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PROOF OF INSURANCE (2008) CLOSED_T ACORD CERTIFICATE OF LIABILITY INSURANCE OP IDLM DATE INIMMDnYYY) COPLOG1 11/20/07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION TYPE OF INSURANCE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ISG International HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 204 Cedar Street, P.O. Box 716 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Cambridge MD 21613 GENERAL LIABILITY Phone: 410 - 228 -6464 Fax: 410- 228 -7645 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Great American of New York 22136 INSURER B'. SPP6175202 Coplogic, Inc. 07/14/08 DAMAGE TO RENTED PREMISES (Ea oocuren Randy Burkhammer INSURER C § 10000 INSURER arA� 1 231 Market Place San Ramon CA 94583 INSURER E: GOVEKAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANOWIS 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 D -L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMOD/YY) POLICY EXPIRATION DATE (MMIDD/YY) LIMITS NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO $O SHALL City Clerks GENERAL LIABILITY 350 Main St EACH OCCURRENCE § 1000000 A X COMMERCIAL GENERAL LIABILITY SPP6175202 07/14/07 07/14/08 DAMAGE TO RENTED PREMISES (Ea oocuren s300000 MED EXP(Any one permn) § 10000 arA� 1 CLAIMSMADE OCCUR PERSONAL S ADV INJURY § GENERAL AGGREGATE § 1000000 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG § PRO - X POLICY JECT LOC AUTOMOBILE LIABILITY X ANY AUTO COMBINED SINGLE LIMIT (Ee eccldent) § 1000000 ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per Perron) § A X HIRED AUTOS SPP6175202 07/14/07 07/14/08 A X NONOWNEDAUTOS SPP6175202 07/14/07 07/14/08 BODILY INJURY (Pere"laent) § PROPERTY DAMAGE (Per..,d.nt) § GARAGE LIABILITY AUTO ONLY - EA ACCIDENT § OTHER THAN EA ACC § ANY AUTO § AUTO ONLY AGG EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE § OCCUR ❑ CLAIMS MADE § E DEDUCTIBLE § RETENTION § WORKERSCOMPENSATIONAND EMPLOYERS' LIABILITY OH X TORY WC STATU LIMITS E- R E.L. EACH ACCIDENT $ 1000000 A AN V PROPRIETOR /PARTNER /EXECUTIVE WC7576127 00/01/07 08/01/08 E. L. DISEASE - EA EMPLOYEE § 1000000 OFFICER/MEMSER EXCLUDED? If yee, de—,W under E.L. DISEASE - POLICY LIMIT § 1000000 SPECIAL PROVISIONS EeIaw OTHER DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS The City of El Segundo its officers, officials, employees, agents, and certified volunteers are added as additional insured as respects their contract with the insured. Coverage is deemed primary and non - contributory. GEKTIFIGATE HOLDER CONCFI 1 ATIAN AUUKU ZO (ZUU11U5) © ACORD CORPORATION 1988 CITYOEL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN City of El Segundo NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO $O SHALL City Clerks Office 350 Main St IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR El Segundo CA 90245 -3813 REPRESENTATIVES. arA� 1 AUUKU ZO (ZUU11U5) © ACORD CORPORATION 1988 0488860 GREAT AMERICAN INS CO OF NY Administrative Offices 580 walnut street GREATCincinnati, Ohio 45202 AMERICAN, Tel: 1- 513- 369 -5000 INSURANCE GROUP THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: SAFEPAK8 BUSINESSOWNERS POLICY SPECIAL FORM PART TWO - SAFEPAK® LIABILITY COVERAGE FORM Schedule Name of Person or Organization: CITY OF EL SEGUNDO 350 MAIN STREET EL SEGUNDO, CA 90245 -3813 BP 86 41 (Ed. 11 06) (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement). PART TWO - SAFEPAK LIABILITY COVERAGE FORM, C. Who Is an Insured is amended to include as an Additional Insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury," "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: a. in the performance of your ongoing operations; or b. in connection with your premises owned by or rented to you. Includes copyrighted material of the ISO Properties, Inc., with its permission. BP 86 41 (Ed. 11/06) PRO (Pace 1 of 1) POLICY : SPP- 6175202 -02 -03 INSURED NAME : COPLOGIC, INC. POLICY OUTPUT OFFICE : IS ISG - CCBSURE AGENCY BATCH CYCLE DATE: 11/20/2007 * * * 1. PREPRINTED POLICY FORMS TO BE PULLED: GAIC180 10 2. UNIDENTIFIED FORMS : * * SYSTEM OUTPUT RECAP * * 3. FORMS INCLUDED IN OUTPUT AB BP8203NC BP8641 BP8641 INSTR34 0488860 GREAT AMERICAN INS CO OF NY Administrative Offices 580 Walnut Street GREAT Cincinnati, Ohio 45202 AMERICAN Tel: 1- 513-369 -5000 INSURANCE GROUP ISG /CCBSure (0488860, 0488935) MAIL TO: SEQURE UNDERWRITERS, LLC 204 CEDAR STREET, SUITE 101 CAMBRIDGE, MD (21613) ATTENTION CENTRAL ASSEMBLY • PLEASE MAIL POLICY COPIES (ORIGINAL, AGENT AND COPY OF ORIGINAL) TO THE AGENT OF RECORD. • PLEASE MAIL COMPANY COPY TO THE ABOVE LISTED ADDRESS. • PLEASE MAIL THE WORKERS' COMPENSATION KIT (GAIC928) AND THE ERGONOMICS FLYER (GAIC1458) TO THE INSURED ADDRESS USING THE SDM605 MAILER SHEET (IF/WHEN APPLICABLE). • PLEASE MAIL THE PROPERTY LIABILITY KIT GAIC929 TO THE INSURED ADDRESS USING THE SDM605 MAILER SHEET (IF/WHEN APPLICABLE). • DISREGARD THE ABOVE INSTRUCTIONS IF SDM512 PRINTS WITH THE POLICY. INSTR34 (Ed. 09/07) XS 0488860 GREAT AMERICAN INS CO OF NY Administrative Offices BP 82 03 (Ed. 06 86 ) 580 Walnut Street �iREAT Cincinnati, Ohio 45202 A M E R I C A N , Tel: 1- 513- 369-5000 Po I i c y No. SPP 6 - 1 7 - 52 - 02 - 02 INSURANCE GROUP E f f e c t i v e Date o f Change 11/20/07 SAFEPAK POLICY CHANGES NAMED INSURED AND ADDRESS: POLICY PERIOD: COPLOGIC, INC. MARKET PLACE 250 12:01 A.M. Standard Time at the address 231 M SAN AMON, PL of the Named Insured shown at left. 94583 From 07/14/07 To 07/14/08 AGENT'S NAME AND ADDRESS: THIS ENDORSEMENT CHANGES THE POLICY. ISG INTERNATIONAL INC 204 CEDAR ST PLEASE READ IT CAREFULLY. CAMBRIDGE MD 21613 Insurance is afforded by company indicated below: GREAT AMERICAN INSURANCE COMPANY OF NEW YORK (A capital stock corporation) POLICY CHANGES: Designate the Location to which these changes apply: Location Number THE FOLLOWING ARE HEREBY ADDED AS ADDITIONAL INSURED PER BP8641: CITY OF CORPUS CHRISTI CITY OF EL SEGUNDO POLICY AMOUNT AND PREMIUM ADJUSTMENT Coverage Description Limits of Liability Additional Premium Return Premium Previous Limit New Limit Building $ $ $ $ Business Personal Property $ $ $ $ SAFEPAK (Reg.U.S.Pat.Off.) BP 82 03 (Ed. 06/86) PRO (Page 1 of 2) 0488860 GREAT AMERICAN INS CO OF NY Administrative Offices 580 Walnut Street GREAT Cincinnati, Ohio 45202 AMEPJC'AN Tel: 1- 513-369 -5000 INSURANCE GROUP OPTIONAL COVERAGES - When designated by an "X" in the parenthesis shown, the following Additional Return coverages are added or changed: Premium Premium ( ) Deductible ( )$500 ( )$1,000 ( )$2,500 ( ) Money and Securities $ On Premises $ Off Premises ( ) Employee Dishonesty Coverage $ ( ) Exterior Grade