PROOF OF INSURANCE (2009) CLOSEDMACIGIN -01 MAMI
ACORD. CERTIFICATE OF LIABILITY INSURANCE
D`W512008
PRODUCER (916) 231 -1741
Wells Fargo of California Insurance Services, Inc.
CA DOI L[C 110352275
CAD I UC 0 352 Drive, Suits 100
Rancho Cordova, CA 95670
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND
ALTER THE COVERAGE AFFORDED BY THE POLICIES
OR
BELOW.
INSURERS AFFORDING COVERAGE
NAIC 0
INSURED Macias Gini & O'Connell U.P and Macias Consulting
Group
3000 S street" Suite 300
Sacramento, CA 95816
INSURER A: American Automobile Insurance ComFL&n
�— LIMITS
INSURER s: Everest National Insurance
REPRESENTATIVES.
INSURER C:
INSURER D:
INSURER E:
$ 2,000,00
f _nVR RAf3FA
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
JIM
AMC—
K=
TYPE OF INSURANCE
POLICY NUMBER --
POLICY EFFECTIVE
POLICY EXPIRATION
�— LIMITS
REPRESENTATIVES.
GENERAL LIABILITY
EACH OCCURRENCE
$ 2,000,00
PREMISES Me ooarenoe
S 100,00
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE a OCCUR
AZC80825971
4130/2008
4/30/2009
MED EXP (Any one )
$ 10,00
PERSONAL a ADV INJURY
S 2,000,00
GENERAL AGGREGATE
S 4,000,00
GENT. AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMPIOP AGO
S 4,000,00
X POLICY 7 PRO LOC
A
AUTOMOBILE
LIABILITY
ANY AUTO
C80825971
443012008
4/30/2009
COMBINED SINGLE LIMB
Me wddeM)
' 2,000,0
BODILY INJURY
(Per Person)
[xx
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
e0
(Per ddent)
s
MIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE
(Per socident)
_
_
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
AUTO ONLY: AGO
S
ANY AUTO
$
EXCESSAIMBRELLA LIABILITY
EACH OCCURRENCE
S 1,000,00
AGGREGATE
S 2,000,00
A
X OCCUR CLAIMS MADE
AZC80826971
4130/2009
4130/2009
a
DEDUCTIBLE
:
RETENTION S
WORKERS COMPENSATION AND
X WC STAT(I OTH-
E.L. EACH ACCIDENT
Is 1,000,00
B
EMPLOYERS 'LIABILITY
ANY PROPRIETOR/PARTNERIEXECUTWE
OFFICERMIEMBER EXCLUDED?
CA20011402081
4130/2006
413012009
E.L. DISEASE - EA EMPLOYO
S 1,000,00
K oADnder
SPECIAL deePROVIeuSIONS below
E.L. DISEASE - POLICY LIMIT
18 111000100
OTHER
A
Crime
AZC80826971
4/30/2008
4130/2009
Employee Dishonety 25,00
A
Property
AZCW825971
4/30/2008
4/30/2009
Business Personal Properl 108,00
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Certificate holder ls included as additional Insured perform OABO189 05 -99 attached. 'Subject to 10 day notice of cancellation for
on- payment of premium.
The City of El Segundo, Its official, and employees are named as addltllonal insured per form NAS9189 05 -99 attached.
e+reTmrrrwre unr n=o CANCFI I ATInrJ
ACORD 25 (2001108) 0 ACORD GORPORATION 1953
la
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES eE CANCELLED BEFORE THE EXPIRATION
City of El Segundo
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAR. 30 DAYS WRITTEN
Attn: Deborah Cullen
et
350 Main Street
OTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL
El Segundo, 80245 -
IM POSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2001108) 0 ACORD GORPORATION 1953
la
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(les) 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 endomement(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
MACIGIN -01 MAMI
INSURED: Macias, Gini & O'Connell, LLP June 5, 2008
POLICY NUMBER: AZC80825971 COMMERCIAL GENERAL LIABILITY
INSURANCE COMPANY: Fireman's Fund Insurance Company
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED -- OWNERS, LESSEES OR CONTRACTORS (FORM B)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
Name of Person or Organization: City of El Segundo its officials, and
employees
Attn: Deborah Cullen
350 Main Street
E1 Segundo, CA 90245
Asrespects: RE: Audit work performed on behalf of the certificate holder.
