PROOF OF INSURANCE (2009) CLOSEDAC-ORD. CERTIFICATE OF LIA131LITY INSURANCE OP ID A2
DATE(MMIDD/YYYY)
FILSO -1
08/13/08
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Arthur J Gallagher RMS Inc.
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 2 925
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Tacoma WA 98401 -2925
Phone:253 -627 -7183 Fax :253 -572 -1430
INSURERS AFFORDING COVERAGE
NAIC#
INSURED
INSURERA: American Cam Cc of Reading pa
$1,000,000
INSURER B: ContLuental Casualty Company
X
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE FX] OCCUR
INSURER C: Transportation Xnmurance Cc
06/01/08
FileOnQQ, Inc
832InddustArl'8Drive
ii 99
INSURER D:
$100,000
INSURER E:
$5,000
PERSONAL & ADV INJURY
NUV
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUN ENT 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.
IMOK
LTR
NSR
TYPE OF INSURANCE
POLICY NUMBER
DATE (MMID
DATE MID N
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$1,000,000
A
X
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE FX] OCCUR
2050119015
06/01/08
06101109
PREMISES Eaoccurence
$100,000
MED EXP (Any one person)
$5,000
PERSONAL & ADV INJURY
S 1, 000, 000
GENERAL AGGREGATE
s2,000,000
GENT AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP /OP AGG
$2,000,000
X POLICY PRO-
JECT LOC
Ben.
1,000,000
B
AUTOMOBILE
LIABILITY
ANY AUTO
2079902656
06/01/08
06/01/09
COMBINED SINGLE LIMIT
(Ea accident)
E 1, 0 0 0, 0 0 0
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per person)
$
X
X
HIREDAUTOS
NON -OWNED AUTOS
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
S
ANY AUTO
OTHER THAN EA ACC
AUTO ONLY: AGG
E
S
C
EXCESSIUMBRELLA LIABILITY
X I OCCUR EI CLAIMSMADE
CUP2093370216
06/27/08
06101109
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$110001000
S
$
DEDUCTIBLE
X RETENTION $0
$
A
WORKERS COMPENSATION AND
EMPLOYER ANY PROPRIETORETORILrrr IPARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
Nixes , describe under
SECIAL PROVISIONS below
2050119015
gMP L IAB /WA STOP GAP
06/01/08
06101109
TORY LIMITS X ER
E.L. EACH ACCIDENT
$1,000,000
E.L. DISEASE - EA EMPLOYEE
$1,000,000
E.L. DISEASE - POLICY LIMIT
$ 1, 0 0 0 , 0 0 0
OTHER
•
Property Section
2050119015
06/01/08
06/01/09
Contents 30,000
•
Data Processing
2050119015
06/01/08
06/01/09
Ded 500
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / EXCLUSIONS ADDED B" ENDORSEMENT I SPECIAL PROVISIONS
Verification of insurance. Blanket additional insured applies to certificate
holder per attached endorsment G- 134802 -C (8d 11/04)
R8: Software Development.
*10 Day notice of cancellation for non- payment of premium*
NCR i itm p%i C KULUCK CANCFI I ATinim
—W—W `o 1` °° 1wo) ® ACORD CORPORATION 1988
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of 81 Segundo, its
officals, and employees
DATE THEREOF, THE ISSUING INSURER MLLOW A VA-W MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Attn: City Clerk's Office
T-N& 11sumft R9
305 Main Street
�B•
81 Segundo CA 90245
NE!D�RZRESENTAW
—W—W `o 1` °° 1wo) ® ACORD CORPORATION 1988
ACORD CERTIFICATE OF LIA131LITY INSURANCE OP ID A2
FILSO -1
° "TE`M�D°,YY,"'
08/13/08
PRODUCER
Arthur J Gallagher RMS Inc.
