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PROOF OF INSURANCE (2012) CLOSED69120 V CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 11 /22/2011 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 NAME: Heather Berglund Commercial Lines - (952) 830 -3000 rriOrvE 952- 563 -0507 FAX 952 - 563 -9507 Wells Fargo Insurance Services USA, Inc. (� A M xtl, Heather.hel lurid " wellsfarco com (A/C A DRfss? _ g , � 4300 MarketPointe Drive, Suite 600 INSURER(S) AFFORDING COVERAGE NAIC # Bloomington, MN 55435 -5455 INSURER A: Allied Property & Casualty Insurance Co 42579 _ .. .. - — INSURED INSURER B: _ Allied Insurance Company 42579 INSU American Zurich Insuranc „�...._, A- Throne Co., Inc. RER c : e Company 40142 Attn: Nikki Hussein INSURER D 1850 E. 33rd Street Long Beach, CA 90807 -5208 INSURER F: COVERAGES CERTIFICATE NUMBER: JD0141 It REVISION NUMBER: See below 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 AWL SU6k POLICY NUMBER MM/DDY/YYYY LTR TYPE OF INSURANCE.. MOLICY EXP M/DD/YYYY LIMITS E LIABILITY A GE ACP7133675981 11/22/2011 11/22/2012 EACH OCCURRENCE $ - - - -- 1,000,000 fOA NTFi COMMERCIAL GENERAL LIABILITY _. Pt�MA6 �, Ila 4.'o.�r9.,�gYr'Oularltl 500 000 CLAIMS X OCCUR , a ®a -MADE MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000, 000 GENE, LAGGREGATE $ 2,000,000 GEN'L AGGREGATE TE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ ,'0.00. 2,000,000 POLICY X JECT {'0C $ A AUTOMOBILE LIABILITY ACP7133675981 11122/2011 11/22/2012 COMBINED SINGLE LIMIT 1 000,000 X ANY AUTO BODILY INJURY (Pei person) $ ALL OWNED SCHEDULED AUTOS AUTOS .. BODILY INJURY (Per accen $ acc ident P ( ) NON -OWNED X HIRED AUTOS _ X AUTOS 4 of ar RW CJAMA6E, .. r"ROPF f " %Id,r.a)1t $ ,,,,.. ..... ... $ B X UMBRELLA LIAB X OCCUR ACP7133675981 11/22/2011 11/22/2012 EACH OCCURRENCE $ 10,000,000 _. EXCESS LIAB CLAIMS -MADE AGGREGATE $ 10,000,000 DEO RETENTION $ $ WORKERS COMPENSATION X I WC 8TAfU- OTH- C AND EMPLOYERS' LIABILITY YIN WC6558298 -02 11/22/2011 I 11/2212012 ! TORY I ER , - - - - -- ___1 ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $ 1,000 000 OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) EL DISEASE - EA EMPLOYEE $ 1,000,000 If yes describe under- - - - - -- _ DESCRIPTION OF OPERATIONS below E,L, DISEASE POLICY LIMIT $ 1,000 000 A Business Personal Property ACP7133675981 11/22/2011 p y 11/22/2012 04,e00 $5,0 Deductible $5,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Certificate Holder is named as an Additional Insured with respects to the General Liability. CERTIFICATE HOLDER CANCELLATION City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 401 Sheldon Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo CA 90245 AUTHORIZED REPRESENTATIVE 001919 The ACORD name and logo are registered marks of ACORD © 1988 -2010 ACORD CORPORATION. All rights reserved.. ACORD 25 (2010/05) 1 1111111 III 111111111 1111 VIII 111111 IIII VIII VIII VIII VIII VIII VIII VIII VIII VIII IIII IIII `CY®OIA2 2/0 0 061 1 /02/0 2 /0/0/0/0' POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 7160 08 04 THIS ENDORSEMENT CHANGES, THE, POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED- OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or anization s : Location And Description Of Completed O orations The City of El Segundo, its All contracted operations officers, officials, employees, agents and volunteers Information required to complete this Schedule If not shown above, will be shown In the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organiza- tions) shown in the Schedule, but only with respect to liability for "bodily injury' or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorse- ment performed for that additional insured and included in the "products- completed operations hazard ". B. With respect to the Insurance provided to the person or organization shown in the Schedule of the Endorse- ment the following provisions apply: 1. We will have the right and duty to defend the additional insured against any "suit " seeking damages to which this endorsement applies, However, our duty to defend the additional Insured is limited to defending only those claims or "suits " specifically pertaining to " °bodily Injury" or "property damage" caused by "your work" at the location designated and described in the schedule of this endorsement performed for that ad- ditional insured and included in the "products- completed operations hazard", We will have no duty to de- fend any claims or "suit" pertaining to any other liability on the part of the additional insured.. 2. This Insurance does not apply to liability arlsing out of the sole negligence or willful misconduct of the addi tional insured. All terms and conditions of this policy apply unless modified by this endorsement. CG71 60 08 04 Includes copyrighted material of Insurance Services Office, Inc. with permission. Page 1 of 1 © ISO Properties, Inc., 2004 ACP GLO 7133675961 LMCL 11356 AGENT COPY 74 0019334