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PROOF OF INSURANCE (2009) CLOSEDH'eri : IbIIU4 JLtttNU DATE (MMID ACORDTM CERTIFICATE OF LIABILITY INSURANCE 10 /31 /08D1YY) PRODUCER . _ .... � .... ..�,�.,_,.., THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION HRH Professional Practice ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 100 Marine Parkway, #200 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Redwood City, CA 94065 -1517 650 369 -5900 INSURERS AFFORDING COVERAGE INSURED INSURER A: Employers Fire Insurance COm JLee Engineering Inc. _ -- - INSURER B: OneBeacon America Insur ------------- INSURER c: Ace American Insurance Comp Alhambra, CA 91801 �_ - America ----- Insurance INSURER D: .,. INSURER .. E ...................... ....................W..._..... 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. IN- R POLICY EFFECTIVE POLICY EXPIRATION L TYPE OF INSURANCE POLICY NUMBER / LIMITS A GENERAL LIABILITY FFIU39673 09/01/08 09/01/09 EACH OCCURRENCE $2L,QQQ-,QQQ LIABILITY COMMERCIAL GENERAL..,. FIRE DAMAGE (Any one fire) $300,000 CLAIMS MADE X N OCCUR , MED EXP (Any one person) ,......, ............. .........._..,_ $5,000 ........................... ...,. PERSONAL, &ADVINJURY s1­1 21000 000 GENERAL AGGREGATE $4,000,,000 ',. GEN'LPAGGREGATE APPL IES PRODUCTS - COMP /OP AGG $4,g000,OOO LIMI LOC A AUTOMOBILE LIABILITY IFF1 U39673 09/01/08 09/01/09 COMBINED SINGLE LIMIT (Ea accident) $2,000,000 ANY AUTO ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) ..° ................................$................................... .,..BODILY .............................., HIRED AUTOS X NON -OWNED AUTOS accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY 1A ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN ACC O $ „- AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR I" CLAIMS MADE ... AGGREGATE .... A.. $ .... DEDUCTIBLE $ RETENTION S $ B WORKERS COMPENSATION AND 406018801 09101/08 09/01/09 X WC STATU OTH ITQRY. -LIM7$ ............ ER I J ..... --- ......... ............. EMPLOYERS' LIABILITY E.L,. EACH ACCIDENT ..- ..EA.EMPLOYEE...$1,.,000, $1,000,00_0 $1,0.Q0,,000­- . DISEASE EA ..DI- 000 E.. L.. SEASE..- POLICY.LIMIT $1,�Q66. D.666,.µ_........,....,....... C OTHER Professional EONNO0917977005 11/02/08 11/02/09 $1,000,000 Per Claim Liabilit $1,000,000 - re ate DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS All operations of the Named Insured. General Liability only: City of El Segundo, its officers, officials, employees and volunteers are named as Additional Insured but only as respects liability arising out of the Named Insureds' operations; such coverage is primary and non - contributory as (See Attached Descriptions) AD D IITIONAL INSURED City of El Segundo Attn: Sam Lee, Building Manager 350 Main Street El Segundo, CA 90245 CANCELLATI SHOULD ANYOFTH E ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WIWXRJMXn TO MAIL 30 _DAYSWRITTEN NOTICETOTHE CERTIFICATE HOLDER NAMED TOTHELEFT, X b( AUTHORIZED REPRESENTATIVE ACORD 25 -S (7/97)1 Of 3 #M446516 AXC O ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 -S (7/97) 2 of 3 #M446516 AMS 25.3 (07197) 3 of 3 #M446516 OneBeacon Architects and Engineers Extender Additional Insured Language* The following policy language is from OneBeacon Business Owners Liability Coverage Form G 15911 03 05: Form G 15911 03 05 Amends the Commercial General Liability Coverage Form: The following are added to Section II — Who is an insured: a. Person or organization required by Written Contract Any person or organization that you agree to add as additional insured under this General Liability coverage Part in a written contract or agreement that is made before, and in effect when, the "bodily injury" or "property damage" occurs or the offense that causes the "personal and advertising injury" is first committed, but only with respect to that person's or organization's liability arising out of your non- professional work for that person or organization. However such person or organization is not an additional insured with respect to any: (1) "Bodily Injury", "property damage ", or "personal and advertising injury" that does not arise out of: (a) Your Negligence: or (b) The negligence of another person or organization for whom you are liable; (2) "Bodily injury: "property damage" or "personal and advertising injury for which such person or organization has assumed liability in a contract or agreement, except for liability for damages that such person or organization would have in the absence of the contract or agreement; (3) "Property Damage" to: (a) Property owned, used or occupied by or loaned or rented to, such person or organization: or (b) Property over which such person or organization is for any purpose exercising physical control: (4) All Professional liability as an architect or engineer arising out of any construction agreement or activities under which any insured or anyone acting on any insured's behalf provides or provided service, advise, expertise or work. Construction includes, but is not limited to, the plan, conception, design, build, construct, assembly, development, safety, erection formation, reconstruct, repair, or in any improvement made to real property. Construction also includes the hiring, supervision or management of these activities. However, this exclusion does not apply to liability arising out of an insured's presence at a jobsite that was not caused by professional activities listed in the above paragraph. Primary & Non - Contributory: This insurance will be considered primary to, and non - contributory with any other insurance issued directly to a person or organization added as an additional insured. Per Project Aggregate: Section III Limits of Insurance is amended by adding the following: The General Aggregate Limit under Section III - Limits of Insurance applies separately to each of "your projects" or each location listed in the location information in the common policy declarations. Separation of Insureds: Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this Coverage Part to the First Named Insured, this insured applies: a. As if each Named insured were the only Named Insured; and b. Separately to each insured against whom a claim is made or "suit" is brought. Waiver of Subrogation: Transfer of Rights of Recovery Against Other to Us in Section IV — Commercial General Liability Conditions: However, we waive the right of recovery and proceeds we may have against any person or organization that is added as an additional insured under 1.1.a a. Because of payments we make for "bodily injury ", "property damage" or "personal and advertising injury" arising out of "your work" in ongoing operations include or included in the "products- completed operations hazard" and b. Performed under a written contract or agreement that is made before, and in effect when, the "bodily injury" or "property damage" occurs or the offense that causes the "personal and advertising injury" is committed; and c. You specifically agree in such written contract or agreement to waive those rights of recovery and proceeds for such person or organization. Named Insured: JLee Engineering Inc. Policy No.: FF11.139673 Additional City of El Segundo, its officers, officials, employees and volunteers Insured: *From Form: G15911 03 05