Floor Glass - Replacement Cost ( ) Exterior Signs $ ( ) Liability and Medical Expenses Limit $ ( ) Fire Legal Liability Limit $ FORMS AND ENDORSEMENTS hereby added: BP8641 FORMS AND ENDORSEMENTS hereby amended: FORMS AND ENDORSEMENTS hereby deleted: The Total Premium for this Endorsement is $ N/C Due at Endorsement Effective Date Additional Premium Return Premium $ 1 $ o....,.;....,. A.4i „etmcnt if Premium is Pavable in Installments. Original Installments Increase Decrease Revised Installments $ $ $ $ $ $ $ $ REMOVAL PERMIT - If Covered Property is removed to a new location that is de- scribed on this Policy Change, you may extend this insurance to include that Covered Property at each location during the removal. Coverage at each loca- tion will apply in the proportion that the value at each location bears to the value of all Covered Property being removed. This permit applies up to 10 days after the effective date of this Policy Change; after that, this insurance does not apply at the previous location. Countersigned Date BP 82 03 (Ed. 06/86) PRO By Authorized Representative SAFEPAK (Reg.U.S.Pat.Off.) (Pane 2 of 2) 1 /20nY 7 ACORD COPL CERTIFICATE OF LIABILITY INSURANCE PL 1 DATE O - 11 20 07 LTR THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE I DATE MMIDDIYY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Company, Inc. Sadler 6 Comp any, ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW P. O. Drawer City of E1 Segundo COMMERCIAL GENERAL LIABILITY Columbia Sc 29250 -5866 Phone: 803- 254 -6311 Fax: 803- 256 -4017 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A, ACE American Insurance Co. CLAIMS MADE OCCUR - ] _ -1 INSURER B: INSURER C: GENERAL AGGREGATE ''$ Coplogic, Inc. Mr. Randy Burkh r 231 Market Place 520 INSURER D: INSURER E. PRODUCTS - COMP/OP AGG $ San Ramon CA 94583 GUVtKAII 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. LTR NSR TYPE OF INSURANCE GENERAL LIABILITY POLICY NUMBER I DATE MMIDDIYY DATE MM /DD/YY LIMITS EACH OCCURRENCE $ _ PREMISES (Ea occurence) I $ IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR City of E1 Segundo COMMERCIAL GENERAL LIABILITY 350 Main Street REPRESENTATIVES. AuT I EPRE TIV El Segundo CA 90245 CLAIMS MADE OCCUR - ] _ -1 VIED EXP (Any one person) $ - -- PERSONAL & ADV INJURY $ GENERAL AGGREGATE ''$ PRODUCTS - COMP/OP AGG $ GEN'L AGGREGATE LIMIT APPLIES PER POLICY PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ (Per accident) NON -OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT ! $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ ANY AUTO EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE $ OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION AND ATU- TORY LIMITS ER E.L. EACH ACCIDENT $ EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ If yes, describe under SPECIAL PROVISIONS below OTHER A Prof. Liability G21481440001 DEDUCTIBLE: $25,000 06/20/07 06/20/08 Occurrenc 1,000,000 Aggregate 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS GtK I IrIL A 1 C nvLUCR — ---- — SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CI TY017 DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR City of E1 Segundo 350 Main Street REPRESENTATIVES. AuT I EPRE TIV El Segundo CA 90245 F ArnRn rnPPnROTI0N 1 ACORD 25 (2001108) 988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. 25