PROOF OF INSURANCE (2010) CLOSEDACORD- CERTIFICATE OF LIABILITY INSURANCE DATEIDD/YYYY
PRODUCER (818) 224 -6100 FAX: (818) 224 -6099 THIS CERTIFICATE IS ISSUED AS A MATTER OF I IMMNFORMAT ON
C. M. Meiers Company, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
21045 Califs St. #100 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Woodland Hills CA 91367 INSURERS AFFORDING COVERAGE NAIC:R
INSURED
INSURER A: Golden Eagle Ins. CO 10836
Everbridge, Inc. INSURER 13- Ll0 ds AA1120810
505 North Brand Blvd Suite 700 INSURER C: Employers 11512
INSURER D:
Glendale CA 91203
INSURER E:
'OVFRAGP-q
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING TN
REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAII
THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIE� WN MAY HAVE REE N REDUCED BY PAID CLAIMS
NSR D1 POLICY EFFECTIVE POLICY EXPIRATION
TYPE OF INSURANCE POLICY NUMBER DATE MMNWYY DATE IMMIDDIM LIMITS
GENERAL LIABILITY -96.QH OCCURRENCE X COMMERCIAL GENERAL LIABILITY E 1,000,001 PAMAGE TO RENTED $ 500,00
A CLAIMS MADE a OCCUR CBP8317783 9/9/2009 9/9/2010 MED EXP (Any one person) $ 10,00
A DEDUCTIBLE CUS314476 9/9/2009 9/9/2010 s
X 0 S
C WORKERS COMPENSATION AND EIG10733150 02/01/2009 02/01/2010 X WCSTATU OTH
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE ER
OFFICERIMEMBER EXCLUDED? E.L. EACH ACCIDENT $ 1,000,00
If yes, describe under E.L. DISEASE - EA EMPLO YE 1,000,00
-SPECIAL R VII N low
E.L. DISEASE - POLICY LIMIT I $ 11000,00
B OTHER PROFESSIONAL 287108717 2/15/2009 2/15/2010 82,000,000 EA OCC.
LIABILITY
84,000,000
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESOEXCLUSIONS ADDED BY ENDORSEMENTISPECLAL PROVISIONS
Certificate Holder is included as Additional Insured, as their interest may appear. Additional Insureds as required
by Contract, Permit, or Agreement are covered under this policy. 30 Days Notice of Cancellation,
for non - payment of premium as noted below. except 10 days
City of E1 Segundo
Attn: City Clerk
350 Main Street
E1 Segundo, CA 90245 -0989
ACORD 25 (2001108)
IMCnos ,n.no'
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION 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 REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
3erbert Rothman /JOHN
® ACORD CORPORATION 1888
Pone 1 M I
PERSONAL 8 ADV INJURY
S 1,000,01
GENERAL AGGR GATE
$ 2,000,0(
GEN'L AGGREGATE LIMIT APPLIES PER:
R
X POLICY JET LOC
PRODUCTS - COMP/OP AGG
S Incluch
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
CBP0317793
9/9/2009
9/9/2010
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,0(
X
X
BODILY INJURY (Per (Per Person)
BODILY INJURY (Per (Per accident)
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EAACCIDENT
$
OTHER THAN
AUTO ONLY:
S
EXCESSAIMBRELLA LIABILITY
X OCCUR CLAIMS MADE
A
E
S 4,000,00
LAGOREGATE Is
4.000.00
A DEDUCTIBLE CUS314476 9/9/2009 9/9/2010 s
X 0 S
C WORKERS COMPENSATION AND EIG10733150 02/01/2009 02/01/2010 X WCSTATU OTH
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE ER
OFFICERIMEMBER EXCLUDED? E.L. EACH ACCIDENT $ 1,000,00
If yes, describe under E.L. DISEASE - EA EMPLO YE 1,000,00
-SPECIAL R VII N low
E.L. DISEASE - POLICY LIMIT I $ 11000,00
B OTHER PROFESSIONAL 287108717 2/15/2009 2/15/2010 82,000,000 EA OCC.
LIABILITY
84,000,000
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESOEXCLUSIONS ADDED BY ENDORSEMENTISPECLAL PROVISIONS
Certificate Holder is included as Additional Insured, as their interest may appear. Additional Insureds as required
by Contract, Permit, or Agreement are covered under this policy. 30 Days Notice of Cancellation,
for non - payment of premium as noted below. except 10 days
City of E1 Segundo
Attn: City Clerk
350 Main Street
E1 Segundo, CA 90245 -0989
ACORD 25 (2001108)
IMCnos ,n.no'
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION 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 REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
3erbert Rothman /JOHN
® ACORD CORPORATION 1888
Pone 1 M I
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.
WORD 26 (2001108)
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