(If no entry appears above, information required to complete this endorsement will be shown in the
Declarations as applicable to this endorsement)
WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization
shown in the Schedule, but only with respect to liability arising out of your ongoing operations
performed for that insured.
WELLS FARGO OF CALIFORNIA INSURANCE SERVICES, INC.
CG 20 10 10 93 Copyright, Insurance Services Office, Inc., 1992
ABC MuldCover - AB 91 89 05 99
This endorsement modifies Insurance provided under the following:
American Business Coverage
Your policy is broadened and clarified as follows:
1. Non Employment Discrimination Liability
Unless Personal Injury or Advertising Injury is
excluded from this policy:
A. Section III - Definitions, Item 17. Personal
Injury is amended to include:
f. Discrimination
a. Section III - Definitions, Item 2. Advertising
Injury is amended to include:
e. Discrimination
C. Section III - Definitions is amended to in-
clude:
30. Discrimination means the unlawful treat-
ment of individuals based on race, color,
ethnic origin, gander, religion, age, or
sexual preference.
D. Section II - Liability Coverage, Part H. Ex-
clusions, Item 1.p Persoaal Injury or Adver-
tising Injury is amended to include:
(11) Arising out of discrimination directly or
indirectly related to the past employ-
ment, employment or prospective em-
ployment of any person or class of
persons by any insured; or
(12) Arising out of discrimination directly or
indirectly related to the sale, rental, lease
or sub -lease or prospective sale, rental,
lease or sub -lease of any dwelling,
permanent lodging, or premises by or at
the direction of any insured; or
(13) Arising out of discriminstion, if insurance
thereof is prohibited by law; or
(14) Fines, penalties, specific perfortnanoe, or
injunctions levied or imposed by a go-
vernmental entity, or governmental code,
law, or statute because of discrimination.
2. Blanket Additional Insured
Section It - Liability Coverage, Part 1. Who Is Air
Insured, Item 2. is amended to include:
f. Any person or organization that you are re-
quired by a written Insured contract to include
as an insured, su ect to all of the following
provisions:
(1) Coverage is limited to their liability aris-
ing out of:
(a) the ownership, maintenance • or use
of that part of the premises, or land
owned by, rented to, or leased to
you; or
(b) your ongoing operations performed
for that insured; or
(e) that insured's financial control of
you; or
(d) the maintenance, operation or use
by you of equipment leased to you
by such person(s) or organization(s);
or
This Form must be sawhed to Chutge Fndomment when issued sttcr the policy is wdlwn.
Onc of tho nreasn's Fwd Insurance Compwtn as nomad in tho policy
o wn. Z
Aresident
A99189 5.99
Page I of 5
(e) a state or political subdivision per -
assumption of liability in a contract
mit issued to you,
or agreement. This exclusion does
not apply to liability for damages
(2) Coverage does not apply to any occur -
that the vendor would have in the
rence or offense:
absence of the contract or agree -
(a) which took place before the exe.
meet;
cution of, or subsequent to the
b. Any express warranty unauthorized
completion or expiration of, the
by you;
written insured contract, or
c. Any physical or chemical change in
(b) which takes place after you cease to
the product made intentionally by
be a tenant in that premises.
the vendor;
(3) With respect to architects, engineers, or
d. Repackaging, unless unpacked solely
surveyors, coverage does not apply to
for the purpose of inspection, dem-
Bodily Injury, Property Damage, Per-
onstration, testing, or the subed-
sonal Injury or Advertising injury arising
tution of parts under instructions
out of the rendering or the failure to
from the manufacturer, and then re-
render any professional services by or for
packaged in the original container.
you including:
(a) The preparing, approving, or failing
e. Any failure to make such in-
speraions, adjustments, testa or ser-
to prepare or approve maps, draw-
vicing as the vendor has agreed to
ings, opinions, reports, surveys,
change orders, designs or specifies-
make or normally undertakes to
make in the usual course of busi-
tions; and
ness, -in connection with the distrib-
(b) Supervisory, inspection, or engi-
ution or sale of the products;
neering services.
