PROOF OF INSURANCE (2005) CLOSEDCOVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN
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.
—• -•- - - - -- -- -- --
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
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TYPE OF INSURANCE
POLICY NUMBER
DATE MM /DD/YY
DTE MM /DD/YY
LIMITS
rA LTR
NSR
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE a OCCUR
72UUVGN7129
04/01/2004
04/01/2005
EACH OCCURRENCE
$ 1 , 000 , 000
PREMISES Ea occurence
$ 300, 00
MED EXP (Any one person)
$ 10 , 000
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP /OP AGG
$ 2,000,000
GENT AGGREGATE LIMIT APPLIES PER:
POLICY PRO JECT LOC
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
72UUVGN7129
04/01/2004
04/01/2005
COMBINED SINGLE LIMIT
(Ea accident)
$
1,000,000
X
BODILY INJURY
(Per person)
$
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
AUTO ONLY: AGG
$
$
B
EXCESS /UMBRELLA LIABILITY
X OCCUR El CLAIMS MADE
]DEDUCTIBLE
RETENTION $ 10,00
72RHVGN6591
04/01/2004
04/01/2005
EACH OCCURRENCE
$ 2,000,000
AGGREGATE
$ 2,000,000
$
$
$
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER /MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
I TORY LIMITS ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE - POLICY LIMIT
$
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
The City, its officers, officials and employees and volunteers are named as additional insured as
respects liabilities arising out of activities of the named insured.
Insurance is primary.
r10 day notice for non - payment of premium.
ucm I Ir 11.,m I C nvt_ucrc
—• -•- - - - -- -- -- --
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30: DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
The City Of El Segundo
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
City Clerk's Office
350 Main Street -Room 5
AN D N THE I.RSURER, ITS AGENTS OR REPRESENTATIVES.
AUTH RIZED rSENT(IVE
El Segundo, CA 90245 -3895
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e1ArfAT1A \I Aff00
ACORD 25 (2001/08) FAX: (310)615 -0529 7
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JUL -29 -2003 TUE 04:17 PM AMETRON AUDIO /VIDEO FAX NO. 1 323 871 0127
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HOLDER. THIS CYRTIFICATC OMB
2450 7cpn $ lrwat ALTER THE COVERAGE APFORDEt
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1011y Purdy INsuRMs ARF4RI?INO COVRRAOE
n + An[ceiv»:ilnler can k'IoCtro ,C oppl y Inc. INSURER& Fveruit National
1545 North argyle Avenue INSURER :
11allywwd, Ca 90028 -6410 I liacpc;��"
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City Clerk'S Offita
ISO Main Street
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El Sa491+n44), CA 90145 -3895
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P. 02/03
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DATE tw#mrYYYY1
NAIC 0
RTIPK:ATR MAY OF. ISSUED Oft
J610 *6 AND CONDITONS Of SUCH
UMITS
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OF
.L! ADY INJURY
!
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t "i"Mpc,I81N4LE LIMIT !
1013ILY MJURY
(p" 1►reenl
OOD11 INJURY I
trw 60012m)
PROPIRTYDAMIOE
tp.r reawen[i
AUTO ONLY J FA ACCIOGNT I
OTHER TMN CA A" t
AUTO ONLY: 400 !
CACMOCCURRCNM >I
AOOREOATE !
!
D.L. ttACM ACCIDINT { _ 16000
E1. 01S EAK • FA EMPLOYE ! - 11000
G.L. OIERASF • POLICY LIMIT I �� 1.000
SMOU D ANT OF THE ANOVO De3CIDOCD POUCWS W CANCELLED OEPORE ThE
CRPIMRON DATC TNE11CtM YMC JI M NG MOURrR PALL CNOCAVOR TO [AAA.
„W._ DAYS VAUTTRN MOTOR TO TNt CRRTIMOATI NOLOM NAW TO TNO LW,
OWT FAR.YRL TO A YON N�CTIC�I GNALL IMPOSA NO ORUPATIO[I OR LUDILITY
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