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PROOF OF INSURANCE (2012) CLOSED
CERTIFICATE OF LIABILITY INSURANCE DATE05!2212012 (M"012YYY) 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 INSU'RE'D, the pollcy(les) must be endorsed. It 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 E-. NAME'.. AOn Risk services central, Inc. FAT Pittsburgh PA Office C86fi) 263 -7122 (8471 953 -5390 ( No. Ext )� E-MAIL Dominion Tower, 10th Floor 625 Liberty Avenue ADDRESS: COMBINED SINGLE LIMIT S1,000,000 Pittsburgh PA 15 22 2 -3 110 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURERA Liberty Mutual Fire Ins Co 23035 RBF Consulting INSURER e: Libert y insurance Corporation 42404 Po Box 57057.- Irvine CA 92619 -7057 USA . y ... INSURER C: LTO cE -syndicate No. 2623 1128623IT "__. INSURER D: .. .... . . ... ......... BODILY INJURY ( Per person) INSURER ER E: .F......".".._._._".._ .... ALL OWNED SCHEDULED ...... INSURER COVERAGES CERTIFICATE NUMBER: 570U46324746 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. Limits shown are as requested INSR "CR TYPE OF INSURANCE POLICY NUMBER POLICY dwooprY AMf r" LIMITS A GENERAL LIABILITY TB EACH OCCURRENCE S2,000,000 - _ . ........... ... -.._.. f..._ ILITY PREMISES Ea $1, 000' 000 X COMMERCIAL GENERAL LIABILITY ccurrence CLAIMS -MADE 0 OCCUR MED EXP (Any one person) $5,000 X Contractual PERSONAL B ADV INJURY $2,000,000 X.. BFPD XCU GENERAL AGGREGATE $4,000,000 „",,,,,,,,,,,,,_ GEN'L. AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMPIOP AGG $4,000,000' POLICY E PR0. X LOC ......... A AUTOMOBILE LIABILITY El Segundo CA 90245 -3813 USA tXlord at�zteD A52-681-004145-721 06/30/2011 06/30/2012 COMBINED SINGLE LIMIT S1,000,000 a ALCkI1nN11..........._. AUTO BODILY INJURY ( Per person) ALL OWNED SCHEDULED BODILY INJURY(Per accident) IANY AUTOS AUTOS -OWNED — •--•-- - .- ....•• PROPERTY DAMAGE HIREDAUTOS X ,.NON AUTOS APer accident) ...$10,000,000. B X UMBRELLALIAR.., X OCCUR TH7681004145681 06/36/2011 OCCURRENCE EXCESS LIAB CLAIMS -MADE AGGREGATE $10 , 000 , 000 ...OED RETEKVIONS10,000 WORKERS COMPENSATION AND WC STAN- OTH- EMPLOYERS' L ILITY YIN TORY LIMITS E ANY PROPRIETOR I PARTNER! EXECUTIVE j '"'p E,L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED? NIA - .... .m..- ....�....." ............... kN t0'. (Mandatory In NH) E.L. DISEASE -EA EMPLOYEE it .... - WE OI CR# 1T1T `PPIOFOrPL " "4,RwTG04+IS.baiarw L.. DISEASE- POLI CY LIMIT C ! E&O- ProfLiabPrl QK1102675 06/30/2011 06/30/2012 Per Claim $5,000,000 Professional & Pollution Aggregate $5,000,000 SIR applies per policy ter ns & conditions DESCRIPTION OF OPERATIONS! LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: Project: Chevron Facilities CEQA Review, JN 10- 108736. The City of E1 Segundo, its officials and employees are included as Additional Insured on the General Liability policy as required by written contract. Primary and Non - Contributing coverage applies to GL as required by written contract. CERTIFICATE HOLDER CANCELLATION ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.. City of El Segundo Attn: Kimberly Christensen, AICP AUTHORIZED REPRESENTATIVE Planning Manager 350 Main Street El Segundo CA 90245 -3813 USA tXlord at�zteD na ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 19926110040540UMS THIS ENDORSEMENT CHANGES THE POLICY. PLEASE RF,AD IT CAREFULLY. BLANIKET ADDITIONAL lei iSURED This endorsement modifies insurance provided under the following. COM MI~ItML GEM ULkl. LIABILITY COFEFUAGE FOIL11 SECTION H - WHO IS AN INSURED is attended to indude as an insured any person or orp =ation for whore you have agreed in writing to provide Liability insurance. But: The insurance provided by ails amendment. I. Applies only ro "bodily injury" or "property damage" arising out of (a) "your work' or (b) premises or other property owned by or rented to you; 2. Applies only, to coverage rid rrunimum, limits of insurance required by the written agreement, but in no event e>cecds either the scope of coverage or the Limits of insurance provided by this polity; and 3. Does not apply to any person or organ=ztion for whom your have procured separate liability insurance while such insurance ss 61 effect regardless of whatbar the scope of cos•crage or 16 is of insurance of this policy ezcced those of such other insurance or arhedter such otherinsutance is valid and collecabSe. The followingprovisions also apply: 1. Where the applicable wrinen agreement requires the insured to provide lialrlity insurance on a primary, excess, contingent, or any other basis, this policy will amply solely on the basis requited by such written agreement and Ita-n 4. Other Insurance of SECTION IV of this policy will not apply. ? inhere the applirable written 2 eemant doea not specify on wha t basis the li A iliry insurance will apply, the provisions of Item 4. Other Insurance of SECTION "R" of this policy will govem. 