PROOF OF INSURANCE (2011) CLOSED� f
4� �e DATE (MMIDDIYYYY)
CERTIFICATE OF LIABILITY INSURANCE 611/2011 6/1/2010 ---. -
PRODUCER Lockton Insurance Brokers, LLC THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
725 S. Figueroa Street, 35th Fl. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
CA License #OF1 5767 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Los Angeles CA 90017 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
(213) 669-0065
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED- NOTWITHSTANDING
INSURERS AFFORDING COVERAGE
NAIC #
INSURED Joe's Sweeping, Inc.
1026052 dba: Nationwide Environmental SerV rI s
and JNL Building Services
11914 Front St.
Norwalk CA 90650
INSURER A ° Granite State Insurance Company
23809
INSURER B : United States Fire Insurance Company
21113
INSURER C : St Paul Fire and Marine Insurance Co
24767
INSURER D
INSURER E'
GENERAL LIABILITY
COVERAGES JOESW01 P4 THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING
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
ADD'L
INSRD
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MMlD
POLICY EXPIRATION
DATE (MWDDIYY)
LIMITS
X
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE a OCCUR
02LX- 0$6477711 -1
61112010
6/1/2011
DAMAGE TO RENTED
PREMI aoccurence
$ 300 000
MED EXP (Any one person)
$ 10,000
PERSONAL & AOV INJURY
$ 1000 000
GENERAL AGGREGATE
$ 2,000,000
GEWL AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMPIOP AGG
$ 2,000,000
PRO -
POLICY JECT LOC
A
AUTOMOBILE LIABILITY
X ANY AUTO
02CA- 019656311 -1
6/P2010
6 /1/2011
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
BODILY INJURY
(Per person)
$ XXxxxxX
ALL OWNED AUTOS
SCHEDULED AUTOS
X HIRED AUTOS
X NON- OWNEDAUTOS
BODILY INJURY
(Per accident)
$ X)CxxxXX
PROPERTY DAMAGE
(Per accident)
$ X�X
GARAGE LIABILITY
ANY AUTO
NOT APPLICABLE
AUTO ONLY - EA ACCIDENT
$ xxxxic%
OTHER THAN EA ACC
$ XXXXXM
AUTO ONLY: AGG
$ XXXXXXX
C
EXCESSIUMBRELLA LIABILITY
X OCCUR CLAIMS MADE
QK04500$58
6/1/2010
61I 12011
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$ 1,000,000
$ XXXXXxx
UMBRELLA
$ XXXXXXX
❑
DEDUCTIBLE X FORM
$ xxxxxxx
XJ RETENTION S 10,000
B
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY YIN
ANY PROPRIETORIPARTNERlEXECUUVE
OFFICERNEMBER EXCLVDED7 FNJ
(Mandalary in NH)
If yes, describe under
SPECIAL PROVISIONS bekw
TBD
6/112010
6/1%2011
X WC STATU- OT
TORY LIMIT ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE I
$ 1,000,000
E.L. DISEASE -POLICY LIMIT 1
$ 1,000,000
A
OTHER
02CA- 019656311 -1
6 /1/2010
6/1/2011
Physical Damage Limit ACV: $100,000
Hired Auto Physical Damage
Ded.: $ 100 Com�ensive
Ded.: 51,000 Co 11 isi
DESCRIPTION OF OPERATIDNSILOCATION SIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
Auto Liability Physical damage deductibles: $100 Comprehensive and $1,000 Collision, Re: RFP No. 03 -OI - To provide sweep ng of streets, alleys and city-owned
parking lots, City of El Segundo, its officers, officials, emplo ees, agents and volunteers are named as an Additional Insured as their interest may appear as
respects to General Liability per the attached endorsement. Coverage provided is primary and non - contributory.
%,r-m I Irwx I c nULUerc L;AIVC:tLLA I IVN tvLY ro f o r
1876365 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
El S undo DATE THEREOF, THE ISSUING INSURER WILL I,-tX MAIL 30 DAYS WRITTEN
City 0T El Segundo NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Cindy Mortesen
350 �
350 Main Street
El Segundo CA 90245
r e010 T
ACORD 25 (2009101) 1988-Mbg ACOR15 CORPORATION. All nahts reserved
The ACORD name and logo are registered marks of ACORD
For auestions Fenardino this certificate. contact the number Ii d in Om'P ucer section shave and snecifv the client code'JOESWOV.
COMMERCIAL GENERAL LIABILITY
POLICY NUMBER: 02LX-08647771 1 -1
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - (FORM B)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
Name of Person or Organization: WHERE REQUIRED BY WRITTEN CONTRACT
(If no entry appears above, information required to complete this endorsement will be shown in the
Declarations as applicable to this endorsement.)
WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown
in the Schedule, but only with respect to liability arising out of "your work" for that insured by or for you.
CG 20 10 11 85 Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1
Miscellaneous Attachment: M448164
Certificate ID : 1876365