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PROOF OF INSURANCE (2010) CLOSEDACORD,a, CERTIFICATE OF LIABILITY INSURANCE 0416 2 0) PRODUCER 3 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Eichberg Associates, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR License # 0332590 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 16255 Ventura Blvd, Suite 350 IN R DD' Encino, CA 91436 AFFORDING COVERAGE NAIC# OMITS A ARTFORD ACCIDENT & INDEMNITY 22357 INSURED Flo- Systems Inc. 04 15 2009 *INSURERSAFFORDING ARTFORD ACCIDENT & INDEMNITY 22357 3010 Floyd Street DAMAGE rence $ MED EXP IAny one perso Mn) Burbank, CA 91504 -2599 PERSONAL &ADVINJURY ARTFORD CASUALTY INSURANCE CO 29424 FLOS03 5 2, 000, 000 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABUVt I-UH imt: r1JL1UT rrnrvu nvUr1.+rw....,. ........ ... .— 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. IN R DD' POLICY NUMBER POLICY EFFECTIVE POUCYEXPIRATION D Y Y OMITS A SRO GENERAL LIABILITY CLAIMSMADE © OCCUR 72 a= aM2868 04 15 2009 04 15/2010 EACH OC1,000,000 DAMAGE rence $ MED EXP IAny one perso Mn) S 100000 PERSONAL &ADVINJURY S 1,000,000 GENERAL AGGREGATE 5 2, 000, 000 PRODUCTS - COMP /OP AGG 6 2, 000, 000 GEN'L AGGREGATE LIMIT APPLIES PER; B POLICY PRO LOC JFCT AUTOMOBILE LIABILITY O 72 UUN UM2868 04/15/2009 04 15/2010 COMBINED SINGLE LIMIT (Ea accident) S 1,000,000 ED AUTOS BODILYINJURY (Per person) S LED AUTOS UTOS NED AUTOS BODILY INJURY (Per accident) S PROPERTY DAMAGE (Per accident) S ILITY TO AUTO ONLY - EA ACCIDENT S OTHERTHAN EA ACC AUTO ONLY: AGG $ $ C EXCESSNMBRELLA LIABILITY X OCCUR CLAIMSMADE 72 RHU VZ8776 DS 04/15 2009 041151261-0 EACH OCCURRENCE $ 4,000,060 AGGREGATE $ 4,000,000 5 S DEDUCTIBLE X RETENTION $10,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WCSTATU- OTH- LI S E.L. EACH ACCIDENT S E.L. DISEASE - EA EMPLOYEE $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMSER EXCLUDED? E.L. DISEASE - POLICY LIMIT S If yes, describe under SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Certificate Holder is included as additional insured, but only insofar as their interest may appear. Form CG2010 attached applies. This insurance is Primary CERTIFICATE HOLDER CANCELLATION 10 -Day Notice for Non - Payment of Frem SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of H2 Segundo DATE THEREOF, THE ISSUING INSURER WILL &TW9 MAIL 30 DAYS WRITTEN Office of City Clerk NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, 350 Main Street El Segundo,, CA 90245 AUTHORIZED REPRESENT ATIV IM18988 ACORD 25 (2001 /08) ®ACORD CORPOR ACORD CERTIFICATE OF INSURANCE ISSUE DATE 4/16/2009 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFEP.I -BA Insurance Services, Inc. NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT 21601 Devonshire Street #105 AMEND EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Chatsworth, CA 91311 COMPANIES AFFORDING COVERAGE INSURED LETTER A COMPANY FLO SYSTEMS 3010 FLOYD STREET LETTER B COMPANY BURBANK ,CA 91504 -2599 PRODUCTS- COMPIOPS AGG LETTER C COMPANY CA STATE LICENSE #385732 $ LETTER D LETTER E EMPLOYERS COMPENSATION INSURANCE COMPANY COVERAGES THIS IS TO CERTIFY THAT 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 PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO ILTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE OLICY EXPIRATIO LIMITS DATE (MMIDD/YY) DATE (MNUDDlYY) WORKERS' COMPENSATION A AND EMPLOYERS' LIABILITY SH 81 -0409 I 4/112009 I 411/2010 21097 DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLES /SPECIAL ITEMS ALL OPERATIONS CERTIFICATE HOLDER City of El Segundo Office of City Clerk 350 Main Street E( Segundo, CA 90245 -0989 STATUTORY LIMITS EACH ACCIDENT $1,000,000.00 DISEASE POLICY LIMIT $1,000.000.00 DISEASE EACH EMPLOYEE $1,000,000.00 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NA TO THE LEFT. AUTHORIZED REPRESENTATIVE GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE ❑ OCCUR OWNER'S & CONTRACTORS PROT, GENERAL AGGREGATE $ PRODUCTS- COMPIOPS AGG S PERSONAL & ADV. INJURY $ EACH OCCURRENCE $ FIRE DAMAGE (Anyonefire) $ MED. EXPENSE (Any one person) $ AUTOMOBILE LIABIITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS GARAGE LIABILITY COMBINED SINGLE LIMIT $ BODILY INJURY (Per person) $ PROPERTY DAMAGE $ EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE $ AGGREGATE $ WORKERS' COMPENSATION A AND EMPLOYERS' LIABILITY SH 81 -0409 I 4/112009 I 411/2010 21097 DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLES /SPECIAL ITEMS ALL OPERATIONS CERTIFICATE HOLDER City of El Segundo Office of City Clerk 350 Main Street E( Segundo, CA 90245 -0989 STATUTORY LIMITS EACH ACCIDENT $1,000,000.00 DISEASE POLICY LIMIT $1,000.000.00 DISEASE EACH EMPLOYEE $1,000,000.00 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NA TO THE LEFT. AUTHORIZED REPRESENTATIVE COMMERCIAL GENERAL LIABILITY POLICY NUMBER: 72 UUNUM2868 EFFECTIVE DATE: 04 -15 -2009 INSURED: Flo - Systems, Inc. 3010 Floyd Street Burbank, CA 91504 -2599 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -- OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies the insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART NAME OF PERSON OR ORGANIZATION: The City (City of El Segundo), its officers, officials, employees, agents, and volunteers WHO IS AN INSURED (Section Il) 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. NOTHING HEREIN CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, LIMITS OR CONDITIONS OF THE POLICY EXCEPT AS HEREIN SET FOURTH. EICHBERG ASSOCIATES, INC. AGENT'S SIGNATURE _ DATED- G 2010 1185 Copyright, Insurance Servipso6frice, Inc. 1984 (t