PROOF OF INSURANCE (2003 - 2004) CLOSED09/17/'2003 07:31 9096267768
Sep 15 03 12144p
CERTIFICATE OF INSURANCE
Thra G n1flr; that ❑ STATE FARM FIRE AND CASUALTY COMPANY, Bloomington. Illinois
Fia STATp FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois
I ,I STATE FARM FIRE AND CASUALTY COMPANY, Scarborow7h, Ontario
j STATIL FARM FLORIDA INSURANCE COMPANY. Winter Hnvnn, Florida
❑ STATE FARM LLOYDS, DAIIAS Texas
m:urnri the foliow r%q policyholocr for thu covernanS mdicAad below.
PAGE 03
p.2
6
L
Nsrnr±of poltCyholdcr MOt3Il,A': 't, JOHN JOLE)Pll DBA KTRRY CONESULTING (:ROUE
Addrr__,339of po!icyholdnr 1' U W. 1:0Cn'I1ILL Arvin.
r'r•I:P1:u?JNI'. r'n '_�l'�li-- '.' /tl', _ - -
Lor_;lrlon or opUraiiOnr.
Dewipbon of eperatons
Thr policn3i. iInWC Mow Kivu W orl ir:uurd 10 tht) policyholdor for tho policy pc:nodt. a,hown. Tho inner :3ncu dllscribod in thue.0 policies it,
e ubJ�ct to nil the terms exclualona, and condlt;onn of (nose pollcloo. The limits of Iiability shown may havo been reduced by any paid clams.
THE CERTIFICATE OF INSURANCE It NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR N- nA:tVELY
AMENDS. EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN.
•CDDi rtor)A� r r: _!i cu If ony of the do:Cribed policies are canceled borore
its expirntion date, State Form will IN to mail n writt+on
noUcf) to thy, corti icatu hoidur :iq d: +y: buforu
Narrw and Addros„ of Certificate FtOldur cancellation, It hewevdr, wo fall It) m311 sucn notice,
no obhAabon cr liability will be Imposed on Stntn
CITY 01; i.:L SY.CUNDO, Flan or its nijunt:: or roDrca.(!nljtivn::.
ITS OFFLCLRS, li-MOI.UYLLS AND VOLUNTEERS
AS ADDITIONAL INSUREDS
350 VAIN STREET, It11 5
CL suc:uNDO. CA 9024; -3895
„N.nrd 3 'A.iiO) P.inrn0 i, U S.A
Signahiro of Authorizoa K&vec .enbtiw,
ni : mr,l,
Aganrs Code Stamp
^FO Coax F414
SEP -1 r- 0077 08 : "Is 9t795?5 X758 99',
�3�3G
P.03
POLICY PERIOD
LIMITS OF LIABILITY
POLICY NUMBER
TYPE OF INSURANCE
Effoctivo Date Expiry ton Dato
(al beginning of policy poriod)
�empr�hCiftalvn
BODILY INJURY AND
;:- .v-'b7S3 -6 c
Bunlne9sLiaoildy_... 01/01/9'_ .. 101/^,4'
PROPERTY DAMAGC
..... .. ..............
TMr: mrur;,nc r 3nCIUCrn.
......... ....... .....;........... . ..
[, P(04u7tZo - Corrplutud Opnr)t.oA,3
Contractual LI.10ility
❑ Underground Hzz,vd Covvoae
Eneh Occurruncc $ i, Ono, OOC
%j Po .on:)I Injury
Advcrtisino Injury
General A.ggrugato 3 2, uao, 000
❑ Explosion Hnzard Cover,gn
❑ Coil,tD!:n t .v .,rrd Covnragr
Products - COmplctcd 3
�v,,Lunhi� p1pu� 3
OperationsAlgrugotc
OOOILY INJURY AMC) PROrERTY C-AMACt_
POLICY PERIOD
EXCESS LIABILITY
EHoctivo Date Explrabon DvW
(Comtlined Sirx)te Lirrlr,)
❑ Umorcila
Each Occurrence S
n Olhur
AQGrr n�lp
Part 1 STATUTORY
Part 2 BODILY INJURY
'12 P7- 5.3611 -r,
Workers' Cornpon�tation
1 /0 /04
and Emotoycrs L ability
Erich Accldunt $ 1 ;OU, 000
Disease Ench Empleye,u S JOD
-
Policy Limit S L. ou' , UuU
POLICY NUMBER
TYPC OF INSURANCE
POLICY PERIOD
Effoetivo Dato i Expiratlon Oato
LIMITS OF LIABILITY
(at beginning of policy poriod)
Ar)'TQ INUVPANCP
0l /lb /03- 01;26/04
L MILLION SENCLY /LZNT'1'
THE CERTIFICATE OF INSURANCE It NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR N- nA:tVELY
AMENDS. EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN.
