PROOF OF INSURANCE (2009) CLOSEDr
DATE (MM/DDIYYYY)
CERTIFICATE OF LIABILITY INSURANCE DATA 1 07/29L-8
Mo-irp
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
PRODUCER
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
California Insurance Center
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
CA Lic . # 0423393
CA
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
3697 Mt . Diablo Blvd., , #3 0 0
Lafayette CA 94549
Phone :925- 299 -1112 Fax:925- 299 -0328
INSURERS AFFORDING COVERAGE NAIC #
INSURER A: Federal In8urariC® Com ari
INSURED
INSURER B:
Hubb Systems LLC
INSURER C:
dba: Datli
2021 Chattel 501D _ Drive
INSURER D:
INSURER E:
COVERAGES
BEEN ISSUED TO THE INSURED NAMED
DOCUMENT WITH
ABOVE FOR THE POLICY
RESPECT TO WHICH
PERIOD INDICATED.
THIS CERTIFICATE MAY
NOTWITHSTANDING
BE ISSUED OR
THE
POLICES
OF INSURANCE LISTED BELOW HAVE
ANY
REQUIREMENT,
TERM OR CONDITION OF ANY
CONTRACT OR OTHER
HEREIN IS SUBJECT
TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS
OF SUCH
MAY
PERTAIN,
THE INSURANCE AFFORDED BY THE
POLICIES DESCRIBED
AGGREGATE LIMITS SHOWN MAY HAVE BEEN
REDUCED BY PAID CLAIMS.
POLICIES.
POLICY NUMBER
35877943
DATE WDDIYY
05/25/08
DATE MWOOIYY
05/25/09
LIMITS
EACH OCCURRENCE $1000000
NSR
TYPE OF INSURANCE
rA
X
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
PREMISES Eaoccurence
$ 1000000
MAID OCCUR
MED EXP (Any one Person)
$10000
PERSONAL & ADV INJURY
$ 1000000
CLAIMS
GENERAL AGGREGATE
s2000000
PRODUCTS - COMP/OPAGG
s2000000
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY jg6T LOC
AUTOMOBILE LIABILITY
05/25/08
05/25/09
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
ANY AUTO
73547478
x ALL OWNED AUTOS
BODILY INJURY
(Per person)
$
SCHEDULED AUTOS
HIRED AUTOS
BODILY INJURY
(Per accident)
$
NON-OWNED AUTOS
PROPERTY DAMAGE
$
(Per accident)
AUTO ONLY- EAACCIDENT
$ 100000
GARAGE LIABILITY
EA ACC
$
ANY AUTO
73547478
05/25/08
05/25/09
OTHER THAN
AUTO ON LY AGG
$
A
X GKLL
79865313
05/25/08
05/25/09
EACH OCCURRENCE
$ 1000000
EXCESSIUMBRELLA LIABILITY
❑ MADE
AGGREGATE
$ 1000000
SIR
so _
A
X OCCUR CLAIMS
S
I—L–
DEDUCTIBLE
$
X RETENTION so
7x.726376
12/01/07
12/01/08
X TORY LIMITS ER
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT
$ 1000000
E.L. DISEASE - EA EMPLOYEE
$1000000
A
ANY PROPRIETORIPARTNERIEXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yes describe under
E.L. DISEASE - POLICY LIMIT
$ 1000000
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
El Segundo, its officials, and employees are
Per form 800223678/04 City of
named additional insured as respects general
liability. Coverage is primary.
Re: Services agreement
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITYELS
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 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 El Segundo
REPRESENTATIVES.
348 Main Street
AUTHORIZ7EIfPRESE I
E1 Segundo CA 90245
® ACORD CORPORATION 1988
ACORD 26 (2001108)
IMPORTANT
If the certificate holder is an ADDITIONAL. INSURED, the policy(les) 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.
. +
0
Liability Insurance
CHUBS
Endorsement
Policy Period 5/25/08 to 5/25/09
Effective Date 5/25/08
Polley Number 3587 - 79-113 PLE
Insured HUB13 SYSTEMS. I, -1.,L:
Name of Company FEDt;AM. INSURANCE COMPANY
Date issued 5/25/08
This Endorsement applies to the following forms;
GFNERAL LIABILITY
Under Who Is An Insured, the following provision is added;
Who is An Insured
Scheduled Person Or Subject to all of the twins and conditions of this insurance, any person or organization shown in the
Organization Schedule,, acting pursuant to a written contract or agreement between you and such person or
organization, is an insured; but they are insureds only with respect to liability arising out of your
operations, or your premises, if you are obligated, pursuant to such contract or agreement, to provide
them with such insurance as is afforded by this policy,
However, no such person or organization is an Insured with respect to any;
assumption of liability by them in a contract or agreement. This limitation does not apply to
the liability for damages for injury or dainage, to which this insurance applies, that the person
or organization would have in the absence of such contract or agreement.
0 damages arising out of their sale negligence.
Schedule
I
LlabMfy insurance - "—
Addivanat Insured • Scheduled Person Or Organization
continued
�,
Form SO-OR-2287 (Aev, 8.04)
Endorsement
Page t
Uablllty Endorsement. rrri
(continued} !
All ather.[erms and conditions retrain unchanged.
LlabOty Inswanoo Addlgonal Insured • SOoduled Person Or Organization last page
Pont 8003.2967 (Rev. 8-04) Endo►se►nent