PROOF OF INSURANCE (2005) CLOSED;
CERTFICATE NUM BER
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HOU'000527484 06
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
Marsh USA Inc. NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE
1601 Elm St. POLICY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
Suite 2100 AFFORDED BY THE POLICIES DESCRIBED HEREIN.
Dallas75201 COMPANIES AFFORDING COVERAGE
Attn: Rosie Perez Fax (212) 948 -0500
COMPANY
99043 — all -04 -05 02721 W EL CA A AMERICAN HOME ASSURANCE CO
INSURED S .
COMPANY
Blockbuster Inc.
B NATIONAL UNION FIRE INS. CO. OF PITTSBURGH, PA
1201 Elm St.
COMPANY
Dallas, TX 75270
C INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA
COMPANY
D ILLINOIS NATIONAL INSURANCE COMPANY
.:
,.,,f, ,�� .,.. 1 "hisctrtif#auparfi�das`andreploe an, Y. k! reuioi�lY' Issuedcsrtiflcate ;tsr4the;P11cY.{idtillci�lq►;
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY
PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS AND EXCLUSIONS OF SUCH POLICIES. AGGREGATE
LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MM /DD/YY)
POLICY EXPIRATION
DATE (MM/DD/(Y)
LIMITS
A
GENERAL
LIABILITY
GL 5548709
09/30/04
09/30/05
GENERAL AGGREGATE
$ 5,000,000
X
PRODUCTS - COMP /OP AGG
$ 5,000,000
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE OCCUR
PERSONAL & ADV INJURY
$ 2,000,000
EACH OCCURRENCE
$ 2,000,000
OWNER'S & CONTRACTOR'S PROT
FIRE DAMAGE (Any one fire)
$ 1,000,000
MED EXP (Any one person)
$ -0-
A
AUTOMOBILE
LIABILITY
CA 1914437 (AOS)
09/30/04
09/30/05
COMBINED SINGLE LIMIT
$ 2,000,000
X
A
ANY AUTO
CA 1914434 (TX)
09/30/04
09/30/05
BODILY INJURY
(Per person)
$
A
A
ALL OWNED AUTOS
SCHEDULED AUTOS
CA 1914435 (MA)
CA 1914436 (VA)
09/30/04
09/30/04
09/30/05
09/30/05
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
DAMAGE
$
riPROPERTY
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN AUTO ONLY:
ANY AUTO
EACH ACCIDENT
$
AGGREGATE
$
EXCESS LIABILITY
EACH OCCURRENCE
$
AGGREGATE
_
$
UMBRELLA FORM
$
OTHER THAN UMBRELLA FORM
A
A
WORKERS COMPENSATION AND
EMPLOYERS' UABIUTY
WC 5898827 (AOS)
WC 5898828 (CA)
09/30/04
09/30/04
09/30/05
09/30/05
STATU
X TORY LIMITS ER
'
EL EACH ACCIDENT
$ $2,000,000
EL DISEASE- POLICY LIMIT
$ $2,000,000
C
THE PROPRIETOR/ X INCL
WC 5898829 (AR,FL,MA,TN,VA)
09/30/04
09/30/05
D
PFFIC ERS/EXECUTIVE
OFFICERS ARE: EXCL
WC 5898830 (IL,LA,NY,WI )
09/30/04
09/30/05
EL DISEASE -EACH EMPLOYEE
$ $2,000,000
B
OTHER
WORKERS COMPENSATION
WC 5898831(AK,ME,NM,NV,OR,RI
09/30/04
09/30/05
SAME LIMITS AS ABOVE
A
WC 5898832 (OH)
09/30/04
09/30/05
DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES /SPECIAL ITEMS
STORE 02721 - 121 W. GRAND, #A, EL SEGUNDO, CA 90245
WHERE REQUIRED BY WRITTEN CONTRACT THE CITY OF EL SEGUNDO, ITS OFFICIALS AND ITS EMPLOYEES ARE ADDITIONAL INSURED
(EXCEPT ON WORKERS COMP) AS RESPECTS OPERATIONS OF THE NAMED INSURED
'CERTIFICATE' OLDER
CANCELLATION
SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,
THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL 'A DAYS WRITTEN NOTICE TO THE
CITY OF EL SEGUNDO
350 MAIN ST.
CERTIFICATE HOLDER NAMED HEREIN, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
EL SEGUNDO, CA 90245
LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE, ITS AGENTS OR REPRESENTATIVES, OR THE
ISSUER OF THIS CERTIFICATE.
MARSH USA INC.
BY: Michael Denike
MM1(3/02) VALID AS OF: 09/30/04
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