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PROOF OF INSURANCE (2012) CLOSEDCERTIFICATE 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