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PROOF OF INSURANCE (2010) CLOSEDA Co! ZZ OP ID AD � DATE (MMJDDfYYYY) ........... CERTIFICATE OF LIABILITY INSURANCE JONES-3 11/17/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Poole Professional Ltd. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 107 Audubon Rd. #2, Ste. 305 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Wakefield MA 01880 Phone: 781-245-5400 Pax:781-245-5463 INSURERS AFFORDING COVERAGE NAIC # INSURED . ............. . . ... . ....... INSURER A: Phoenix Insurance 25623 INSURER B: Charter Oak Fire ins. Co. 25615 .. ... ....... The Jones, Payne Group INSURER C, Travelers Indemni Co. 25658 123 Washinqton Street INSURER D : Boston MA 02114 . . .... . ....... . . .... 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 BYTHE 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. . .. . . ..... .. ... ........................ . . ...... ... ........ . ... ......... —_ — .... - _ .0 , - _ --- LTR DD TYPE OF INSURANCE POLICY NUMBER DATE M.MIDONY � 1�r6CTdY`FX90D`D7YTY N LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1 qpq,000 X X COMMERCIAL GENERAL LIABILITY MISES(Eao=jre.ce) $1,000,000 CLAIMS MADE OCCUR VIED _E_X_P (Any ,one . person) s,5 000 A - - - ------- _ 680-23311,213 06/01/09 06/01/10 PERSONAL &ADV INJURY $1 000 000 INSURANCE IS PRIbWY GENERAL AGGREGATE s2,000,000 . .. GERL AGGREGATE LIMIT APPLIES PEk PRODUCTS - COMPIOPAGG $2,000,000 JECT LOC I POLICY fil PRO- r AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $1,000,000 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per Person) . .. ... . .. . . .... ........ X HIRED AUTOS BODILY INJURY B X NON-OWNED AUTOS BA-2341L323 06/01/09 06/01/10 (Par accident) S PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ . . ... .. ............. m. ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABIUTY EACH OCCURRENCE $3,00 000 X OCCUR CLAIMS UP- 6568Y159 06/01/09 06/01/10 AGGREGATE — C X $3,000,000 .......... DEDUCTIBLE RETENTION $ TA, WORKERS COMPENSATION AND WCSTI !I�O EMPLOYERS' LIABILITY R ER' ANY PROPRIETORIPARTNER/EXECUTrVE E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED? E , L, DISEASE - EA EMPLOYEE $ E6,descfiba under S At. PROVISIONS below E.L. DISEASE -POLICY LIMIT 3 OTHER A Business Owners 680-2331L213 06/01/09 06/01/10 Valuable Package I Papers $370,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS The certificate holder is included as additional insured under the general liability policy, subject to all policy terms and conditions. CERTIFICATE HOLDER CANCELLATION CIELS-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THIMSSUING INSURER ML0qffJ*W MAIL 30 DAYS WRITTEN City of El Segundo NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT ?WY4Uft441WFdrAXLX Office of City Clerk 350 Main Street El Segundo CA 90245-3813 AUTH;ORIRYPAE�WATATIVE ACORD 25 (2001/08) CACOM 11 0 - RPORATION 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 (2001108) IN5025 loioa) oea Page z or z _A__C0&), CERTIFICATE OF LIABILITY INSURANCE OP ID AD YYYY) JOKE -3 109 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Poole Professional Ltd. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 107 Audubon Rd. #2, Ste. 305 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Wakefield MA 01880 Phone: 781- 245 -5400 Fax:781-245-5463 INSURERS AFFORDING COVERAGE NAIC # . ............ . .. .... .... .... INSURER A- XL e9i�� X_ Insurance Co. 37885 �.INSURER . .. .... The Jones Payne Grou ..LNSU�RERC,___' 123 WashinaRn Str= INSURER D: Boston MA 14 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 r"R'rUWa ............ ...... POLICY NUMBER .......... P1 G(Ifi. NSR TYPEOFINSURANCE DAY -IMMfOD1111 DA (FAM/DDIVY1 LIMITS GENERAL LIABILITY EACH OCCURRENCE 3 COMMERCIAL GENERAL LIABILITY _1DANrAGI-_Rr:T4T`ED"'- PREMISES (Ea oCa , jce) ]CLAIMS MADE OCCUR MED EXP (Any one person) $ . . ........... .... PERSONAL & ADV INJURY .•a . .......... .. . GENERAL AGGREGATE GENT AGGREGATE LIMIT APPLIES PER, PRODUCTS -COMP/OPAGG $ POLICY !j: &-j LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY 5 SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY NJURY $ NON -OWNED AUTOS (Per accideril) . . ......... . PROPERTY DAMAGE 41 (Per accident) GARAGE LIABILITY AUTO ONLY • EA ACCIDENT 3 ANY AUTO OniER THAN FA ACC 3 AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE S __1 OCCUR Ej CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION 3 WORKERS COMPENSATION AND TORY k.IMIS ER EMPLOYERS' LABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? _E.L, . ..... ... E.L. DISEASE - EA EMPLOYEE $ IfIges, Oesabo under 111 .