E Demonstration, installation, servic-
If an Additional Insured endorsement is attached
ing or repair operations, except such
to this policy that specifically names a person or
operations performed at the vandor's
organization as an insured, then this coverage does
premises in connection with the sale
not apply to that person or organization.
of the product;
3. Blanket Additional Insured rer Vendors
g. Products which, after distribution
or sale by you, have been labeled or
Unless the Products - Completed Operations Haz-
relabeled or used as a container, part
and is excluded from this policy, Section li - Ll-
or ingredient of any other thing or
ability Coverage, Part 1. Who is an insured, Item
substance by or for the vendor.
2. is amended to include:
2• This insurance does not apply to any in-
g. Any vendor but only with respect to Bodily
sured person or organization, from
Injury or Property Damage arising out of your
whore you have acquired such products,
products which arc distributed or sold in the
or any ingredient, part or container, en-
regular course of the vendor's business, sub-
tenng into, accompanying or containing
ject to the following additional exclusions:
such products.
1. The insurance afforded the vendor does
If an Additional Insured - Vendors endorsement
not apply to:
is attached to this policy that specifically names a
a Bodily Injury or Property Damage
person or organization as an insured, then this
for which the vendor is obligated to
coverage does not apply to that person or organ -
pay damages by reason of the
ization.
Aa9189 599
Page 2 of 5
4. Blanket Waiver of Subrogation
Section 11 - Liability Coverage, Part K. Liability
and Medical Payments General Conditions, is
amended to include:
6. Transfer of Rights of Recovery Against Oth-
ers to us and Blanket Waiver of Subrogation
L If the insured has rights to recover all or
part of any payment we have made under
this Coverage Part, those rights are
transferred to us. The insured must do
nothing after loss to impair those rights.
At our request, the insured will bring suit
or transfer those rights to us and help us
enforce them.
b. If required by a written insured contract,
we waive any right of recovery we may
have against any person or organization
because of payments we make for injury
or damage arising out of your operations
or your work for that person or organ-
ization.
S. Broadened Named Insured
Section 11 - Liability Coverage, Part 1. Wbo is An
Insured, Item 4. is replaced with:
4. All of your subsidiaries, companies, corpo-
redons, firms, or organizations, as now or
hereafter constituted, qualify as Named In-
sured under this policy if.
(a) you have the responsibility of placing in-
surance for each such entity; and
(b) coverage for the entity is not otherwise
more specifically provided; and
(c) the entity is incorporated or organized
under the laws of the United States of
America.
But each entity is insured only while you
own, during the policy period, a controlling
interest in such entity of greater than 50% of
the stock or assets. However.
(a) Coverage under this provision is afforded
only until the and of the policy period,
or the 12 month anniversary of the policy
inception date, whichever is earlier;
(b) Coverage C does not apply to bodily in-
jury or property damage that occurred
before you acquired or formed the or-
ganization;
(c) Coverage C does not apply to personal
Injury or advertising injury arising out of
an offense committed before you ac-
quired or formed the organization.
6. Medical Payments
Unless Coverage D. Medical Payments is excluded
from this policy:
A. Section II - Liability Coverage, Part H. Ex-
clusions, Item 2.f. is replaced with:
f. Included within the products- completed
operations hazard. However, this exclu-
sion does not apply to expenses for den-
tal services.
B. Section 11 - Liability Coverage, Part G. Cov-
erage, item 2., is amended to include:
c. Coverage D. Medical Payments is pri-
mary and not contributing with any
other insurance, even if that other tr=-
ance is primary also.
7. Tenant's Legal Liability
A. Section Ili - Liability Coverage, Part J. Li-
ability and Medical Payments Limits of In-
surance, Item 3. is replaced with:
3. The most we will pay under Coverage C
- Liability for damages because of prop-
erty damage to premises while rented to
you, temporarily occupied by you with
the permission of the owner, or managed
by you under a written agreement with
the ownerr,
a. arising out of any Covered Cause of
Loss shall be the greater of:
(1) $1,000,000; or
(2) The Tenant's Legal Liability
limit shown in the Declarations.
8. Cbertered Aircraft
Section 11 - Liability Coverage, Coverage C, Part
H. Exclusions, Item l.g. is amended to include:
(S) An aircraft in which you have no ownership
interest and that you have chartered with
crew.
Aa9199 5-99
Page 3 of 5
9. Coverage Territory Broadened
Sudan III - Definitions, Item 5.a. is replaced with:
a. The United States of America (including its
territories and possessions), Puerto Rico, Ca-
nada, Bermuda, the Bahamas, the Cayman
Islands and the British Virgin Islands.
