PROOF OF INSURANCE (2010) CLOSED (2)ACORD., CERTIFICATE OF LIABILITY INSURANCE
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PRODUCER (415) 788 -9810 FAX: (415) 248 -3534
ISU /San Francisco
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
201 California St., Suite 200
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Attn : Patti Kight
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
License # 0778092
San Francisco CA 94111 -5098
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
INSURER A: Hartford Casualty Ins CO
29424
INSURER B:
INNOVATIVE INTERFACES INCORPORATED
INSURER C:
PETER SKLAR
INSURER D:
5850 SHELLMOUND WAY
INSURER E:
EMERYVILLE CA 94608
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.
AG REGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
ADD'L
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MM /DD/YY
POLICY EXPATIO
DATE MM /DIR N
DIYY
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED
PREMISES Ea occurrence
$ 300 000
X COMMERCIAL GENERAL LIABILITY
MEDEXP (Any one person)
$ 10,000
A
CLAIMS MADE FXI OCCUR
57UUNTL9438
10/1/2009
10/1/2010
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
[G�ENI AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP /OP AGG
$ 2 r 000 , 000
POLICY PE � LOC
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
X
BODILY INJURY
(Per person)
$
A
ALL OWNED AUTOS
SCHEDULED AUTOS
57UUNTL9438
10/1/2009
10/1/2010
X
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
•
•
PROPERTYDAMAGE
(Per accident)
$
COMP $1,000
X
I COLL $1 000
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
EXCESS /UMBRELLA LIABILITY
EACH OCCURRENCE
$ 5,000,000
AGGREGATE
$ 5,000,000
X OCCUR FI CLAIMS MADE
$
A
DEDUCTIBLE
57XHUTL9505
10/1/2009
10/1/2010
$
X RETENTION 10,000
WORKERS COMPENSATION AND
O STIMIT ER-
E.L. EACH ACCIDENT
$
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER /EXECUTIVE
E.L. DISEASE - EA EMPLOYEE
$
OFFICER/MEMBER EXCLUDED?
E.L. DISEASE -POLICY LIMIT
$
If yes, describe under
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS
IF required by written contract or agreement City of E1 Segundo is included as an Additional Insured respect General
Liability as their intent may appear in connection with services provided by the Named Insured for the Additional
Insured.
f1C0TICl/`ATC un1 nCO rAFJrI=1 I ATH)N
ACORD 25 (2001/08)
INS025 (oios).osa
AL;UKU (;UKNUKA I IUN IVVIS
Page 1 of 2
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City Of El Segundo
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
City Clerks Office
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
Attn : Patti Kight
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
350 Main Street
ROOM 5
INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
El Segundo, CA 90245 -3895
Mark Uthe /MARKUT
ACORD 25 (2001/08)
INS025 (oios).osa
AL;UKU (;UKNUKA I IUN IVVIS
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 (2001/08)
INS025 (0108).0ea Page 2 of 2