3 .T"tnis endorsement shall not apply to any person or organization for arty "bodily injury" or "property damage" if any other additional insured endo .cmrnt on this policy, spplies m that person or orpnization with regard to the "bodily injury" or "property damage ": 4. If any other additional insured endorsement applies to any person or organization and you are obligated under a written agteatnent to provide liability instrmwe on a primary, excess, contingent, or any od= basis for that additional insured, this policy will apply solely on the bass required by such written agreement and Itrra 4.Other Insurance of SECTION IV of des policy will not apply, regardless of whether the person or orgdnization has available other valid and collectible insurance. If the applicable written agreement does not specify on what hasis the liability insurance will apply, the provisions of Item 4. Other Insurance of SECTION IV of this policy -rill gwerm 11t;rrnaoreestterit se.tedbytha LIBERTY MUTUAL. F1 RE INSURANCE COM13AI+fY Premium S Effceuve Datc Fspi arse Date few ntmahtnwr ro 1'a$cy Na TB2. 6131 -004145 -711 Audi &uiw l:aucd To 7scucd LN20010605 Cowslcrrngtrc bt Saler office and NM find. Serial No. 18 _ RBFCO-1 OP ID: KH DATE (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 06130111 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(les) 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 r:r►rtlficate holder In pieta of Such endorsements , 1 PRODUCER 714 -70p3 4370 NAME: — .... .. dX .. _ _. United' Captive Ins, Brokers P"ONI- p 714708 -2300 w.tt� 17151 NewYhope Sri., Ste 211 MAIN. Fountain Valley, CA 92'7'08 =��._ _– __.� y Mark Barrie INSURER a AFFORDING cow'ERAOE Nalc � —., _� States Fidel #1y & 426887 �..�............. — ... _...�. L_ StsRFRa Un „Ited S.. _ _........_ _._..._ �.. INSURED _...... ... . -RBF Consulting 9N'SNJREf' a laNl "a� ±"eOfn+'B11N� ,.�....�..-..... ...._��... _ ,•......_.._.�..,... 14725 Alton Parkway INSURER C. 1 Irvine, CA 92618 INSURER o. rNSURER'E,. ..._ _._. —... ..._. _.__- _.. INS � P COVERAGES CERTIFICATE NUMBER: REVISION NUMBER* THIS IS TO CERTIFY THAT THE POLICIES OF INSUR4NCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PENTIOD INDICATED, NOTWITHSTANDING ANY REOUIREMENT, 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 TYPE OF INSURANCE SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, .�- ... „,_..., ... AND CONDITIONS OF SUCH POi gCIES. LItuIITSmm� POLICY EFF5 "EIN LIMITS tNSR GENERAL L FOLtCY NUMBER MN Y (ABILITY � EACH OCCURRENCE �I'IiFTE COMMERCIAL GENERAL LNABILI: "Y PR • 'VI6 („F Wr, r M;OPJ).,., S ,..,.� ._,_...... .- MED EXP ( An one orsan) CLAIMS -MADE 7 OCCUR PERSONAL & ADV INJURY 'S •_•www,,,,� _. -..- TE ' S.... � .... ........._.._, GENERAL AGGREG A ........... mmJ_ GEN'L AGGREGATE LMI OC MP /OP AGL IMIT 5 � _ APPLIES PER: $ PRODUCTS - CO POLICY L C MBIN -ED TI NGLE LNMIT AUTOMOBILE LIABILITY E' Maratl_— . "'— "'._.. BODILY INJURY (Per person) S ANY AUTO ALL OWNED SCHEDULED BODILY INJURY (Peraccidenq' $ AUTOS AUTOS P� °RTY DA AGE NON- OWNED P,.Ctldenu.,.,,_,,............ HIRED AUTOS AUTOS $ I UMBRELLA LIAR OCCUR EACH OCCURRENCE $ ,,,,, •m_IT,•..._.. EXCESS LIAR CLAIMS- AGGREGATE _ .... S DED R TENtI N WvTIdII.. cTra• 1 000,00' COMPENSATION Y / N 07!01111 07!01112 X EACH It _ C9 OI) WORKERS COMPENS AND EMPLOYERS' LIABILITY DI CH ACCID Nfi a e A ANY PRC,PRN'ETORMAR'TNERIEXECUTIVE NIA 1,00 r OFFICERmt- MBEREXCLUDED? ❑N EL DISEASE -EA EMPLOYEE S _ IMandntM in NHp 1,t3Iii0 „0II It Wes{ d salbe utrd E,L. DT''EASt • POLICY Ltlrdtll "N S DF,$gR IJINUN OF OPERATIONS 0010M: DESCRIPTION OF Specific I LOCATIONS RBF JN 10-107917 (Attach ACORD 101, Additional Remark %Schedule, If more space Is required) CERTIFICATE HOLDER CANCELp1ION CITYELS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of El Segundo Attn: Masa Alklre AUTHORIZED REPRESENTATIVE 350 Main Street El Segundo, CA 902 - 798 01988 -2010 ACORD CORPORATION. All rights reserved. ACORD 26 (2010105) The ACORD name and logo are registered marks of ACORD