10. Broadened Advertising Injury
Unless Advertising Injury is excluded from this
policy:
A. Section III - Definitions, Item 2. is replaced
with:
2. Advertising Injury means injury arising
out of one or more of the following of-
fenses:
Payments Definitions, Items 17b., d. and e. are
replaced with:
b. Malicious prosecution or abuse of process;
d. Oral, written, televised or videotaped publica-
tion of material that slanders or libels a person
or organization or disparages a person's or
organization's goods, products or services;
e. Oral, written, televised or videotaped publica-
tion of material that violates a person's right
Of privacy;
12. Broadened Personal or Advertising Injury
Unless Personal Injury or Advertising Injury is
excluded from this policy, Section II - Liability
Coverage, Coverage C, Part H. Exclusions, Item
I.p.(4) Exclusions is deleted in its entirety.
a. Oral, written, televised or videotaped
publication of material that slanders
13. Fellow Employees Coverage
or libels a person or organization or
Section If - Liability Coverage, Part I. Who Is an
disparages a person's or organize-
Insured, Item 2.a.(1) is amended as follows:
tion's goods, products or services;
b. Oral, written, televised or videotaped
(1) Personal Injury to you or to a co- employee
while in the course of his or her employment,
publication of material that violates
or the spouse, child, fetus, embryo, parent►
a person's right of privacy;
brother, sister or any member of the house -
c. Misappropriation of advertising
hold of that employee or co- employee as a
ideas or style of doing business; or
consequence of such Personal injury, or for
any obligation to share damages with or repay
d. Infringement of trademark, copy-
someone else who must pay damages because
right, title or slogan.
of the injury; or
B. Section II - Liability Coverage, Coverage C,
Part H. Exclusions, Items Lp.(1) and (2) are
replaced with:
(1) Arising out of oral, written, televised or
videotaped publication of material, if
done by or at the direction of the insured
with knowledge of its falsity;
(2) Arising out of oral, written, televised or
videotaped publication of material whose
first publication took place before the
beginning of the policy period;
11. Broadened Personal Injury
Unless Personal Injury is excluded from this pol-
icy, Section III - Property, Liability and Medical
AB91" S."
14. Mental Anguish Is Included In Bodily Injury
Section III - Dellaltions , Item 4. is replaced with:
4. Bodily Injury means bodily Injury, sickness or
disease sustained by a person. It includes
death or mental anguish which result at any
time from such physical harm, physical sick-
ness or physical disease. Mental anguish me-
ans any type of mental or emotional illness
or disease.
15. Unintentional Failure to Disclose Hazards
Section II - Liability Coverage, Part IG Liability
and Medical Payments general Conditions, is
amended to include:
Page 4 of 5
6. Unintentional Failure to Disclose Hazards
If you unintentionally fail to disclose any ha-
zards existing at the inception 'date of your
policy, we will not deny coverage under this
Coverage Form because of such failure.
However, this provision does not affect our
right to collect additional premium or exercise
our right of cancellation or non- renewal.
16. Supplementary Payments, Increase Limits
Section 11- Liability Coverage, Part G. Coverage,
Items Le. (2) and (4) are replaced with:
(2) The cost of bail bonds required because of
accidents or traffic law violations arising out
of the use of any vehicle to which the Bodily
Injury Liability Coverage applies. We do not
have to furnish these bonds,
(4) All reasonable expenses incurred by the In-
sured at our request to assist us in the inves-
tigation or defense of the claim or suit
including substantiated loss of earnings up to
$500 a day because of time off work.
17. Per Location Aggregate
A. Section II - Liability Coverage, Part J. Limits
of Insurance, Item 4. is amended to include:
The Aggregate Limit of Insurance applies se-
parately to each location owned by you,
rented to you, or occupied by you with the
permission of the owner.
B. Section III - Property, Liability and Medical
Payments Definitions, is amended to include:
31. Location means premises involving the
same or connecting lots, or promises
whose connection is interrupted only by
a street, roadway, waterway or right -of-
way of railroad.
