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PROOF OF INSURANCE (2012) CLOSEDCERTIFICATE OF LIABILITY INSURANCE DATE (MM' 12/077 /11 /11 YY) 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 EPIC Lanzillotta CBIA Insurance Agency, Inc PHONE (818) 926 - 4410 -C Nq (818)459-9037 8001 Canoga Ave Suite A EMAIL e,rtl @cbjamember.com Canoga Park, CA 91304 INSURERS AFFORDING COVERAGE NAIC # Phone (877)900 -2242 Fax (866)746 -4801 INSURER A : Atain Ins Co 29033 INSURED Golden Meters Service INSURER C 14812 Hunter Lane I INSURER D: INSURER E: Midway City, CA 92655- (714) 450 -5929 INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: HIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD DICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS ERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY LNS THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, XCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ ........................... ............................... ADD TYPE OF INSURANCE INSR UBR MDa POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM /DD /YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $.....1,000,000.00 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 1 OO,000.00 [:1 F-1 CLAIMS -MADE ] OCCUR CIP132219 MED EXP (Any one person $ 5,000.00 A Y N 11/23/2011 11/23/2012 PERSONAL & ADV INJURY www $ 1,000,000.00 GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000.00 I"! POLICY ❑ PRO- ❑ LOC� $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT F_a accident ❑ ANY AUTO BODILY INJURY (Per person) 1 $ ❑ALL OWNED SCHEDULED AUTOS Li BODILY INJURY (Per accident ' .. $ NON -OWNED ❑ HIRED AUTOS F1 AUTOS PROPERTY "DAMAGE Per acrrdenf $ .. ....... ......... ❑ ❑ $ ❑ UMBRELLA LIAB ❑ OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAB CLAIMS -MADE AGGREGATE $ ❑ DED [I RETENTION $ $ .............. W WORKERS COMPENSATION I.O. W C STATU- RH - ❑ AND EMPLOYERS' LIABILITY y / N TOR LIMIT, ��° ANY PROPRIETOWPAR "rN�ERrEXECUTIVE. N / A E,L EACH ACCIDENT $ OFFICEWMEMSFR EXCLUDED? (Mandatory in NH) F-1 E,L, DISEASE- EA EMPLOYE $ If yyYY�w, describe undwa $ IDIE4SCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT .................. _........_ ...... ............ _._ ..... . DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of El Segundo, is named as additional insured on the above indicated General Liability policy per the attached endorsement. Re: All operations at multiple locations for cert holder clients, Scope of Duties : Testing Meters and Meter Repair CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 400 Lomita Street El Segundo 90245 Segundo, ° AUTHORIZED REPRESENTATIVE C. 31 O a 070 ......�_�1 ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) QF The ACORD name and logo are registered marks of ACORD Aq"' RF3 -- DATE (MMIDDIYYYY)------ CERTIFICATE OF LIABILITY INSURANCE 12/07/11 THIS CERTIFICATE IS ISSUED ASWA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON RIGHTS 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). NTK PRODUCER NAME: Eric Lanzillotta CBIA Insurance Agency, Inc PHONE (818) 926 -4410- F OQi„ @18)459-9037 8001 Canoga Ave Suite A MA sus; a�rrc( chuamember.com Canoga Park, CA 91304 INSURERS AFFORDING COVERAGE NAIC # Phone (877)900 -2242 Fax (866)746 -4801 INSURER A: Atain Ins Cc 29033 INSURED INSURER B: ..... ............................... ............. Golden Meters Service INSURER C: 14812 Hunter Lane INSURER D ............._.._ _.�._....................._�... Midway City, CA 92655 (714) 450 5929 INSURER E : ....................... ............. ............... _._- _.-- _.._.._. INSURER F 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 CONTRACTOR 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 LTR .................. TYPE OF INSURANCE ADDL SUBR POLICY NUMBER m POLICY EFF MMIDD/YYYY ......... POLICY EXP (MM /DD /YYYY) .................................... _ ................................................................................................................. ............ .__ ........ LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000,00 ® COMMERCIAL GENERAL LIABILITY e . DAMAGE RGESOI,E_ ence„,, ,....$-..... .....,,_._._..._....�........_. 100,000.00 P �._... RENTED ❑ ❑ CLAIMS -MADE �/❑ OCCUR CIP132219 MEDEXP(Anyona, person $ 5,000.00 A p Y N 11/23/2011 11/23/2012 PERSONAL & ADV INJURY $ 1 ,000,000.00 GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000.00 POLICY ❑ PRO- ❑ LOC .... $ .._.._�.❑ AUTOMOBILE LIABILITY ...- .............................................. . ..... ..... _.