PROOF OF INSURANCE (2011) CLOSEDACORD,M CERTIFICATE OF LIABILITY INSURANCE
DATE(MM /DDIYYYY)
PRODUCER 3
Eichberg Associates, Inc.
License # 0332590
16255 Ventura Blvd, Suite 350
Encino, CA 91436
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
NAIC#
INSURED Flo- Systems Inc.
3010 Floyd Street
Burbank, CA 91504-2599
FLOS03
INSURER A: HARTFORD ACCIDENT & INDEMNITY
22357
INSURER B: HARTFORD ACCIDENT & INDEMNITY
22957
INSURER C: HARTFORD CASUALTY INSURANCE CO
29424
INSURER D:
EACH OCCURRENCE
INSURER E:
1001TI4 9_[H *I
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.
INSR
ADDT
— TYPE OF INSURANC
POLICY NUMBER
POLICY EFFECTIVE
D DD
POLICY EXPIRA
D M DD Y TION
LIMITS
A
GENERAL LIABILITY
72 UUN ON2868
041151202010411512011
SM
EACH OCCURRENCE
$ 1,000,000
X COMMERCIAL GENERAL LIABILITY
PREMISGAMAGES E T Ea occureO RENTED nce
$ 300,000
MEDEXP (Any oneperson)
$ 10,000
CLAIMSMADE OCCUR
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP /OPAGG
$ 2,000,000
X POLICY M PROT LOC
B
AUTOMOBILE
LIABILITY
ANY AUTO
72 UVN UM2868
0411512010
0411512011
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
X
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
X
HIRED AUTOS
NON - OWNEDAUTOS
BODILY INJURY
(Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANYAUTO
$
AUTOONLY: AGG
C
EXCESS /UMBRELLA LIABILITY
X OCCUR F-1 CLAIMSMADE
72 RHU VZ8776 DE
0411512010
0411512011
EACH OCCURRENCE
$ 4,000,000
AGGREGATE
$ 4,000,000
$
S
DEDUCTIBLE
R
X RETENTION $10,000 _
$
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
WC STATU- OTH-
T LIMIT
E.L. EACH ACCIDENT
$
ANY PROPRIETORlPARTNER /EXECUTIVE
E.L. DISEASE - EA EMPLOYEE
$
OFFICER /MEMBER EXCLUDED?
If yes, describe under
E.L. DISEASE - POLICY LIMIT
$
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / 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 rAlUr9lIATIniU 1n -ns., 7,T_s: c,. IT_ _x
t:►�ursuzylzuu� /utsl - ®ACORDCORP ION 1988
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of El Segundo
DATE THEREOF, THE ISSUING INSURER WILL XKffff&XXXMAIL 30 DAYS WRITTEN
Office of City Clerk
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
350 Main Street
El Segundo„ CA 90245
AUTHORIZED REPRESENTA
SM
t:►�ursuzylzuu� /utsl - ®ACORDCORP ION 1988
CL 690
(10 -93)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 20 10 10 93
ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM B)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
This endorsement chances the nolicv effAntivA nn the incantinn data of tha nnliry unlace ann +har eln +o i� in.d:..n +o,l L.^1—
Endorsement effective
Policy No.
12:01 A.M. standard time
72 UUN
Named Insured Flo- Systems Inc.
Countersigned
(Authori 6"-presentative)
SCHEDULE
City of E1 Segundo
Name of Person or Organization: 350 Main Street
El Segundo„ CA 90245
(If no entry appears above, 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 ongoing operations performed for that insured.
Certificate Holder is included as additional insured, but only insofar as their interest may
appear. Form CG2010 attached applies. This insurance is Primary
CL 690 (10 -93)
CL 20 10 10 93 Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1