PROOF OF INSURANCE (2009) CLOSEDFrom: Lulu Sandoval At: Vanorsdale Ins Svcs FaxID: To: Dan O'Toole
Date: 7292008 09:16 AM Page: 2 of 3
MEDICON -01 LLS
ACORD OF LIABILITY INSURANCE
DA 712 2008 >
PRODUCER {858) 541 -2900
Vanorsdale Insurance Services
4909 Murphy Canyon Road, Suite 510
p y
San Diego, CA 92123
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
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NAIC S
INSURED Media Control Systems, LLC.
1050 Pioneer Way, Ste # 0
El Cajon, CA 92020 -
INSURER A. Hartford Casualty Insurance Company
POLICY EFFECTIVE
muRER B Hartford Insurance
LIMITS
INSURER C
]]A
INSURER D.
INSURER E
rnvCOer_CC
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
LTR
L
F
POLICY NUMBER
POLICY EFFECTIVE
POLICY EXPIRATION
LIMITS
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
GENERAL LIABLnY
EACH OCCURRENCE
i 1,000,00
ISEE 10 RE"'
$ 300,0
A
X
X COMMERCIAL GENERAL LIABILITY
2SBAAA9368
7/1812008
7/1812009
CLAIMS MADE M OCCUR
MED EXP (Any one person)
S 10,
PERSOWL aADV INJURY
$ 1,000,
X Hired 8 Non -Owned Auto
GENERAL AGGREGATE
$ 2,000,
MN L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
3 2,000,
Hired & Non -Owned A
1,000,
PoLlcv PRD- LOC
AUTOMOBILE
LIABILITY
ANY AUTO
COMB94ED SINGLE LIMIT
(Ea accident)
s
BODILY INJURY
(Per person(
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident)
S
HIRED AUTOS
NON - OWNED AUTOS
PROPERTY DAMAGE
(Per accident)
S
GARAGE LIABILITY
AUTO ONLY - EAACCIDENI
S
OTHER THAN EA ACC
E
ANY AUTO
S
ALtTO Ott Y.- AGG
EXCESSANMBRELLA LIABILITY
EACH OCCURRENCE
_
OCCUR CLAIMS MADE
AGGREGATE
$
s
S
DEDUCTIBLE
Z
RETENTION S
WORKERS COMPENSATION AND
y WC STATUE OTR
B
EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNER/EXECUTIVE
OFFICERAEMBER EXCLUDED?
72WECKP5822
711812008
7/1812009
E.L. EACH ACCIDENT
s 1,000,00
E.L. DISEASE - EA EMPLOYEE
S 1,000,000
It yes, describe under
SPECIAL PROVISIONS below
E DISEASE - POLICY LIMIT
S 1,00O.Wo
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
010 days notice Is given H policy Is cancelled for non - payment of premium.
City of El Segundo is named additional insured per the attached CG201010193 form regarding General Liability. "THIS CANCELS AND
UPERCEDES CERTIFICATE ISSUED 7115108"
CERTIFICATE HOLDER CANCELLATION
ACORD 25 (2001108) 0 ACORD CORPORATION 1988
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of El Segundo
30
Attn: Dan O'Toole
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAL DAYS WRITTEN
Community Cable Division
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
350 Main Street
"POSE NO OBLIGATION OR LIABILITY OF ANY KID UPON THE INSURER, ITS AGENTS OR
El Segundo, CA 90245- 1
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2001108) 0 ACORD CORPORATION 1988
From: Lulu Sandoval At: Vanorsdale Ins Svcs FaxID: To: Dan OToole
Named Insured: Media Control Systems, LLC
POLICY NUMBER: 72SBAAA9368
Date: 7/292008 09:16 AM Page: 3 of 3
COMMERCIAL GENERAL LIABILITY
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
SCHEDULE
Name of Person or Organization:
City of El Segundo
350 Main Street
El Segundo, CA 90245
(If no entry appears above, information required to complete this endorsement will be shown in
the Declarations as applicable to this endorsement.)
WHO IS 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.
CG 20 10 10 93 Copyright, Insurance Services Office, Inc. 1992 Page 1 of 1