-- _Lil��Tl- ECIAL PROVISIONS below E.L. DISEASE - POLICY OTHER A Arch./Engr. I DPR9680141 06/01/09 06/01/10 Per Claim $2,000,000 jProf. Liab. Aggreclate $2 000 000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT I -SPECIAL PROV_1SJONS_"' For professional liability coverage, the aggregate limit is the total insurance available for all covered claims presented within the policy period. The limit will be reduced by payments of indemnity and expense, CERTIFICATE HOLDER CANCELLATION CERTHOLDER COPY SC P.O. BOX 420807, SAN FRANCISCO,CA 94142 -0807 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 10 -27 -2009 GROUP: POLICY NUMBER: 1880522 -2009 CERTIFICATE ID: 6 CERTIFICATE EXPIRES: 08- 01-2010 08 -01- 2009/08 -01 -2010 THE JONES PAYNE GROUP, INC. SC 2580 GARDEN RD STE 105 MONTEREY CA 93940 -5395 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. JThfORI EU REPRESENTATI PRESIDENT / EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,00 PER OCCURRENCE. ENDORSEMENT #1600 - DILLON, RANDOLPH CEO - EXCLUDED„ ENDORSEMENT #1600 - BARKER, ELLIOT SEC,TRES - EXCLUDED. ENDORSEMENT #2085 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 08 -01 -2008 IS ATTACHED TO AND FORMS A PART OF THIS POLICY.; EMPLOYER BASE ARCHITECTURE, PLANNING & ENGINEERING, INC. 617 W 7TH ST STE 405 LOS ANGELES CA 90017 M0408 IREV.2 -051 PRINTED : 10 -28 -2009 ACORD,,, CERTIFICATE OF LIABILITY INSURANCE DATE PRODUCER (503)222 -1831 FAX: (503)274-0323 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Beecher Carlson Insurance Agency LLC A4 Y HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 220 NW 2nd Ave Ste 800 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Portland OR 97209 -1831 INSURERS AFFORDING COVERAGE NAIC # INSURED wSURER A land Casualt y Cop an 19356 Base Architecture Inc INSURERBUnderwriters at Lloyds 617 W Seventh Street Suite 405 INSURER c INSURER D Los Angeles CA 90017 INSURER E OVERAOES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TH,E POLICY PERIOD INDICATED, NOIWiT'HSTANDING 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 SHOVVNi MAY HAVE BEEN REDiJ 6 INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LIMBS TYPE OF INSURANCE POLICY NUMBER DATE MWDDIYY ATE D t!MMD1Y I'll, 11 11-i— *11111-1111 GENERAL LIABILITY EACH OCCURRENCE $ 1,000,066 X COMMERCIAI GENERA. LIAF1kTY ' DAAr S O E14TED a bins mmo , $ 1, 000, 0001 A X CLAIMSMADE �ULCUR�',..PAS42202g30 5/21/2009 5/21/2010 MEDEXP Anvono person) $ 10,000. 1,000,000 PER,1�IaAIAaYI GENERAL AGGREGATE S 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER O.. S _ co PN r„.. S 3,000,000 PRO. AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 ANY AUTO (Ea acadenl) $ A ALL OWNED AUTOS IPAS42202730 5/21/2009 5/21/2010 BODILY INJURY (Per Person) $ SCHEDULED AUTOS X HIREDAUTOS BODILY INJURY $ X I NON•OVNJED AUTOS (Peracadml) $ PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC AUTO ONLY AGG EOSIURBRELLA® I FIE�rv1C $ CLAIMS MADE AGGREGATE. DEDUCTIBLE $ 1 11 RETENTION I WORKERS COMPENSATION AND "T T OT 1• EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERJEYECUTIVE E.:L,. EACH ACCIDENT OFFICERIMEMBER EXCLUDED? E,L DISEASE - EA EMPLOYEE $ If yes. describe under SPECIAL„ PROVISIONS bean EL DISEASE, POLICY LIMIT $ B OTHER Professional Liab SUAAFBB50106 7/21/2009 7/21/2010 Aggregate $2,000,000 Occurrence $1,000,000 DESCRIPTION OF OPERATIONSI LOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS The Janes Payne Group, Inc is included as additional insured as respects general liability where required by written contract. Waiver of subragation included an general liability. This form is subject to policy terms, conditions, and exclusions, CERTIFICATE HOLDEN CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE The Jones Payne Group, Inc EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 2560 Garden Road, Ste 105 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT Monterey, CA 93940 FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE '.. INSURER. ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENT ATIVE Jeryl Coleman / JERYCO ACORD 25 (20OV08) C ACORD CORPORATION' 1988 I N5025 Iwo) Oea Page 1 012