PROOF OF INSURANCE (2008) CLOSEDJul 24 07 03:22p
P.1
DATE t" 00" YrY1
,4coRd CERTIFICATE OF LIABILITY INSURANCE 07/24/2007
THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION
PRODUCER
Tom Hrundidge License 0479986 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
214 Standard St. Ste H HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
El Segundo, CA 90245 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
0=1111RD
James i Ashley Savela 6 Kirk Lebowe
341 Main Street
E1 Segundo, CA 90245
INSURERS AFFORDING COVERAGE
imsuaERA state Farm General Ins
INSURER B:
D:
25151
NAIC B
COVERAGES
ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY
PERIOD INDICATED. NOTWITHSTANDING
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN
OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT
BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
MAY PERTAIN, THE INSURANCE AFFORDED
POLICIES. AGQREOATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CroIUS.
LTA NEUD TYPE OF INSURANCE POLICY DATE DATE
92-GA 8234 2 05/31/2007 05/31/2008
��
HO REIN 1,000,000
X GENIVIALLJABIUTV
X COMIIERCUIL GENERAL
P
LIED E]UP M aw on= E _ ._-
�� X OCCUR
PER i ADV INJURY_
GE AGGR TE s 2,000,000
pRpDUICTS- CONPAPAOG f 11000,000
GBILAQw4 1ELMr/PPLEi9PER
'
LE;Y PCT MLOC
AUIOYOYE LIABILITY
cOLSME 3i6t E LMT
(6� seae�
:
ANY At JTO
INJURY
i
ALL OWNED AUTOS
Mw pw
cP�>Ia+i
«
SCHEDULED AUTOS
BODILY INJURY
f
HIRED AUTOS
(Pr ldrtl
NON.OWNED AUTOS
PROPERTY DAMAGE
f
(Per saw wt)
AUTO ONLY - EA ACCEIENT
f
I OTHER THAN EA ACC
f
GARAGE LIA/SJTY
ANY AUlrO
AUTO ONLY:
VAA LI�MMM
EACH OCCURRENCE
S
f
OCCUR 1:1 CLANS MADE
3
s
DEDUCTIBLE
RETENTION S
YIIC ATU- 0TH-
f
RE CORV41MUT�M AND
TORY LIARS ER
EL EACH ACCIDENT
S
EMPLOYER''LIASSJTY
AN PROPMETORRARTNEWEIC
OFFICERXAEMSER EXCLUDED?
EL DISEASE • EA EWLOYEE
f
E.L. DISEASE - POLICY LDAIT
b
SPE I d PROVISION$ t »Ior
OTHER
DlSCRIPTION Oi OPERATIONS I LOCATIONi / VEHICLES 1 EXCLUSIONS ADDED BV EMDORSlMENT / SPlCW PROVISIONS
Encroachment permit, reference license agreement 3729
04w&U-CM I ATUAY
City Of Ei segu
Employees
350 Main Street
El Segundo, CA
do, Its officers, agents and SHOULD ANY OF THE MME DOWRSSID POLES BE CANCEI-IUM aOM� THE E>WIeATIOM
DATE THER60F, THE ISSUER; RSURER WILL ENDEAVOR TO MAIL •ZL DAYS WRITTEN
NOTICE TO THE CER,r CATI HOLDER NAMED TO THE LEFT. 910 FAR-URE TO 00 EO 5H LL
90245 IMPOSE NO OOLWrtoN qR' A!S _ITY OF ANY YD UPON THE HIEIMI R. R8 AGENTS OR
FROM : TOM BRUNDIDGE -STATE FARM PHONE NO. : 310 322 0831 Jun. 04 2007 11:47AM P1
CERTIFICATE OF INSURANCE
STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois
This certifies that ® STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois
❑ STATE FARM FIRE AND CASUALTY COMPANY, Scarborough, Ontario
Q STATE FARM FLORIDA INSURANCE COMPANY, Winter Haven. Florida
❑ STATE FARM LLOYDS. Dallas. Texas
insures the following policyholder for the coverages indicated below.
James & Ashley 3avela & Ki.rk Lebowe
Policyholder 9029 5
347 Main Street , F,.1 Segundo, CA
Address of policyf+°tder 90 2 4 5
Location of operations 347 Main Street, E1 Segundo, CA
Description of operations Trash Bin in Street
The polities listed below have been issued to the policyholder for the policy periods shown. The insurance described in these policies is
and conditions of those policies• The limits of liability shown may have been reduced by any paid claims,
subject to all the terms exclusions, POLICY PERIOD LIMITS OF LIABILITY
TYPE OF INSURANCE p� (at beginning of policy period)
POLICY NUMBER Effective Date ' Etrprratien BODILY INJURY AND
92 -GA 8234 -2 Comprehensive 05 -31 -2001 05 -31 -2008 PROPERTY DAMAGE
'
Business Liabifity
- ---------
insurance inGudes: ® Products - Completed Operations
® Contractual Liability Each Occurrence $ 500,000
❑ Underground Hazard Coverage
® Personal injury General Aggregate $1,000,000
® Advertising Injury
❑ Explosion Hazard Coverage Products - Completed $2,000,000
❑ Collapse Hazard Coverage Operations Aggregate
El
❑ POLICY PERIOD BODILY INJURY AND PROPERTY DAMAGE
EXCESS LIABILITY Ef (active pate Expiration Data (Combined Single Limit)
❑ Umbrella Each Ooeurtenoe $
Aggregate $
❑ Other Part 1 STATUTORY
Pert 2 BODILY INJURY
Workers' Compensation �� Accident $
and Employers Liability Disease - Each Employee $
pisease - Policy Limit $
POLICY PERIOD LIMITS OF LIABILITY
POLICY NUMBER TYP�SURAN
CE Effective pate ;Expiration Dane (at beginning of policy penod)
THE CERTIFICATE OF INSURANCE I- NOT A CONTRACT OF INSURANCE AND NEITHER wrrrrser.%11v« - --
AMENDS, SENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESaCnyRIBED HEREIN. llcies are canceled before
Additional Insured includes: City of E1 Segundo, its office=s, Ifs ny of btthe dat5eCa7Sbteadfe� rlrt will mail awritten
agents and Employees notice to the certificate holder 30 days before
cancellation. If however we fail to mail such notice.
Name and Address of Certificate Holder no on or nab' will be imposed on to
Fa is or S.
City of E1 Segundo, its officers, agenr.s and employees
350 Main Street, Rm 5 re ofAutl10019 d raserlta"M
El Segundo, CA 90245 AGENT o6 /Ol 007
Title Date
Agent's Code StsmP
AFO Cove F412 2140STANDARID ST SUITE 8
EL SEGUNDO, CA. 90245
BUS (310) 322 -5910
563994 3A 11.12 2002 Prinind In U.SA. TOLL (90x3) 603.0303