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PROOF OF INSURANCE (2010) CLOSEDRD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYY) 10/06/09 PRODUCER LIC #OE67768 1- 925- 660 -3514 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION IOA 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 ers Pro ert _Casualt Com and of America JLee Engineering Inc. NSURERA;Travel – INSURERB:Travelers Casualty Insurance Company of America -._ 430 S. Garfield Avenue, Suite 320 I.N..S... UR_E... RC ACE American Insurance Coma ae .......... Alhambra, CA 91801 INSURER D: _.- .,......mmmm -,... W W .................. 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. _ ...........� ... . .........�� .. �... ....m, _..... . ". _ ER , ........ _ _„ _ .. _ ........�.. INSR TYPE OF INSURANCE POLICY NUMB POLICY EFFECTIVE POLICY EXPIRATION LTR ................ .,.,......... ....... ........................... LIMITS • GENERAL LIABILITY 680- 8855N594 09/01/09 09/01/10 EACH OCCURRENCE 62,000,000 , — - X .IABILITY ^^ At. _NERAL t ,....... FIRE DAMA_ 00 000 GE(A�onelila X 1 CLAIMS MADE OCCUR ME CkP"n dnR°:rn)- $ 100000 � .....� ., ......... '.._PERSONA_L &ADVINJURY $ 2,000,000 . -.w GENERALAGGREGATE _ 4,000,000 § -__-- GEN L AGGRE PLIE,'SPER: GA7 ELIMITAP _ _ PRODUCTS COMP /OPAGG $4,000,000 POLICY X JECT LOG • AUTOMOBILE LIABILITY 680 - 8855N594 09/01/09 09/01/10 COMBINED SINGLE LIMIT $2,000,000 ANY AUTO (Ea accident) .........— ---- ............... ALL OWNED AUTOS .... ............--------- BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIRED AUTOS ........... r... ......."... BODILY INJURY $ X NON -OWNED AUTOS (Per accident) - - - - - - -� ••• PROPERTYDAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ - - --- ANY AUTO E A OTHER THAN - _. AC .0 $............_.. . ''.... AUTO ONLY: AGG $ C EXCESS LIABILITY EACH H OCCURRENCE $ ......-- ---- _............_ .. _ OCCUR CLAIMS MADE AGGREGATE $ ......._..._ .._,m.,.., ... ....... ..._ DEDUCTIBLE RETENTION $ $ * WORKERS COMPENSATION AND UB- 3290T632 09/01/09 09/01/10 X T�%RYJIti,I.Ti EfZ EMPLOYERS' LIABILITY E.L. EA_C_H ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE ....... -- ...... -... ......... $ 1, 000, 000 ._. E.L. DISEASE - POLICY LIMIT $ 1,000,000 OTHER C Professional Liability EONNO0917977 11/02/08 11/02/09 Per Claim $1,000,000 Annual Aggregate $1,000,000 S DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS All operations of the Named Insured. General Liability only: City of El Segundo, its officers, officials, employees, and authorized volunteers is named as Additional 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. I In MIM I a nyLuam I ADDITIONAL INSURED; INSURER LETTER. t,.AN t;,t.1.„A 11UN "' 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 @WXWV4 MAIL 30 DAYS WRITTEN Attn: Sam Lee, Building Manager NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, IIrItIla'ad�I,:.X 350 Main Street XA7ffi>Offiffi�X�gN767C8ipIX E1 Segundo, CA 90245 _ AUTHORIZED g IBS{Kx7tXXXXX,X7�XXXXXXXXXX7 xxxxXXXX�C](XXX'XXXXXXX%CXX} xx g REPRESENTATIVE USA /'[JJ�.2 -"I_ I ACORD 25 -S (7/97) gyuenSFP m ACORD CORPORATION 1988 1.7LOOD /D POLICY NUMBER: 680- 885SN594 NAMED INSURED: JLee Engineering Inc.. COMMERCIAL GENERAL LIABILITY DATE ISSUED: 10106109 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 E1 Segundo, CA 90245 USA City of E1 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 INSURED (Section II): The person or organization shown in the Schedule above is an additional insured on this Coverage Part, but only with respect to liability for "bodily injury", "property damage" or "personal injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: a. In the performance of your ongoing operations; b. In connection with premises owned by or rented to you; or c. In connection with "your work" and included within the "products- completed operations hazard ". which that person or organization has assumed liability in a contract or agreement. The insurance provided to such additional insured is limited as follows: d. This insurance does not apply to the rendering of or failure to render any "professional services ". e. The limits of insurance afforded to the additional insured shall be the limits which you agreed in that "contract or agreement requiring insurance" to provide for that additional insured, or the limits shown in the Declarations for this Coverage Part, whichever are less. This endorsement does not increase the limits of insurance stated in the LIMITS OF Such person or o nization does not qualify INSURANCE (Section III) for this as an addition ,„. �n urea for "bodily injury", Coverage Part. property da g r "personal injury" for CG d3 82 09 07 © 2007 The Travelers Companies, Inc. Page 1 of 2 Inclwalq opyrighted material of Insurance Services Office, Inc., with its permission. B. The following is added to Paragraph a. of 4. Other Insurance in COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): However, if you specifically agree in a "contract or agreement requiring insurance" that, for the additional insured shown in the Schedule, the insurance provided to that additional insured under this Coverage Part must apply on a primary basis, or a primary and non - contributory basis, this insurance is 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 person or organization shown in the Schedule as an additional insured on this Coverage Part, provided that the "bodily injury" and "property damage" occurs, and the "personal injury" is caused by an offense committed: a. After you have entered into that contract or agreement; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. 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.