PROOF OF INSURANCE (2005) CLOSED1PRODUCER
Marsh USA Inc.
The Financial Center
1215 Fourth Avenue
Suite 2300
Seattle, WA 98161 -1095
Attn: ATTWIRELESS .CERTREQUEST @MARSH.COM
105408- RANCH - ALL -04 -05 1027220086 LAH GAEW
INSURED
AT &T WIRELESS SERVICES, INC.
3140 GOLD CAMP DR., SUITE 300
RANCHO CORDOVA, CA 95670
CERTIFICATE NUMBER
SEA - 000621836 -04
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE
POLICY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
AFFORDED BY THE POLICIES DESCRIBED HEREIN.
COMPANIES AFFORDING COVERAGE
COMPANY
TYPE OF INSURANCE
A
AMERICAN HOME ASSURANCE CO
COMPANY
LIMITS
B
NATIONAL UNION FIRE INS. CO.
COMPANY
07109/04
C
INS CO OF THE STATE OF PA
COMPANY
PRODUCTS - COMP /OP AGG
D
AMERICAN INTERNATIONAL SPECIALTY LINES INS. CO.
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS AND EXCLUSIONS OF SUCH POLICIES.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MM/DD/YY)
POLICY EXPIRATION
DATE (MM /DDNY)
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
77cLAIMS MADE a OCCUR
OWNER'S & CONTRACTOR'S PROT
X $1,000,000 SIR
RMGL 5350857
07109/04
07i09i05
GENERAL AGGREGRATE
$ 4,000,000
PRODUCTS - COMP /OP AGG
$ 4,000,000
PERSONAL & ADV INJURY
$ 1,500,000
I EACH OCCURRENCE
$ 1,500,000
FIRE DAMAGE (Any one fire)
$ 1,500,000
MED EXP (Any one person)
$ 5,000
A
B
B
X
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
RMCA 5189336 (AOS)
RMCA 5189335 (MA)
RMCA 5189334 (TX)
07/09/04
07/09/04
07/09/04
07/09/05
07/09/05
07/09/05
COMBINED SINGLE LIMIT
$ 2,500,000
BODILY INJURY
(Per person)
$
B (per aca ent)
(per accident)
$
PROPERTY DAMAGE
$
GARAGE LIABILITY
ANY AUTO
AUTO ONLY- EA ACCIDENT
$
OTHER THAN AUTO ONLY:
..rT
;r
EACH ACCIDENT
$
AGGREGATE
$
D
EXCESS LIABILITY
X UMBRELLA FORM
OTHER THAN UMBRELLA FORM
BE 7411885
07/09/04
07/09/05
EACH OCCURRENCE
$ 5,000,000
AGGREGATE
$ 5,000,000
$
C
A
B
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
THE PROPRIETOR/
PARTNERS /EXECUTIVE
OFFICERS ARE: EXCL
RMWC 5213148 (AOS)
RMWC 5213147 (CA)
213151 (OR)
07/09/04
07/09/04
07/09/04
07/09/05
07/09/05
07/09/05
X
WC STATU-
TORY LIMITS
OTH-
ER
i
EL EACH ACCIDENT
$ 2,500,000
EL DISEASE - POLICY LIMIT
$ 2,500,000
EL DISEASE -EACH EMPLOYEE
$ 2,500 000
' C OTHER RMWC 5213150 07/09/04 07/09/05 LIMITS & COVERAGES
WORKERS' COMPENSATION (AR,ME,MO,NC,NV,NY) SAME AS ABOVE
A RMWC 5213149 07/09/04 07/09/05
(ND,OH, WA, WI, WV, WY)
DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES /SPECIAL ITEMS
SITE CODE: EL SEGUNDO WATER TANK /0086 CONTRACT NO: 400 LOMITA ST LOCATION: 400 LOMITA ST., EL SEGUNDO, CA. 90245 TERM OF CONTRACT 10/28/02
TO 10/27/22
THE CITY OF EL SEGUNDO IS AN ADDITIONAL INSURED AS RESPECTS THEIR INTEREST IN THE OPERATIONS OF THE NAMED INSURED AS REQUIRED BY WRITTEN
CONTRACT REGARDING GENERAL LIABILITY.
SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION
CITY OF EL SEGUNDO DATE THEREOF, THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL 30 DAYS
ATTN: ROGER GROMAN, CITY MANAGER WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED HEREIN,
350 MAIN ST. MX300ZXXAWNWXXXKMXM XXXX
EL SEGUNDO, CA 90245 xx�1t)Daxc x>ecXaoecxxxxx
ri DDB X XK XXXXXXXXXXXXXXxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
MARSH USA M.
BY: Edward M. Belsky LL �''t,•