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PROOF OF INSURANCE (2012) CLOSEDDATE (MMIDDIYYYI') - -.... Iu CERTIFICATE OF LIABILITY INSURANCE DA-FE 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. It the certificate holder is an ADDITIONAL INSURED, the pollcy(los) must be endorsed. If SUBROGATION IS WAIVE, 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). ?DUCER .NAME; M „2l e, ,. cerWest Insurance Services PHONE TV. IAA - #0 NA Yg 5 ARESs16 1 w ns . com N I ot l and CA9695 xiRbuc R ,,, C T4N8R I7.N• USHEAI .. _ INSURER(S VISORED iE'.`e.l'tlamrol "I�r, rJ .L.(.:1.. T1 Cf YiYr:7 c5Y ..... I. ..... .... ----..... ,.._...... INSURERA Scottsdale )' ` .1 ``" ` INSURERS: Safet ' Nat, 25124 Springfield Ct., Ste 200 Valencia CA 91355 INSURER C: Travelers INSURER D INSURER E Cas COVERAGES CERTIFICATE NUMBER: 2073239167 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN N astlED TO THE INNSURE'D NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUNREMENNT„ TERM OR OONDII"I"ION OF ANY CONTRACT OR OTHER DOCUN'�IENJ'T' WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN M SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS'S'HOV0J MAY HAVE BEEN REDUCED BY PAID CLAIMS; Vfk TYPE OF INSURANCE A GENERAL LIABILITY % COMMERCIAL GENERAL LIABILITY CLAIMS- IVIADE IX � OCCUR 1,,FJ,TL AGGREGATE LIMIT APPLIES PER POLICY V r I), x,,.,.. LOC C AUTO MOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS CUR A �X'... �.....ED CESS LBAE AB ..... �X CL IMS MADE NAIC p 41297 - INSR WVD 11 POLICY NUMBER MMIODIYYYY „)MMIMPY:;YY..t. I LIMITS Y BCS0022924 9%1/2011 9/1/2012 EACH OCCURRENCE $1,000,000 v ., ,. ®,,,, Sm ih aa¢m rl le, e $ "00 „00 ..... IVIED EI XP (Any o one person) $ 10,0 PERSONAL 3 ADV INJURY $1,000,000 G_ENEnA .AGGREGATE $3,000,000 � ...... PRODUCTS - COMPIOP AGG $3,00G.000 BA7470R699 9/1/2011 9/1/2012 COMBINED SINGLE LIMIT (Ea accident) ,....... $1,000,000 .......... ------ BODILY INJURY (Per person) ... ...... ......... $ BODILY INJURY (Pei accident) $ PROPERTY DAMAGE $ (Per accident) ....----- .............. ..... .... ..... ------ $ RLS007646a 9/1/2011 9/1/2012 EACH OCCURRENCE $25,000,000 T _AGGREGATE _....- .. .... $25,000,000 0 $--_—_. $ B WORKERS COMPENSATION LDC4042721 AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR /PARTNERIEXECUTIVE OFFI CERIMEMBER EXCLUDED? ❑ NIA (Mandatory in NH) IlYes, describe under 1/2011 9/1/2012 EL E EL DISEASE- POLICY LIMIT $1,000.000 4 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) ADDITIONAL INSURED IN FAVOR OF CITY OF EL SEGUNDO, ITS OFFICIALS, AND EMPLOYEES (ON ALL POLICIES EXCEPT WORKERS' COMPENSATION /EL AND MEDICAL PROFESSIONAL LIABILITY) WHERE AND TO THE EXTENT REQUIRED BY WRITTEN CONTRACT. L9J3CA1171y_\1= CANCELLATION 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 350 MAIN STREET EL SEGUNDO CA 90245 -3813 AUTHORIZED REPRESENTATIVE ©1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD POLICY NUMBER:BCS0022924 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following,. COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organ ization s : Location And Description Of Completed Operations C:I`:V'Y OF LL SN(:.,UND0 ADDIT'Tt7I AT. I SURE2 IN PAVOR OF CUPY OF EL 3'30 N[AIN Si'RERT SECUNDO, ITS OFFI( IAES, AND EMPLOYNFS (ON L:L SECC[. UNDO CA 90245 -3£313 ALL POLICTRS EXCEPT WORKERS' COI. PE.i01SWTIf7N/EL AND NEDICAIC E'F OPESS LC)l` A L:LABILIT'Y) WHERE AND TO THE EXTENT REQUIRED BY WR:YT °TEN CONTRACT. Information required to complete this Schedule, if not shown above will be shown m the Declarations. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property dam- age" caused, in whole or in part, by "your work" at the location designated and described in the sched- ule of this endorsement performed for that additional insured and included in the "products- completed operations hazard ", CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 � r� GATE (MMIDDIYYYYI � CERTIFICATE OF LIABILITY INSURANCE 5f 9/2011 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, EXTENT) 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 certificate holder in lieu of such endorsement(s). TACT PRODUCER NA aE_; Michell _Goodwin. InterWest Insurance Services PHONE FAX License #01301094 2,1" ,,F,>4Si .S .tl ..65 r..i3Sdth (A� MAIL 222 Court: Street ADDRESS.. mcfq W-i catrt.... Woodland CA 95695 GV574I�IB.iD( tJSi A INSURERM) AFFORDING COVERAGE NAIC 0 INSURED INSURER q: U.S. Healthworks, Inc, 1NSURERB 25124 Springfield Ct., Ste 200 Valencia CA 91355 -INSURER C. E: COVERAGES CERTIFICATE NUMBER: 194 853 9903 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. m... A-DrYL SU(lYt..,...... .P......,_.... _� ............ P L G+ EF6 kt, C'i" xP TYPE OF INSURANCE INSR OLICYNUMBER D YY ! D YYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ ..� -• RooaEer (a eCCUR�n CO�4hCLAIMS•MADE IERCLIL GENERAL LIABILITY PRA SQL, OCCUR MEDEXP $ ..., ,... -J OCCUR � song M._ � ..,,,�... _- PERSONAL & AnV INJURY $ GENERALAGGREGAT£ $ GENLAGGREGATE LIMIT APPLIES PER: PRODUCTS- COMP/OPAGG $ POLICY ._., PO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO 130DILY INJURY (Per person) �..--._— -._ ........ $ ALLpWNEDAUT05 BODILY �_._. INJURY(Paraoddent) ... $ .. SCHEDULEDAUTOS .... PROPERTY DAMAGE 3...... HI RED AUTOS (Per accident) NON -OWNED AUTOS $ UMBRELLA LIAR OCCUR BCLA EACH OCCURRENCE $ EXCESS LIAR MS-MADE AGGREGAT........._.m DEDUCTIBLE $ .. .............. ..�._ ._ RETENTION $ WORKERS COMPENSATION WC STATU OTH AND EMPLOYERS' LIABILITY YIN ,_.......TORYLth,115... .. .... _._...__......_m�,_w ANY PROPRIETORIPARTNER/EXEW 11VE OFFICEMIEMBEREXCLUDED? NIA E.L EACH ACCIDENT $ ._._ __._...,... ,„,.,„,.„. ..... (Mandatory In NH) E.L. DISEASE -EA EMPLOYE $ DESCRIP ON OF OPERATIONS below E.L. DISEASE OLICY E LIMIT $ A C+9mci3ca1..vlaipractico 69727 ..5/1/2011 5/1/2012 .Aggregate $3,ODO,000 Limit $1,000,000 Deductible $100,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more space is required) Loc #309 , LAX 101il:tl1affil imiL900111?Ji1 U. S. Healthworks, Inc. 390 N. Sepulveda, Suite :L 0 El Segundo CA 90245 I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY P'ROVISI aN'$. AUTHORIZED REPRESENTATIVE S ' © 9988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD