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PROOF OF INSURANCE (2012) CLOSED14C.OR ., CERTIFICATE OF LIABILITY INSURANCE ^DATE(MMIDDIYY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dealey, Renton & Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 199 S Los Robles Ave Ste 540 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Pasadena, CA 91101 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 626 844 -3070 INSURERS AFFORDING COVERAGE INSURED INSURER A: KOA Corporation INSURER B: 1100 Corporate Center Dr #201 ............... Monterey Park, CA 91754 ..INSURER C: 323 - 260 -4703 INSURER D: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. OTWITHSTANDING 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 'PERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER LTR POLICY EFFECTIVE POLICY EXPIRATION LIMITS B GENERAL LIABILITY 6802075L840 6/15/2011 3/13/2012 EACH OCCURRENCE _. $1, 000— Q0.Q.- , x COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $1,000, 000 ..m CLAIMS MADE D OCCUR MED EXP Any one person) $ j Q Q Q (� GENERAL AGGREGATE ..a- GEN'L AGGREGATE L IIMIIT APPLIES POECR: PRODUCTS COMP /OP AGG $ 2 , 0 0 0 ,� 0 0 0 I B AUTOMOBILE LIABILITY BA2A4 3 9 5 6 8 6/15/2011 3/13/2012 COMBINED SINGLE LIMIT X ANY AUTO $1 0 0 (Ea accident) 000, 000 ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ } NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN .................. ._._. AUTO ONLY: AGG $ A EXCESS LIABILITY CUP6464YO33 6/15/2011 3/13/2012 EACH OCCURRENCE $4, 000p 000_ _ ,+ OCCUR q CLAIMS MADE AGGREGATE 1-4- Q I Q 41 Q-Q Q- DEDUCTIBLE $ TtEfENTION $ . $ C WORKERS COMPENSATION AND WZP80995936 9/19/2011 9/19/2012 X WC STATU- _,,O fH TORYMMITS_X,�)Z, EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $1,- 0 0 0, 0 0 0 EL.DISEASE -EA EMPLOYEE! $1, 000, 0 00 E L, DISEASE - POLICY LIMIT $1 Q Q QD D OTHER G23631684006 3/13/2011 3/13/2012 $2,000,000 per claim Professional Liability $4,000,000 Annual Aggr DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Phe City of E1 Segundo, its officials, and employees are named as additional insured as respects general liability for claims arising from the operations of the named insured. CERTIFICATE HOLDER ADDITIONAL INSURED; INSURER LETTER: CANCELLATIONIQ pgay 12otigp a- t ', s SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER City of E1 Segundo, City Eng Dept WILL MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER 1 350 Main St. NAMED TO THE LEFT. E1 Segundo CA 90245 AUTHORIZED REPRESENTATIV ACORD 25 -S (7/971 CORD CORPORATION 1988 POLICY NUMBER: 6802075LB40 COMMERICAL GENERAL LIABILITY ISSUE DATE: 9/29/2011 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL AL INS D (ARCHITECT'S, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE NAME OF PERSON(S) OR ORGANIZATION (S): City of E1 Segundo, City Eng Dept 350 Main St. E1 Segundo CA 90245 PROJECT /LOCATION OF COVERED OPERATIONS: The City of E1 Segundo, its officials, and employees -- Re: All Operations PROVISIONS A The following is added to WHO IS AN INSURED (Section II): The person or organization shown in the Sched- ule above is an additional insured on this Cover- age Part, but only with respect to liability for bod- ily injury", 'property damage" or 'personal injury caused, in whole or in part, by your acts or omis- sions or the acts or omissions of those acting on your behalf: a. In the performance of your ongoing oper- ations; b. In connection with premises owned by or rented to you; or C. In connection with your work and included within the "products- completed operations hazard." Such person or organization does not qualify as an additional insured for "bodily injury", "property damage" or "personal injury' for which that person or organization has assumed liability in a contract or agreement. The insurance provided to such additional insured is limited as follows: d. This insurance does not apply to the render- ing of or failure to render any "professional services ". The limits of insurance afforded to the addi- tional insured shall be the limits which you agreed in that 'contract or agreement requir- ing insurance" to provide for that additional insured, or the limits shown in the Declarations for this Coverage Part, whichever are less. This endorsement does not increase the limits of insurance stated in the LIMITS OF INSURANCE (Section III) for this Coverage Part. B. The following is added to Paragraph a. of 4. Other Insurance in COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): However, if you specifically agree in a contract or agreement requiring insurance that, for the addi- tional insured shown in the Schedule, the insur- ance provided to that additional insured under this CG D3 82 09 07 Page 1 © 2007 The Travelers Companies, Inc. Includes the copyrighted material of Insurance Services Office Inc., with its permission COMMERICAL GENERAL LIABILITY Coverage Part must apply on a primary basis, or a primary and non - contributory basis, this insurance is primary to other insurance that is available to such additional insured which covers such additional insured as a named insured, and we will not share with the other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought occurs; and (2) The "personal injury" for which coverage is sought arises out of an offense committed; after you have entered into that "contract or agreement requiring insurance" for such additional insured. But this insurance still is excess over valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured when the additional insured is also an additional insured under any other insurance. C. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us in COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): We waive any rights of recovery we may have against the additional insured shown in the Schedule above because of payments we make for "bodily injury ", "property damage" or "personal injury" arising out of "your work" on or for the project, or at the location, shown in the Schedule above, performed by you, or on your behalf, under a "contract or agreement requiring insurance" with that additional insured. We waive these rights only where you have agreed to do so as part of the "contract or agreement requiring insurance" with that additional insured entered into by you before, and in effect when, the "bodily injury" or "property damage" occurs, or the "personal injury" offense is committed. D. The following definition is added to DEFINITIONS (Section V): "Contract or agreement requiring insurance" means that part of any contract or agreement under which you are required to include the person or organization shown in the Schedule as an additional insured on this Coverage Part, provided that the "bodily injury" and "property damage" occurs, and the "personal injury" is caused by an offense committed: a. After you have entered into that contract or agreement; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. CG D3 82 09 07 Page 2 © 2007 The Travelers Companies, Inc. Includes the copyrighted material of Insurance Services Office Inc., with its permission