PROOF OF INSURANCE (2008) CLOSEDA C C T I I C
DATE D/rY)
LIABILITY I N S A C
.
08/29/07
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Armstrong /Robitaille Full 1010
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
680 Lan sdorf Drive #100
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
g
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P.O. Box 34009
WW
Fullerton, CA 92834 -9409
INSURERS AFFORDING COVERAGE
i
INSURED
INSURER A American Intl Specialty Lines Ins Co
Fleming Environmental Inc.
°° - ° °m ° °- ..........m. _ _
INSURER B: American States Ins. Co.
6130 Valley View Street
N R c :e-
INSURER c: Redwood Fire &Casualty Ins Co
Buena Park, CA 90620
_
INSURER D: Hartford Fire Insurance Company
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 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.
INSR
LTR TYPE OF INSURANCE POLICY NUMBER
POLICY EFFECTIVE „- POLICYEXPIRAT10N
DATE (qWQD /+,Py . ...PATE MMlp, yy LIMITS
A GENERAL LIABILITYPROP2O18813
09/01/07 09/01/0$ EACH OCCURRENCE $1j000,000
X COMMERCIAL GENERAL LIABILITY
FIRED one fire) $100,000
�
CLAIMS MADE X OCCUR
MED EXP (Any one
y e person) $10,000
X 1BI 1PD Ded 5,000
PERSONAL & ADV INJURY $1,000,000
X lPollution Incl. _
GENERALAGGREGATE $1,000a000
GEN'L AGGREGATE LIMITAPPLIESPER:
_
PRODUCTS - COMP /OPAGG $1,000,000
PRO L
POLICY X Q OC
)
_ ... .................... _._.. ......_........... w.......... ............................... _ ....._..
B j AUTOMOBILE LIABILITY 01 CH1784762
.
09/01/07 09101/0$
i X ANY AUTO
COMBINED SINGLE LIMIT
(Ea accident) $1,000,000
ALL OWNED AUTOS
BODILY INJURY
$
SCHEDULED AUTOS
(Per person)
X
HIRED AUTOS
BODILY INJURY $
X NON -OWNED AUTOS
(Per accident)
_..
PROPERTY DAMAGE $X
(Per accident)
GARAGE LIABILITY
AUTO ONLY EA ACCIDENT $
f ANY AUTO
EA ACC $
OTHER THAN
AUTO ONLY: AGG 1$
A EXCESS LIABILITY PROU2019429
_. .......
09/01107 09/01/08 EACH OCCURRENCE $4 a OOO 000
Xet OCCUR CLAIMS MADE
_
AGGREGATES $4,000,000
DEDUCTIBLE
Sr
X1 RETENTION $10'000
,
$._-
C WORKERS COMPENSATION AND W7536404
.._
_....,�.__-- _-- - -.... - . ..
05/01/07 05 /01 /08 X
EACH ACCIDENT $1,000,000
El DISEASE -EA EMPLOYF - $1,000,000
El DISEASE' - POLICY LIMIT I $1,000,000
D ; OTHER Equipment 72MSKF9548
...
09/01/07 09/01/08 11,000 Deductible
'Rented /Leased
r
$150,000 Max Per Item
..................
DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY
ENDORSEMENT /SPECIAL PROVISIONS,.. ........ .............._...._
* *10 Day notice to insured of cancellation for non - payment
of premium /non- reporting of
payroll. No other modification to the cancellation section in this certificate will apply
to the Workers' Compensation coverage. Employers Liability
limit $1,000,000 (per
accident /aggregate policy limit). **
(See Attached Descriptions)
CERTIFICATE HOLDER i ADD moNALINSURED INSURER LETTER: CANCELLATION
SHOULD ANYOF TH E ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of El Segundo
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3O__ DAYS WRITTEN
350 Main St.
NOTICE TO THE CERTIFICATE HOLD ER NAM EDTOTHELEFT, BUT FAILURE TO DO SOSHALL
El Segundo, CA 90245
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURERJTS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
ACORD 25 -S (7/97)1 of 3 #M403828
MMWHI 0 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 (7/97) 2 of 3 #M403828
AMS 25.3 (07/97) 3 of 3 #M403828
N
ENDORSEMENT NO,
This endorsement, effective 12;01 AM, 9/1/07
Forms a part of Policy No: PROP 2018813
Issued to: Fleming Environmental Inc.
