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PROOF OF INSURANCE (2011) CLOSED
Client#: 126641/2 e C 305FLEMIEN■/V�_ ACORDTM C _ TIFICA O LIABILITY NV C DATE31 /20/Y0 I 08/31/2010 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., 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). PRODUCER NAME. Gloria Gabriel or Mary Faber BB&T Insurance Services PHONE Ait ...................... (A/c NAw 714 578-7000 ..........m .... of Orange County ADDRESS: 680 Langsdorf Drive Suite 100 PltcQcr� CUSTOMER IQ #:. Fullerton, CA 92831 _. ..... .......... ........ ... ...... ............................ ,� ...,..., .. ...... INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER Chards Specialty Insurance Co. 26883 t D -- ... General Ins. Co. of America 24732 INSURER B 1372 East Valencia Drive - - - - -- -------- _ INSURER C : Granite State Insurance Company 23809 Fullerton, CA 92831 INSURER ..��... ..... w .... ................... ........... _, -__---_..................,...__-._.__.. ..-...............- .......... -- -- Travelers Property Casualty Co. 25674 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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„ INSR ADDLSUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM /DD/YXYY MMRDDfYYYY A GENERAL LIABILITY PROP2018813 09/01/2010 09/01/2011 EACH OCCURRENCE _ $1 a OOO OOO OA @�r�,Ci* 10 RI IV "I "�Q , CLAIMS -MADE X LIABILITY PHEMIt?("�a {t:u oora^durcoa�r ,,..,...$1 001000 ", COMMERCIAL d CLAIMS GENERAL X- OCCUR MED EXP (Any one person) $10,000 INI Pollution Ltab Ihty PERSONAL & ADV INJURY $1,000,000 X Professional Llab. GENERAL AGGREGATE $2,000,000 ........_ ...... ... ... .. _ .. - - -- ---- -- - -------.. ......-- --................ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $2,000,000 - --.... POLICY X PRCi• LOC B AUTOMOBILE LIABILITY 24CC2857811 09/01/2010 09/01/2011 COMBINED SINGLE LIMIT $ (Ea accident) 1 _000,000 X. ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) SCHEDULED . RED AUTOS AUTOS .(Per accident) Y DAMAGE ..............................$ X H ............................... .�.,..mm...............,.,..W.. X NON -OWNED AUTOS $ A �( UMBRELLA LIAB X,, OCCUR PROU2019429 9/01/2010 09/01/2011 EACH OCCURRENCE $5 OOO OOO s,.._.... a. EXCESS LIAB CLAIMS MADE AGGREGATE $5 000 000 .. 11-11,11,111-1 -- ....m.,A..._,_. ., „,._,___... .__...,... ..... �,�_. .... ..... DEDUCTIBLE $ X RETENTION $ 10,000 $ C WORKERS COMPENSATION 003304350 5/01/2010,05101/2011 X JWC STATU- OTH- AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDE EC'U'IIVE YD N/A E,L, EACH ACCIDENT I F —B - $1,000,000 (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $1,000,000 If yes, describe under ._. _ DESCRIPTION OF OPERATIONS below E.L DISEASE - POLICY LIMIT $1,000,000 D Equipment QT6606686M19ATIL10 9101/2010109/011201 1 $160,000 Max Per Item Rented /leased $1,000 Deductible DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: Maintenance Agreement The City, its officers, officials, employees, agents and volunteers are named additional insured as (See Attached Descriptions) City of El Segundo Attn Yvette Simoneau Department of Public Works 150 Illinois Street 01988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD MJFAB ACORD 25 (2009/09) 1 of 2 #S5533805/M5533762 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE AMS 25.3 (2009/09) 2 of 2 #S5533805/M5533762 . . . ........... ..... . ..... . ENDORSEMENT NO, This endorsement, effective 12:01 AM, 9/11/10 Forms a part of Policy No: PROP 2018813 Issued to: Fleming Environmental Inc. By: Chartis Specialty Insurance THIS ENDORSEMENT CHANCES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INS�VR_EDI PRIMARY COVERAGE ENDORSEMENT . . .... . .. ... . ............. ............ PRIMARY ..... This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY AND PROFESSIONAL LIABILITY POLICY In consideration of an additional premium of $ it is hereby agreed that the folloWng is included as an Additional Insured as respects Coverage A and B but only as respects liability arising out of your work for the Additional Insured by or for you. Additional Insured: As Required by written contract This does not apply to bodily injury or property damage arising out of the sole negligence or willful misconduct of, or for defects in design furnished by, the Additional Insured. As respects the coverage afforded the Additional Insured, this insurance is primary and non-contributory, and our obligations are not affected by any other insurance carried by such Additional Insured Whether primary, excess, contingent, or on any other basis. This endorsement does not increase the Company's limits of liability as specified in the Declarations of this policy. All other terms, conditions, and exclusions shall remain the same. ------- . . . . ..... ........ . ...... AUTHORMD"REPRESENTATIVE or counfersignature (in'states where applicable) 90667 (04/06) 012791 PAGE 1 OF 1 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. R NS:R TYPE OF INSURANCE POLICY NUMBER EXPIRATION '.. POLICY EMrI"E.C"IIVE� POLICY' E.XI? SKY _ LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DAMAIaI". IO gILf�I"fiLCJ COMMERCIAL GENERAL LIABILITY CLAIMS MADE EI OCCUR MED EXP (Any one person) �. $ PERSONAL & ADV INJURY S GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS COMP /OP AGG PRO•. POLICY , E .I. LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ (Per accident) NON -OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY • EA ACCIDENT ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG —E EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE RETENTION '$��,,..... $ A WORKERS COMPENSATION AND 003304350 05/01/10 05/01/11 X WC STATU- OTIIw EMPLOYERS' LIABILITY L. EACH ACC_ TDENT $1 000,00 0 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? _E, _ El, DISEASE, EA f MP OYI:1 $1,000,000 If yes, describe under E.L. DISEASE - POLICY UMI'T $1,000,000 SPECIAL PIiOVVSIONS begow OTHER ._..��...... .. . ��... ....... .�.- DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS mmmIT IT nuWWmmmITIT "This is the Workers Compensation Renewal Only. Please retain previous certificate and endorsements for all other lines of coverages" Re: SB989 Repairs and Retest The City, its officers, officials, employees, agents and volunteers are named additional insured as (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of El Segundo DATE THEREOF, THE ISSUING INSURER WILL QI (jaRR4i MAIL _30 _ DAYS WRITTEN 150 Illinois Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, "3tAAI K El Segundo, CA 90245 IZaIIBraattIoKaacaaIItlw I Dlta: x X AUTHORIZED REPRESENTATIVE lofovoq-.10 #4j ACORD 25 (2001 /08) 1 of 3 #S4955804/M4955795 KAVON © 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 (2001/08) 2 of 3 #S4955804/M4955795 AMS 25.3 (2001/08) 3 of 3 #S4955804/M4955795 BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement changes the policy to which it Is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause' need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 4/1/10 forms a part of Policy No. 003304350 Issued to Fleming Environmental, Inc. By GRANITE STATE INSURANCE COMPANY We have a right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against any person or organization with whom you have a written contract that requires you to obtain this agreement from us, as regards any work you perform for such person or organization. The additional premium for this endorsement shall be for this policy. WC 04 03 61 (Ed. 11/90) 2 % of the total estimated workers compensation premium