PROOF OF INSURANCE (2011) CLOSED0B/11/2010 10:14 13106401057 EP MOORE PAGE 01101
CERTIFICATE OF INSURANCE
,... This certifies that ❑ STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois
® STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois
IN /VIANC ❑ STATE FARM FIRE AND CASUALTY COMPANY, Aurora, Ontario
❑ STATE FARM FLORIDA. INSURANCE COMPANY, Winter Haven, Florida
❑
STATE FARM LLOYDS, Dallas, Texas
insures the following policyholder for the coverages indicated below:
Policyholder CITY OU EL SEGUNDO
Address of policyholder 350 MAIN ST, EL SEGUNDO, CA 90295 -3813
Location of operations sr�ME
Description of operations
The policies listed below have been issued to the policyholder for the policy periods shown. The insurance described in these policies is subject
to all the terms, exclusions, and conditions of those policies. The limits of liability shown may have been reduced by any paid claims.
POLICY PERIOD LIMITS OF LIABILITY
POLICY NUMBER TYPE OF INSURANCE Effective Sate j Expiration Date (at beginning of poll period)
Comprehensive BODILY INJURY AND
Business Liability PROPERTY DAMAGE
-------- - - - - -- - - - -- - - - ------ - - - - --
--- - - - - -- ------ - - - - --
This insurance includes: ❑ Products - Completed Operations
[) Contractual Liability
❑ Personal Injury
❑ Advertising Injury
❑ POLICY PERIOD
EXCESS LIABILITY Effective Date EXpiration Date
POLICY NUMBER
92 -QV- 2126 -8 F
❑ Umbrella
❑ Other
Workers' Compensation
and Employers Liability
TYPE OF INSURANCE=
FIDELITY HOND
POLICY PERIOD
Effective Date Expiration Date
Each Occurrence $
General Aggregate $
Products , Completed $
Dperations Aggregate
BODILY INJURY AND PROPERTY DAMAGE
(Combined Single Limit)
Each Occurrence $
Aaarenate $
Part I - Workers Compensation - Statutory
Part II - Employers Liability
Each Accident $
Disease - Each Employee $
Disease - Policy Limit $
POLICY PERIOD LIMITS OF LIABILITY
Effective Date I Expiration Date (at beginning of policy Pe
AUG -10 -J0 ' SEP -16 -11 $25,000
THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVELY
AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN_
Name and Address of Certificate Holder
550 ^994 A.B Printed in U.S.A. Rev. 05 -09 -2006
If any of the described policies are canceled before
their expiration date, State Farm will try to mail a
written notice to the certificate holder 30 days before
cancellation. if however, we fail to mail such notice,
no obligation or liability will be imposed on State Form
or its agents or repr. ntatives.
Sig re of A orized Representative
AGENT 08/10/2010
Title Date
ED MOORE
Agent Name
Telephone Number 3].0- 322 -1,132
Agent's Code Stamp
Agent Code
AFO Code M�OC@ 75-1179
Flre 71
MAF0 Bleach cities F801