PROOF OF INSURANCE (2009) CLOSEDA CORD DATE (MM/DDNYYY)
. CERTIFICATE OF LIABILITY INSURANCE 4/2/2009
PRODUCER (415) 788 -9810 FAX: (415) 248 -3534
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ISU /San Francisco
201 California St., Suite 200
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
License # 0778092
Room 5
San Francisco CA 94111 -5098
INSURERS AFFORDING COVERAGE
NAICS
INSURED
INSURER A: HARTFORD INSURANCE GROUP
29424
INNOVATIVE INTERFACES, INC.
INSURERS:
PETER SKLAR
INSURER C:
5850 SHELLMOND WAY
INSURER D:
EMERYVILLE CA 94608
INSURER E:
OVERAGES
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.
REG kTE LIMITS SHOWN MAY HAVE BE REDUCED BY PAID CLAIMS.
INSR
ADD'L
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MM /DD/YY
POLICY EXPIRATION
DATE MWDDN
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE K OCCUR
57UUNTL9438
10/1/2008
10/l/2009
DAMAGE TO RENTED
R MISES occurrence)
$ 300,000
(Any
MED EXP An ona arson
one n
$ 10 , 0 0 0
PERSONAL &ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GENI AGGREGATE LIMIT APPLIES PER:
X POLICY JECT LOC
PRODUCTS - COMP/OP AGG
$ 2,000,000
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED
(Ea acccldert) SINGLE LIMIT
$ 1,000,000
X
A
ALL OWNED AUTOS
SCHEDULED AUTOS
57HRPTL4146
10/1/2008
10/1/2009
BODILY INJURY
(Per person)
$
X
HIRED AUTOS
NON -OWNED AUTOS
BODILY INJURY
(Per accident)
$
X
X
PROPERTY DAMAGE
(Per accident)
$
Comp $1, 000
X
Coll $1,000
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN ACC
$
H ANY AUTO
$
AUTO ONLY: AGG
EXCESSIUMBRELLA LIABILITY
X OCCUR E CLAIMS MADE
$ 5,000,000
AGGREGATE
$ 5,000,000
$
A
DEDUCTIBLE
57RHUTL9505
10/1/2008
10/1/2009
X RETENTION 10, 000
A
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
X WC STATU- OT -
E.L. EACH ACCIDENT
$ 1,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBEREXCLUDED?
If yes, describe under
57WENQ8348
10/1/2008
10/1/2009
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT Is
1,000,000
PROVISIONS SPECIAL beL3w
OTHER
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLE SIEXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS
If required by written contract or agreement City of E1 Segundo is included as an Additional Insured with respects to
General Liability as their intent my appear in connection with services provided by the Named Insured for the
Additional Insured.
CERTIFICATE HOLDER rAMr=1 1 ATInW
HVVRU L7 (NV "IIUB)
INS025 (otoa).orta
a ACORD CORPORATION 1988
Page 1 of 2
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City of El
City Clerks
Attn : Patti
350 Main Street
Segundo
Office
Kight
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
Room 5
INSURER ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
E l Segundo, CA 9 0 2 4 5 - 3 8 9 5
_
Mark Uthe /MARKUT
HVVRU L7 (NV "IIUB)
INS025 (otoa).orta
a ACORD CORPORATION 1988
Page 1 of 2
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.
ACORD 25 (2001108)
INS025 (oiwpaa Page 2 of 2