PROOF OF INSURANCE (2008) CLOSEDACORDT. CERTIFICATE OF LIABILITY INSURANCE 03/18/08
HRH Professional Practice ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
100 Marine Parkway, #200 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Redwood City, CA 94065-1517
650 369-5900 INSURERS AFFORDING COVERAGE
INSURED
43""0 S. Garfield Avenue, #320
Alhambra, CA 91001
INSURER A: Emr)lovers Fire Insurance C
/wvvps � OnnBoaoonAmohco|nsumnooCom INSURER c: Ace American Insurance Company
1 111111111111-
INvv^s D:
INSURER E:
oovsnAmso
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTIANDING
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 CONDIT17ONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYPE OF INSURANCE POLICY NUMBER
LIMITS
A GENERAL LIABILITY 1U39673 09/01/07 09/01/08
EACH OCCURRENCE s2000000
X COMMERCIAL GENERAL LIABILITY
FIRE DAMAGE (Any one fire) $3010,000
CLAIMS MADE OCCUR
MED EXP (Any one person $5000
GENERAL AGGREGATE s 4,
A AUTOMOBILE LIABILITY 1U39673 09/01/07 09/01/08
COMBINED SINGLE LIMIT
$2,000,000
ANY AUTO
(Ea accident)
ALL OWNED AUTOS
BODILY INJURY $
SCHEDULED AUTOS
(Per person)
X HIRED AUTOS
BODILY INJURY
X NON-OWNED AUTOS
(Per accident)
(Per accident)
GARAGE LIABILITY
- EA ACCIDENT $
ANY AUTO
OTHER THAN ACC $
AUTO ONLY: AGG $
E�CESS LIABILITY
EACH OCCURRENCE $
OCCUR CLAIMS MADE
AGGREGATE
LDEDUCTIBLE
EMPLOYERS' LIABILITY
E L EACH ACCIDENT $1,000,000
EA EMPLOYEE $1,000,000
E-L, DISEASE -POLICY LIMIT $1,000,000
C OTHER
Professional EONNO0917977004 11/02/07 11/02/08
$1,000,000 Per Claim
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLESiEXCLUSIONS 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)
CERTIFICATE HOLDER ADDITkONAL INSURED,� INSURER LETTEM CANCELLATION jun, Day NQti!;g
fgr NQn-E!ilygigilt Qf Prgmium
SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of El Segundo DATE THEREOF, THE ISSUING INSURER WI%XfflM)(§& TO MAIL'Ifl DAYSWRITTEN
Attn: Sam Lee, Building Manager NOT10ETOTHE CERTIFICATE HOLDERNAMED
TOTHE LEFTjWAXXjM"0(X)00Q00WXk
350 Main Street
AUTHORIZED REPRESENTATIVE
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.
ACORD25- S(7197)2 of 3 #S432113/M398016
AMS 25.3 (07/97) 3 of 3 #S432113/M398016
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 G15911 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: Kee Engineering Inc. Policy No.: 1U39673
Additional City of El Segundo, its officers, officials, employees and volunteers
Insured:
*From Form: G15911 03 05