P.O. Box 2925
Tacoma WA 98401 -2925
Phone:253 -627 -7183 Fax :253 -572 -1430
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NAICN
INSURED
FileOnQ, Inc
832 ndustry Drive
Tukw la WA H8188
INSURER A: Continental Casualty Company
DATE MMIDDIYY
INSURERS:
LIMITS
INSURER C:
INSURER D:
INSURER E:
COVERAGES
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
INS
TYPE OF INSURANCE
POLICY NUMBER
DATE MMIDDIYY
DATE M
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$
Lj
PREMISES (Ea occurence)
S
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE 1-1 OCCUR
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$
GENERAL AGGREGATE
$
GEWL AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$
POLICY JJECDT LOC
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Ea accident)
S
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
S
ANY AUTO
$
AUTO ONLY: AGG
EXCESSIUMBRELLA LIABILITY
EACH OCCURRENCE
$
OCCUR 17 CLAIMS MADE
AGGREGATE
$
a
5
DEDUCTIBLE
$
RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
TORY LIMITS ER
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT
S
E.L. DISEASE - EA EMPLOYEE
S
OFFICER/MEMBER EXCLUDED?
It yes, describe under
SPECIAL PROVISIONS below
S
E.L. DISEASE . POLICY LIMIT
OTHER
A
D &O w /Misc
287130815
05/10/07
05/10/09
Misc Prof 1,000,000
Professional Lia
i
I
I Retention 10,000
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Evidence of insurance
CERTIFICATE HOLDER CANCELLATION
AGORD 25 (2001108) 0 ACORD CORPORATION 1988
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, its
officals, and employees
Attn: City Clerk's Office
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
350 Main Street
REPRESENTATIVES.
A
81 Segundo CA 90245
AGORD 25 (2001108) 0 ACORD CORPORATION 1988
Reproduction of Insurance Services Office, Inc. Form
INSURER: ISO FORM CG 20 10 11 85: (MODIFIED)
POLICY NUMBER: COMMERCIAL GENERAL LIABILITY
ENDORSEMENT NUMBER: EXHIBIT 1 -A
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED — OWNERS, LESSEES OR
CONTRACTORS (FORM B)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
The City, its officers, officials, employees, agents, and volunteers
(If no entry appears above, the information required to complete this endorsement
will be shown in the Declarations as applicable to this endorsement.)
WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization
shown in the Schedule, but only with respect to liability arising out of "your work" for that insured by or
for you.
Modifications to ISO form CG 2010 1185:
1. The insured scheduled above includes the Insured's officers, officials, employees and
volunteers.
2. This insurance shall be primary as respects the insured shown in the schedule above,
or if excess, shall stand in an unbroken chain of coverage excess of the Named
Insured's scheduled underlying primary coverage. In either event, any other insurance
maintained by the Insured scheduled above shall be in excess of this insurance and
shall not be called upon to contribute with it.
3. The insurance afforded by this policy shall not be canceled except after thirty days
prior written notice by certified mail return receipt requested has been given to the
Entity.
4. Coverage shall not extend to any indemnity co ge the active neg1. a the
additional insured in any case where an agr ent to in e ify the additio al ' sired
would be invalid under Subdivision b of ction 278 0 i Code.
Signature- rize p entative
L uth u L r iV
Address
CG 20 10 1185 Insurance Services Office, Inc. Form (Modified)
CNA G- 134902 -C
(Ed. 11/04)
THIS ENDORSEMENT CHANGE:1 THE POLICY. PLEASE READ IT CAREFULLY.
NONCONTRACTOR'S ADDITIONAL: INSURED ENDORSEMENT
This endorsement modifies Insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. WHO IS AN INSURED (Section II) Is amended to
Include as an Insured any person or organization
(called additional insured) described in parcgraphs
2.a.through 2.g. below whom you are required to add
as an additional insured on this policy under a written
contract or agreement but the written contract or
agreement must be:
1. Currently in effect or becoming effective during the
term of this policy; or
2. Executed prior to the 'bodily Injury,' 'property
damage' or "personal Injury and advertising injury,' but
Only the following persons or organizations are
additional Insureds under this endorsement and
coverage provided to such additional Insureds Is
limited as provided herein:
a. State or Po1Rk al Subdivisions
A state or political subdivision subject to the
following provisions:
l
(1) This Insurance applies only with respect
to the following hazards for which the
state or political subdivision has iosued a
permit In connection with premises you
own, rent, or control and to wh ich this
insurance applies:
(a) The existence, maintenance, repair,
construction, erection, or removal of
advertising signs, awnings, canopies,
cellar entrances, coal holes,
driveways, manholes, marquees,
hoistaway openings, sidewalk vaults,
street banners, or decorations and
similar exposures; or
(b) The construction, erection, or
removal of elevators; or
(c) The ownership, maintenance, or use
of any elevators covered by this
Insurance.