__. COMBINED SINGLE LIMIT Ea AuRdant�,..........- ........... ❑ ANY AUTO BODILY INJURY (Per person) $ ❑ALL OWNED ❑ SCHEDULED AUTOS SCHE BODILY INJURY (Per accident $ 'PROPERTY' DAMAGE Par acrldant $ NON -OWNED ❑ HIRED AUTOS ❑ AUTOS ❑ ❑ $ ❑ UMBRELLA LIAB ❑ OCCUR ._ . ... ............. .......... ...... „.... EACH OCCURRENCE $ ❑ EXCESS LAB ❑ CLAIMS -MADE AGGREGATE $ DED I.❑ RETENTION $ $........ w.__.,.,_ .... WORKERS COMPENSATION � �.... ❑ W C yTATU S OTH- AND EMPLOYERS' LIABILITY YIN O IdT I ANY PROrPY RIETOR/PARTNER/EXECUTIVE� N/A E.L.. EACH ACCIDENT OFFICER/MEMBER M d NH EXCLUDED? E L.. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E,L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of El Segundo, is named as additional insured on the above indicated General Liability policy per the attached endorsement. Re: All operations at multiple locations for cert holder clients. . CERTIFICATE HOLDER ..--...-.... _......_.-- ...- .- - --- -------------_------------- .- ..�.....- .m........._- ..--....--.........._--...----.....----..--......... ............................... ,.......... ....-...m.---- - _. ----- CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 400 Lomita Street El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE Attn: James C. Turner - 310.524.4070 µ ,. ......._ ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) OF The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 20 33 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II - Who Is An Insured is amended to include as an additional insured any person or or- ganization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an addi- tional insured on your policy. Such person or or- ganization is an additional insured only with respect to liability for "bodily injury ", "property damage" or "personal and advertising injury" caused, in whole or in part, by.: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are com- peted. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to: 1. "Bodily injury ", "property damage" or "personal and advertising injury" arising out of the ren- dering of, or the failure to render, any profes- sional architectural, engineering or surveying services, including: a. The preparing, approving, or failing to pre- pare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifica- tions; or b. Supervisory, inspection, architectural or engineering activities. 2. "Bodily injury" or "property damage" occurring after: a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location 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 subcon- tractor engaged in performing operations for a principal as a part of the same project. CG 20 33 07 04 (0 ISO Properties, Inc., 2004 Page 1 of 1 Mar 28 12 01:08p Golden Meters Service 7148293103 p.2 To: '7148293103AFax.else9undo.or9' From: Timings, LtleieniV' 03/27/12 02:28 IM Fage t % Reproduetkm of Insurance Services Office, Inc. Form INSURER.• ISO FORM CG 2010 1185; (MODIFIER) POLICY NUMBERS COMMERCIAL GENERAL LIABILITY ENDORSEMENT NUMBER: EXHIBIT 1 -A THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ FT CAREFULLY. ADDITIONAL INSURED — OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided underthe following: COMMERCIAL GENERAL LLIkBILITY COVERAGE PART. SCHEDULE The City, its ofReers, officials, employees, agents, and volunteers (if no entry appears above, the information required to complete this endorsement will be shown in the Declarations as applicable to this endarsentertt.) WHO IS AN INSURED (Section It) 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. to ISO famCC 20 10 it $5. 1. The insured scheduled above includes the trtsured's oii'icers, officials, employers weed volunteers. 2. This insurance shall be primary as rmpects the insured shown in the schedule abovey or if excess, shall stand in an unbroken chain of coverage excess of the Flamed Insuteti's scheduled underlyWg primary coverage. In either event, any other insurance maintained by the Insured scheduled above shall use in excess of this insurance and shall not be called upon to contribute with it. 3. The insurance afforded by this policy shall not be canceled except after thirty days prior written notice by certified mail retum receipt requested has been given to the Entity. 4. Coverage shall not extend to any indemnity coverage for the active negligence of additional insisted in any case where an agreement to indemnify the di anal im, would be invalid under Subdivision b eafsection2782 oftttc Civil C CG 20 10 11 85 Insurance Services Oiflice, Inc. Form {Moditled) opt -Out: Ilot DeFilted � A6» ƒ: .