18. Amended Duties in the Event of an Occurrence,
Offense Claim or Suit
Section 11 - Liability Coverage, Part K. Liability
and Medical Payments General Conditions, Items
2.L and b. are replaced with:
a. In the event of an occurrence, offense, claim,
or suit, you must promptly notify us. Your
duty to promptly notify us is effective when
your executive officers, partners, members, or
AB9189 3•99
legal representatives are aware of the Oeneral
Liability occurrence, offense, claim, or soft.
Knowledge of an occurreace, offense, claim,
or suit by other employee(s) does not imply
you also have such knowledge.
b. To the extent possible, notice to us should
include:
(1) How, when and where the occurrence or
offense took place;
(2) The names, addresses, and telephone
numbers of any injured persons and wit-
nesses; and
(3) The nature and location of any injury or
damage arising out of the occurrence, of-
fense, claim, or suit.
19. Common Policy Conditions (AB 00 09 A 01 87),
Part H. Other Insurance, Item 2. is replaced with:
2. Coverage C - Liability
If other valid and collectible insurance is
available to any insured for a loss we cover
under Coverage C of this Coverage Part our
obligations are limited as follows:
L The insurance provided under this policy
is primary if you are required by a written
Insured contract to include any person
or organization as an insured, but only
with respect to that insured's liability
arising out of the ownership, mainte-
nance, or use of that part of the premises
owned by or rented to you, or your work
for that insured by or for you. Any other
insurance available to that person or or-
ganization is excess and noncontributory
with this insurance, or;
b. Except for the circumstance described in
2.L, above, the insurance provided under
this policy is excess over any other li-
ability insurance available to any insured
whether such other insurance is written
as primary, excess, contingent or any
other basis. An exception applies when
any insured specifically has purchased
excess insurance to apply in excess of the
limits of insurance shown in the Decla-
rations of this Coverage Part for Cover-
age C.
All other terms and conditions of the policy apply.
Page 5 of 5
ACORD,, CERTIFICATE OF LIABILITY INSURANCE °05 /02/20 8
PRODUCER (8 47) 385 -6800 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Lemma Insurance Group, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
3701 Algonquin Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 810
Rolling Meadows, IL 60008 CA DO[ Lic #OC42466 INSURERS AFFORDING COVERAGE NAIC#
INSURED I INSURERA:
Macias Gini & O'Connell LLP, Macias Consulting Group, and INSURERS:
Macias Gini Investments, LLC INSURERC: Lexington Insurance
3000 S Street, Suite 300 INSURERD:
Sacramento, CA 95816 INSURERE:
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
ADD'L
POLICYNUMBER
Pp' UCYEFFECTIVE
POLICY EXPIRATION
LIMITS
GENERAL LIABILITY
p:C01MMERCIALGENERALLIABILITY
CLAIMS MADE 7 OCCUR
EACH OCCURRENCE
$
DAMAGE TO RENTED--
REMISES Eaoccurence
_
$
MED EXP An one person
$
PERSONAL &ADV INJURY
$
GENERAL AGGREGATE
$
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY I I PRO LOC
PRODUCTS -COMPIOPAGG
$
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWN ED AUTOS
SCHEDULEDAUTOS
HIRED AUTOS
NON -OWNED AUTOS
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY
(Per person)
$
BODILY INJURY
(Per accident)
$
PROPERTYDAMAGE
(Peraccldent)
$
GARAGE LIABILITY
ANY AUTO
AUTO ONLY -EA ACCIDENT
$
OTHERTHAN EAACC
AUTO ONLY: AGG
$
$
EXCESSIUMBRELLA LIABILITY
OCCUR FI CLAIMS MADE
DEDUCTIBLE
RETENTION $
EACHOCCURRENCE
$
AGGREGATE
S
S
$
$
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yea, describe under
SPECIAL PROVISIONS below
WC STATUS OTH-
E.L. EACH ACCIDENT
$
E.L. DISEASE -EA EMPLOYEE
$
E.L. DISEASE- POLICY LIMIT
$
C
OTHER
Professional Liability
321 -3497
05/01/2008
05/01/2009
7,000,000 Per Claim and Annual Ag
$150,000 deductible
DESCRIPTION OF OPERATIONS /LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
Attn: Deborah Cullen
350 Main Street
El Segundo, CA 90245
ACORD 25 (2001108)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, THE ISSUING PRODUCER WILL MAIL 30
DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.
AUTHORIZED REPRESENTATIVE
0 ACORD CORPORATION 1988