(2) This Insurance applies only with respect
to operations performed by you or on your
behalf for which the state or political
subdivision has Issued a permit.
This insurance does not apply to 'bodily
Injury,' 'property damage' or 'personal
and advertising injury' arising out of
operations performed for the state or
municipality.
G- 134902 -C
(Ed. 11/04)
b. Controping hibrest
Any persons or organizations with a
controlling Interest in you but only with respect
to their liability arising out of:
(1) Their financial control of you; or
(2) Premises they own, maintain or control
while you lease or occupy these
premises.
This Insurance does not apply to structural
alterations, new construction and demolition
operations performed by or for such additional
Insured.
c. Mergers or Lessors of Promises
A manager or lessor of premises but only with
respect to liability arising out of the ownership,
maintenance or use of that specific part of the
premises leased to you and subject to the
following additional exclusions:
This insurance does not apply to:
(1) Any 'occurrence' which takes place
after you cease to be a tenant in that
premises; or
(2) Structural alterations, new construction
or demolition operations performed by or
on behalf of such additional insured.
d. Morlgegs% Assignee or Receiver
A mortgagee, assignee or receiver but only
with respect to their liability as mortgagee,
assignee, or receiver and arising out of the
ownership, maintenance, or use of a premises
by you.
This Insurance does not apply to structural
alterations, new construction or demolition
operations performed by or for such additional
Insured.
a. Ownera/Oftr Interests — Land Is Leased
An owner or other Interest from whom land
has been leased by you but only with respect
to liability arising out of the ownership,
maintenance or use of that specific part of the
land leased to you and subject to the following
additional exclusions:
This insurance does not apply to:
Page 1 of 2
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to
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i
s.
a�
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c
(1) Any 'occurrence' which takes pla,:e after
you cease to lease that land; or
(2) Structural alterations, new construction or
demolition operations performed ty or on
behalf of such additional insured.
f. Co -owner of Insured Promises
A co -owner of a premises co -owned by you
and covered under this Insurance but only
with respect to the co- owners liability as co-
owner of such premises.
g. Lessor of Equipment
Any::person or organization from whom you
lease equipment. Such person or
organization are insureds only with respect to
.their liability for 'bodily Injury,' *aroperty
damage,', or 'personal .and advertising Injury'
caused, In whole or in part by your
maintenance, operation or use of equipment
leased to you by such person or organization.
A : person's or organization's status as an
insured under this endorsement ends when
their written contract or agreement with you
for such leased equipment ends.
With respect to the insurance affordiid these
additional Insureds, the following additional
exclusions apply:
This insurance does not apply:
(1). To any 'occurrence' which taken place
after the equipment lease explres; or
G- 134802 -C
(Ed. 11/04)
G- 134802 -C
(Ed. 1.1/04)
(2) To 'bodily Injury' or 'property damage'
arising out of the sole negligence of such
additional insured.
Any Insurance provided to an additional
Insured designated under paragraphs a.
through g. above does not apply to 'bodily
Injury' or 'property damage' Included within
-the 'products-completed operations hazard.'
B. As respects the coverage provided under this
endorsement, Paragraph 4.1b. SECTION 1V —
COMMERCIAL GENERAL LIABILITY CONDITIONS
Is deleted and replaced with the following:
4. Other knurance
b. Excess Insurance
This Insurance is excess over:
Any other Insurance naming the .additional
insured as and Insured whether primary,
excess, contingent or on any other basis
unless a written contract . or• agreement
specifically requires that this insurance be
either.primary or primary and noncontributing.
Where. required by written contract or
agreement, we will consider arty other
insurance maintained by the additional
insuredJor Injury or damage covered by this
endorsement to be excess and
noncontributing with this Insurance.
Page 2 of 2