•CDDi rtor)A� r r: _!i cu If ony of the do:Cribed policies are canceled borore
its expirntion date, State Form will IN to mail n writt+on
noUcf) to thy, corti icatu hoidur :iq d: +y: buforu
Narrw and Addros„ of Certificate FtOldur cancellation, It hewevdr, wo fall It) m311 sucn notice,
no obhAabon cr liability will be Imposed on Stntn
CITY 01; i.:L SY.CUNDO, Flan or its nijunt:: or roDrca.(!nljtivn::.
ITS OFFLCLRS, li-MOI.UYLLS AND VOLUNTEERS
AS ADDITIONAL INSUREDS
350 VAIN STREET, It11 5
CL suc:uNDO. CA 9024; -3895
„N.nrd 3 'A.iiO) P.inrn0 i, U S.A
Signahiro of Authorizoa K&vec .enbtiw,
ni : mr,l,
Aganrs Code Stamp
^FO Coax F414
SEP -1 r- 0077 08 : "Is 9t795?5 X758 99',
�3�3G
P.03
09,x'17!2 -1003 07: 31 3096267769 i:;CG PAGE O'2
00/17/03 WED 09:16 FA3; 816 998 0656 WJUUI
CERTIFICATE OF INSURANCE
INSURED
JOHN JOSEPH MORIARTY
100 W FOOTBALL BLVD
CLAREMONT CA 91711
Date: 09117►03
This cer lftate Is l9aued as a matter of Information only and confers no rights upon the certiflt:llte
holder. This certificate does not amend, extend or Alter the coverage afforded by the polices
below.
PRODUCER COMPANY AFFORDING COVERAGE
0. G. Kocher, Agent/Broker Nutmeg Insurance Company
3130 Broadway
PO Box 41813'1
Kansas City, MO 64141 -9131
COVERAGES
This is to certify that the policy of insurance listed below has 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 the respect to which this certiflUte may be Issued or may pertain,
the Insurance afforded by the policles doverlbad herein is subject to all the terms, exclusl0me and
conditions of such policies. Limits shown rM have been reduced by paid claims.
TYPE OF INSURANCE
PROFESSIONAL LIABILITY FOR
SOUCATORS IN PRIVATE PRACTICE
AND PREMISES LIABILITY
LIMIT OF LIABILITY
$1,000,000 LIMIT
$3,000,000 AGGREGATE
POLICY EFFECTIVE DATE
12/02/02
POLICY NUMBER
37EENOB1814
$27077
DEDUCTIBLE
$1000
POLICY EXPIRATION DATE
12/02/03
CERTIFICATE HOLDER
CITY OF EL SEGUNDO, ITS OFFICIALS, OFFICERS, EMPLOYEES & VOLUNTEERS
CITY CLERKS OFFICE
350 MAIN ST RM ttt5
EL SEGUNDO CA 90246 -3896
Should the above policy be cancelled before the expiration date therooty the bluing company will endeavor
to mail 30 days written notice to die Certificate holder and/or =y additional insured, but fkilure to mail
such notice shall unpo3c no obliption or liability of any kind upon the company, its agentil or
reprCsmu ktives.
Authorizod Representative
9EP -17-2!083 D8:51 98957-67 758 99%
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