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PROOF OF INSURANCE (2012) CLOSEDOP ID: EY A`CORO V: CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DDIYYYY) 10/05/11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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). PRODUCER 650 - 842 -5200 (PA)) Heffernan Insurance Brkrs 1808A Embarcadero Road 650- 842 -5201 Palo Alto, CA 94303 Joshua Fagin CONT NAMEACT PHONE c Ext : A/C No E-MAI L ADDRESS: PRODUCER INNOVIO CUSTOMERID . INSURERS AFFORDING COVERAGE NAIC # INSURED Innovative Interfaces Inc. INSURER A:HANOVER INSURANCE CO. EACH OCCURRENCE INSURER B: Massachusetts Bay Ins. Co. AMAn-E—TG —RENTED PREMISES Ea occurrence) 5850 Shellmound Way INSURER C: X COMMERCIAL GENERAL LIABILITY Emeryville, CA 94608 INSURER D: ZZF 931602700 10/01/11 INSURER E: MED EXP (Any one person) $ 10,00 INSURER F : CLAIMS -MADE [JI(I OCCUR nGnr1ClnwrC u11RM12=0 KtVINIUN NUMliCK: 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 MAY 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. INSR LTR TYPE OF INSURANCE ADDL UB POLICY NUMBER MM DD EFF MMIDD EXP LIMITS ACCORDANCE WITH THE POLICY PROVISIONS. GENERAL LIABILITY El Segundo Public Library AUTHORIZED REPRESENTATIVE Debra Brighton EACH OCCURRENCE $ 1,000,00 AMAn-E—TG —RENTED PREMISES Ea occurrence) $ 300,00 A X COMMERCIAL GENERAL LIABILITY X ZZF 931602700 10/01/11 10/01/12 MED EXP (Any one person) $ 10,00 CLAIMS -MADE [JI(I OCCUR PERSONAL & ADV INJURY $ 1,000,00( GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,00 Emp Ben. $ 1,000,00 POLICY PRO LOC B AUTOMOBILE X LIABILITY ANY AUTO A21F 931604900 10101/11 10/01/12 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ SCHEDULED AUTOS HIRED AUTOS NON -OW NED AUTOS $ X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 5,000,00 HCLAIMS-MADE AGGREGATE $ EXCESS LIAR UHF 931600400 10/01/11 10101/12 DEDUCTIBLE $ X RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y WC STATU- OTH- TOR LIMIT R E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) N/A E.L. DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) IF regUired by written contract or agreement City of El Segundo is included as Additional Insured respect General Liability as their intent may appear in connection with services provided by the Named Insured for the Additional Insured. rANrGI 1 ATInIU V ItPOO-LUUN AGUKLJ L,UKYUKAI IUN. Ail FIUFIL5 fU5V1VWU. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD ELSEG -7 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of El Segundo El Segundo Public Library AUTHORIZED REPRESENTATIVE Debra Brighton 111 West Mariposa Avenue El Segundo, CA 90245 11711L V ItPOO-LUUN AGUKLJ L,UKYUKAI IUN. Ail FIUFIL5 fU5V1VWU. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD AUTOMATIC DATA PROCESSING INS AGCY PO BOX 33015 SAN ANTONIO TX, 78265 E1 Segundo Public Library, Director Debra Bricrhton 111 W MAR'POSA AVE EL SEGUNDO, CA 90245 ACORD 25 (2009/09) ac A� �� CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYV) to -la -toll THIS CERTIFICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONALINSURED, the policy(ies) must be endorsed. If SUBROGATIONIS 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). PRODUCER AUTOMATIC DATA PROCESSING INS AGCY 250717 P:(877)287-1316 F:(888)443-6112 PO BOX 3301-0 SAN ANTONIO TX 78265 CON I AU I NAME: PHONE FAX Arc. No, =_xcl: (877 287 -131b ArO,Nol: 8138)443 -6112 ADDRESS: PRODUCER CUSTOMER ID: INSURERS) AFFORDING COVERAGE NAIC x INSURED INSURER A : 14111t1 le Cornpanlej INSURER B INNOVATIVE INTERFACES INC 5850 SHELLMOUND S^ EMERYVILLE CA 9460$ INSURER C: INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 MAY PERTAIN, -HE 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. LTR TYPE OF INSURANCE Iry (MM,-DD/YYYY) (MM,DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE S PREMISES (Ea occurrence) S COMMERCIAL GENERAL LIABILITY 7��POLICIY7NUMBER MED EXP ;Any one person) ! S CLAIMS -MADE — OCCUR PERSONAL & ADV INJURY GENERAL AGGREGATE S PRODUCTS - COMFIOP AGG ! S . GEN'L AGGREGATE LIMi.T APPLIES PER: PRO- POLICY 7I LOC POLICY F7 S '.. AUTOMOBILE LL48 1CITY COMBINED SINGLE LIMIT s' (Ea acadentl ANY AUTO BODILY INJURY !Per person) ''. S ALL OWNED AUTOS BODILY INJURY ;Per accident) S PROPERTY DAMAGE ',$ (Per accident) SCHEDULED AUTOS HIRED AUTOS S NCN- OVJNFD AUTOS I S '.. UMBRELLA LIAB OCCUR EACH OCCURRENCE S AGGREGATE $ ''.. EXCESS LIAB ~_ CLAIMS -MADE 5 DEDUCT BILE S X WC STATU- 0TH - TORY LIMITS ER RETENTION S WORKERS COMPENSATION E.L. EACH ACCIDENT OOO , OOO AND EMPLOYERS' LIABILITY Y ; N ANY PROPRIETOR(PAHINER!EX ECU71VEIi A', (MandaRIMEMNH) EXCLUDED: li ,f yes describe under DESCRIPTION OF OPERATIONS below NIA 75 WEG LN3792 10/01/2011 10%01%2012 E.L. DISEASE EA EMPLOYEE!! $ E.L. DISEASE - POLICY LIMIT $ �- , Q r Q 0 0 DESCRIPTION OF OPERATIONS l LOCATIONS! VEHICLES /Attach ACORD 101, Additional Remarks Schedule, K more space n required/ Those usual to the Insured's Operations. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED E1 Segundo PublC Library, Director Debra Brighton 111 W MARIPOSA AVE EL SEGUNDO, CA 90245 BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHOR 2E REPRESENTATIVE 7 -_ o4 1!3bb_LUUyAIIUrlu L.unrunrlr!Uiv. r+n iiyrtra ...— - ACORD 26 (2009109) The ACORD name and logo are registered marks of ACORD