PROOF OF INSURANCE (2010) CLOSEDi
Policy Number:
Date Entered: 1/7/2009
ACOR ,,w CERTIFICATE OF LIABILITY INSURANCE 1/7 /MIDDIVYYY)
1/7/2009
PRODUCER Christopher J. Harley Insurance Agency THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
1355 Laurel Street ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
San Carlos CA 94070 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Phone. (650) 598-9100
Fax: (650) 598 -9474_ - - -
INSURED The Dardanelle Group Inc
106 S Catalina Ave #A
Redondo Beach, CA 90277
P nVFRA(_CC
INSURERS AFFORDING COVERAGE
INSURER A Farmers Insuran ce GTOUE —
I INSURER B&. — — — —
INSURER C-
FINSURER D:
INSURER E'
I NAIC #
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.
INS' DD'L� — _T POLICY EFFECTNE POLICY EXPIRATION
TR N RD TYPE FIN C POLICY NUMBER DATE IMMIDDIYYI DATE (MWDDfYYI LIMITS
350 Main Street
I GENERAL LIABILITY
EACH OCCURRENCE
$1,000,000
A
X,�CO_MMERCIAL GENERAL LIABILITY
604327928 1 1/18/2009 1 1/18/2010 i PRD MIA 3 -S occurence_
_ --
f
_75,000
f 5,000
J GIA'.MS MADE X; OCCUR
M =D FXP (Any one person)
_
Prods /Comp OPS
—
PERSONAL & ADV INJURY
_
$1,000,000 —
Personal Inj — —
$2,000,000
GENERAL AGGREGATE
GEN'L AGGREGATE LIMIT APPLIES PER
k PROOUCTS - COMP /OP AGG
r— -- — --
$1,000,000
1 PRO-
POLICY LOC
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
f
A i X ANY AUTO
(Ea accident)
F
~
ALL OWNED AUTOS
IJ`I SCHEDULED AUTOS 1149037928
BODILY INJURY
i 12/12/2008 6/12/2009 I (Per person)
000
I f 250,000
1 HIRED ALTOS
— —
j
I
BODILY INJURY
(Per accident)
III
S 500,000
I NON -OWNED AUTOS
r- - - -. - -. -
-
I I I
— - - -- — -- - -- -- —
I PROPERTY DAMAGE
I
f 100,000
i 1
; (Per accident)
IGARAGE LIABILITY ;
I AUTO ONLY - EA ACCIDENT
$ _ --
ANY AUTO I I
OTHER THAN EA ACC
$—
AUTO ONLY. AGG
S
EEEXXCC�ESSIUM13RELLAUABILITY I I
E-AC_H OCCURRENCE_ $1,000,000
A
�I
XfX! OCCUR EJ CLAIMS MADE 601584312 1/17/2009
1/17/2010
_
�-
( AGGREGATE f 1,000,000
I
auto excess I
I
I
$ _
0EO1CT ;BLE
I
— — f
—
RETENTION f f
f
WORKERS COMPENSATION AND
WC STATU- OTH-
T kY LIMI, — ER
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT
--
f
ANY PROPRIETORIPARTNER /EXECUTIVE
OFFICER /MFMUCH EXCLUDED?
1
I
_ _— —
E.L. E - kA EMP1_q4A, S
II ycs, des cube under
SPECIAL PROVISIONS below
"- --
EA ISEASE I IC IT Is
OTHER
1
VV
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS L
see additional insured endorsement BP 04500197 attached
I
CERTIFICATE Hni 11FR CANCFI I ATION
ACORD 25 (2001108) j V ACORD CORPORATION 1988
Produced using Forms Boss Plus software www FormsBoss.com. Impressive Publishing 800- 208 -1977 J
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL30 DAYS WRITTEN
City of El Segundo
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
350 Main Street
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
E1 Segundo CA 90245
REPRESENTATIVES.
AUTHORIZED REPRESEN ATN�
ACORD 25 (2001108) j V ACORD CORPORATION 1988
Produced using Forms Boss Plus software www FormsBoss.com. Impressive Publishing 800- 208 -1977 J
1
i
POLICY NUMBER: 60432 -79 -28 BUSINESSOWNERS I
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES
OR CONTRACTORS
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS POLICY
i
SCHEDULE'
Name Of Person Or Organization:
City of El Segundo
Information required to complete this Schedule, if not shown on this endorsement, will be shown in the
Declarations.
The following is added to Paragraph C. Who Is An
Insured in the Businessowners Liability Coverage
Form:
4. Any person or organization shown in the Sched-
ule is also an insured, but only with respect to
liability arising out of your ongoing operations I
performed for that insured.
I
BP 04 50 01 97 Copyright, Insurance Services Office, Inc., 1997 Page 1 of 1 ❑