By - American International Specialty Lines
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY,
ADDITIONAL INSURED /PRIMARY COVERAGE ENDORSEMENT
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 following 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 budily 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. / / -~
" � I
AUTH0 Wt D'RE
PRESENTATIVE
or countersignature (in °states where applicable)
90667 (04/06)
C12791 PAGE 1 OF 1
Client #. 11806 FLEMINEN'V
DATE
M CERTIFICATE OIL LIABILITY ITY INSUR NCE 04/27/07D/YY,
'AOOUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Armstrong /Robitaille Full 1010 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
680 Lan sdorf Drive #100 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
g ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P.O. Box 34009
Fullerton, CA 92834 -9409 INSURERS AFFORDING COVERAGE
._..
INSURED i INSURER A: Redwood Fire & Cas Ins Co (Tanner)
Fgl %'1 Mlmoo-, '` INSURER B:
6130 Valley View Street ,...... ........,
INSURER C
Buena Park, CA 90620 _
INSURER D:
I 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
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.
INSR
LTR I TYPE OF INSURANCE
.....................................................
POLICY NUMBER
POLICY EFFECTIVE
( DATE MM /DDfYY
POLICYEXPIRATI�ON
DATF (jWIMdDDdYY) LIMITS
__. .. ..... ..... _ . ............. .................. ._.
GENERAL LIABILITY
EACH OCCURRENCE j $
COMMERCIAL GENERAL LIABILITY
GE (Any
FIRED y fire) �$
CLAIMS MADE OCCUR
MED EAM�
person
An o ) $
.XP ..
PERSONAL & ADV INJURY $
AGGREGATE �$
,.�GENERAL
GEN'L AGGREGATE LIM ITAPPLIES PER:
PRODUCTS - COMP /OP AGG $
POLICY (), �� LOC
........... _ ..�.�....
.. .....................................................
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT $
ANY AUTO
(Ea accident)
ALL OWNED AUTOS
BODILY INJURY $
SCHEDULED AUTOS
(Per person)
HIRED AUTOS
BODILY INJURY $
NON -OWNED AUTOS
(Per accident)
PROPERTY DAMAGE $
i
( Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT � $
hANY AUTO
OTHER THAN EA ACC $
GAUTO
ONLY: AGG $
EXCESS LIABILITY
EACH OCCURRENCE $
OCCUR l CLAIMS MADE
AGGREGATE $
DEDUCTIBLE
$
RETENTION $
$
A WORKERS COMPENSATION AND
W7536404
05101/07
05/01/08 X � Q8Y LIM1T5_ , FR
EMPLOYERS' LIABILITY
El, EACH ACCIDENT $1,000,000
EASE - EA EMPLOYEEz $1,000,000
El DISEASE - POLICY LIMIT $1,000,000
OTHER
DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES
/EXCLUSIONS ADDED BY ENDORSEMENT
/SPECIAL PROVISIONS
* *10 Day notice to insured of cancellation
for non - payment of premium
/non - reporting
of
payroll. No other modificiation to
the cancellation section in this
certificate will
apply to the workers' compensation
coveration. Employers liability
limit $1,000,000(per
accident /aggregate policy limit)
**
(See Attached Descriptions)
CERTIFICATE HOLDER ADD
ITIONAL INSURED 'INSURERLETTFM
CANCELLATION
SHOULD ANYOF TH E ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of El Segundo
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYSWRITTEN
350 Main St.
NOTICE TO THE CERTIFICATE HOLDER NAM EDTOTHELEFT, BUTFAILURE TO DOSOSHALL
El Segundo, CA 90245
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURERJTS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTQVE
ACORD 25 -S (7/97)1 of 3 #M382468 MMWHI 0 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.
ACORD25- S(7/97)2 of 3 #M382468
u DESCRIPTIONS (Continued from Page 1) 1
RE: All Operations
Certificate holder is named additional insured as respects general
liability per the attached endorsement.
AMS 25.3 (07/97) 3 of 3 #M382468