATE g 2,000,000 GEN L AGGREGATE LIMIT APPLIES PER: - PRODUCTS COMP /OP AGG $ 2 000 000 �... PR POLICY $ mm- B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 - -- ANY AUTO 321 4094- F05 -75 06/05/2012 06/05/2013 a accident) ...... ....... BODILY INJURY (Per person) $ BODILY IN....... INJURY (Per accident) _...... _,� X SCHEDULED AUTOS PROPERTY DAMAGE ....................... H RED AUTOS er accident) Pt NON -OWNED AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS ® IAB .... S .... MAD .E .CLA IMS E AGGREGATE ... ..........._...... $ ..... ......... .......... , DEDUCT(... LE $ RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N - TQRYJ•JMtT.. - -- -�IOT ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? N /A �y ILJII E,L EACH ACCIDENT ................. ................. $ ........ ............ ....--- -' (Mandatory in NH) EL .,DISEASE EA EMPLOYEE $ f describe under' --' oon-ci — tie1— E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER City Of El Segundo ,„.-°" SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXP RATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE 350 Main Street POLICY PROVISIONS. El Segundo, CA 90245 I AUTHORIZED REPRESENTATIVE Richard Dong ©1988- 2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD 1001486 132849.4 02 -11 -2010 PONV Policy No.: 92- BQ- FO64 -9 SECTION II ADDITIONAL INSURED ENDORSEMENT Policy No.: 92- BQ- FO64 -9 Named Insured: APA ENGINEERING 9880 IRVINE CENTER DR IRVINE CA 92618 -4353 Additional Insured (include address): THE CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS, EMPLOYEES, AGENTS AND VOLUNTEERS 350 MAIN ST EL SEGUNDO CA 90245 -3895 FE -6609 WHO IS AN INSURED, under SECTION II 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 insurance. Any insurance carried by the Additional Insured shall be noncontributory with respect to coverage provided to you. All other policy provisions apply. FE -6609 Printed in U.S.A. CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) 312612012 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 PRODUCER INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS NAME: v ' RQWn H.ollo Wood Gutmann & Bogart INSR EFF „gray.. PHONE rn -83,27 License Number 0679263 GENERAL LIABILITY ,71482_4 — -I” 15901 Red Hill Ave., Suite 100 APPl 'rQb L W i lb.,. __ Tustin CA 92780 EACH OCCURRENCE INSURERS) AFFORDING COVERAGE NAIC # INSURER..A :LIQ_y.d.S_of Lud.on, ..... .. ... ........ ........ .... INSURED APAEN -1 INSURER B : --- - - - -- APA Engineering, Inc. COMMERCIAL GENERAL LIABILITY INSURERC 9880 Irvine Center Drive �_ �.... .......:. PREMISES ,Eamoccuarnata ,) Irvine CA 92618 INSURER D: INSURER E : - -- , INSURER F : CLAIMS -MADE OCCUR COVERAGES CERTIFICATE NUMBER: 9F,R1 nRA A 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. INSR EFF TYPE OF INSURANCE POLICY NUMBER MPOLDICDY LT MMIDD.IYMYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ bAMAG� "TO'9EN'T"Eb --- - - - -- COMMERCIAL GENERAL LIABILITY PREMISES ,Eamoccuarnata ,) $ - -- , CLAIMS -MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ POLICY PRCoi LOC AUTOMOBILE LIABILITYCOMBINED-SFUGLE-MI ........................ ............................... ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJ...........`.....�.acci ) INJURY Per accident): $ .... ........................ ............................... AUTOS _- - - - - -. AUTOS -PROPERTY m NON -OWNED m ................ PROPERTY DAMAGE ........ $ HIRED AUTOS AUTOS „.{,PPraccdnt .. .....,.,,, ..'.. UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ RED RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH° AND EMPLOYERS' LIABILITY YIN I ...TOR�G.�11W ... FRr. .... . ....................... ............................... ANY /EXCLUDED? ECUTIVE OFFICER/MEMBER N / A .. CIEA (Mandatory n NH) E,L,. DISEASE EMPLOYEE $ If yes, describe under - -"- " DESCRIPTION OF OPERATIONS below E .. DISEASE - POLICY LIMIT $ A Professional Liability NE1141557.12 /19/2012 /19/2013 Per Claim $2,000,000 Errors & Omissions / Aggregate $2,000,000 Claims Made Form Deductible $50,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo ACCORDANCE WITH THE POLICY PROVISIONS. Dlr of Pub Wrksa StePh Kats Ceas, P „E, 350 Main Street El Segundo CA 9024 AUTHORIZED REPRESENTATIVE ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD CERTHOLDER COPY SG P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS` COMPENSATION INSURANCE ISSUE DATE: 09 -18 -2012 CITY OF EL SEGUNDO SG 350 MAIN ST EL SEGUNDO CA 90245 -3813 GROUP: 000541 POLICY NUMBER: 0000587 -2012 CERTIFICATE ID: 63 CERTIFICATE EXPIRES: 07 -11 -2013 07 -11- 2012/07 -11 -2013 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to Its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions,, and conditions, of such policy. { "alNfaa L Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2012 -07 -11 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF EL SEGUNDO ENDORSEMENT #1600 - ALI PAKZAD PRES,TRES - EXCLUDED. ENDORSEMENT #1600 - PAMELA PAKZAD SEC - EXCLUDED. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 07 -11 -2012 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER APA ENGINEERING, INC SG 9880 IRVINE CENTER DR IRVINE CA 92618 [NAM,CS] (REV.1 -2012) PRINTED : 09 -18 -2012