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PROOF OF INSURANCE (2011) CLOSED3790D J Lee Engineering, Inc. ; C ,, CERTIFICATE OF LIABILITY INSURANCE 0/19/20IYY) r to/19/zolo PRODUCER LIC #oE67768 1-925-660-3514 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION IDA Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 3875 Hopyard Road, Suite 240 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Pleasanton, CA 94588 INSURERS AFFORDING COVERAGE Gigi Yuen INSURED INSURER A:Travels s Pro erL casualty Cop ata Of America JLee Engineering Inc. _ .- ,e.. .. yl _ , INSURERB:ACE American Insurance Company 430 S. Garfield Avenue, Suite 320 INSURERC Alhambra, CA 91801 NSURER D. INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY EFFECTIVE POLICY EXPIRATION TYPE OF INSURANCE POLICY NUMBER - LIMITS A GENERAL LIABILITY 680-8855NS94 09/01/10 09101111 EACH OCCURRENCE $ 2,000,000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any on n a) $1 000,000 CLAIMS MADE X„ OCCUR MED EXP(Any one person) $ 10,000 PERSONAL&ADVINJURY $2 000,000 GENERALAGGREGATE $ 4,000,000 „. -,,, ,e_,,,,,,,,, QE'N'LAGGREGAFE LIMIT APPLIES PER:PRO- ... PRODUCTS-COMP/OP AGO $ 4,000,000 POLICY X LOC A AUTOMOBILE LIABILITY 680-8855N594 09/01/10 09/01/11 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 2,000,000 ALL OWNED AUTOS -- BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHERTHAN AUTO ONLY: AGO $ EXCESS LIABILITY EACH OCCURRENCE $11�OCCUR CLAIMS MADE AGGREGATE $ $ $..... ,,,,,., _ I�F?r't NrI;IN * WORKERS COMPENSATION AND UB-329OT632 09/01/10 09/01/11 X WCSTATU- O"I"H- EMPLOYERS'LIABILITY E..L.EACH ACCIDENT $ 1,000,000 E L DISEASE EA EMPLOYEE $ 1,000,000 E.L.DISEASE-POLICY LIMIT $ 1,000,000 OTHER B Professional Liability IN00917977007 11/02/10 11/02/11 Per Claim $1,000,000 Annual Aggregate $1,000,000 $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS All operations of the Named Insured. General Liability only: City of E1 Segundo, its officers, officials, employees, and authorized volunteers is named a Insured but only as respects liability arising out of the Named Insured's operations in Professional Services Agreement; such coverage is Primary and Non-Contributory as respects any insurance carried by the Additional Insured with respect to work performed by the Named Insured. CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION* 10 DAYS NOTICE FOR NON-PAYMENT OF PREMIUM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of El Segundo DATE THEREOF,THE ISSUING INSURER WILL ffMX9WY4 MAIL ,3.,0,,,, DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,9[!lC)rAKAXIKX6. xX Attn: Sam Lee, Building Manager 350 Main Street Xa 7ffi3G&C]08S�IOSC6gD>19XR]FX�T�SdCP�l7Dg7[�LSICK +'�QtglI7C4Cffi0(X Xq ugm mxrvxiK CXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX E1 Segundo, CA 90245 AUTHORIZED REPRESENTATIVE v SA ACORD 25-S(7/97) gyuenSFP O ACORD CORPORATION 1988 17954061 POLICY NUMBER: 680-8855N594 COMMERCIAL GENERAL LIABILITY DATE ISSUED: 10/19/2010 NAMED INSURED: JLee Engineering Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.. ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE NAME OF PERSON(S) OR ORGANIZATION(S): City of E1 Segundo Attn: Sam Lee, Building Manager 350 Main Street El Segundo, CA 90245 USA City of El Segundo, its officers, officials, employees, and authorized volunteers PROJECT/LOCATION OF COVERED OPERATIONS: All operations of the Named Insured PROVISIONS A. The following is added to WHO IS AN which that person or organization has INSURED (Section II): assumed liability in a contract or agreement. The person or organization shown in the The insurance provided to such additional Schedule above is an additional insured on insured is limited as follows: this Coverage Part, but only with respect to liability for "bodily injury", "property damage" d. This insurance does not apply to the or "personal injury" caused, in whole or in part, rendering of or failure to render any by your acts or omissions or the acts or "professional services". omissions of those acting on your behalf: e. The limits of insurance afforded to the a. In the performance of your ongoing additional insured shall be the limits operations; which you agreed in that "contract or b. In connection with premises owned by or agreement requiring insurance" to rented to you; or provide for that additional insured, or the c. In connection with "your work" and limits shown in the Declarations for this included within the "products-completed Coverage Part, whichever are less. This operations hazard". endorsement does not increase the limits of insurance stated in the LIMITS OF Such person or organization does not qualify INSURANCE (Section 111) for this as an additional insured for "bodily injury", Coverage Part. "property damage" or "personal injury" for CG D3 82 09 07 ©2007 The Travelers Companies, Inc. Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission. B. The following is added to Paragraph a. of 4. person or organization shown in the Schedule Other Insurance in COMMERCIAL as an additional insured on this Coverage GENERAL LIABILITY CONDITIONS Part, provided that the "bodily injury' and (Section IV): "property damage" occurs, and the "personal injury' is caused by an offense committed: However, if you specifically agree in a "contract or agreement requiring insurance" a. After you have entered into that contract that, for the additional insured shown in the or agreement; Schedule, the insurance provided to that b. While that part of the contract or additional insured under this Coverage Part agreement is in effect; and must apply on a primary basis, or a primary and non-contributory basis, this insurance is c. Before the end of the policy period. primary to other insurance that is available to such additional insured which covers such additional insured as a named insured, and we will not share with the other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought occurs; and (2) The "personal injury' for which coverage is sought arises out of an offense committed; after you have entered into that "contract or agreement requiring insurance" for such additional insured. But this insurance still is excess over valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured when the additional insured is also an additional insured under any other insurance. C. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us in COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): We waive any rights of recovery we may have against the additional insured shown in the Schedule above because of payments we make for "bodily injury", "property damage" or "personal injury" arising out of "your work" on or for the project, or at the location, shown in the Schedule above, performed by you, or on your behalf, under a "contract or agreement requiring insurance" with that additional insured. We waive these rights only where you have agreed to do so as part of the "contract or agreement requiring insurance" with that additional insured entered into by you before, and in effect when, the "bodily injury' or "property damage" occurs, or the "personal injury" offense is committed. D. The following definition is added to DEFINITIONS (Section V): "Contract or agreement requiring insurance" means that part of any contract or agreement under which you are required to include the CG D3 82 09 07 ©2007 The Travelers Companies, Inc. Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission.