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PROOF OF INSURANCE (2010) CLOSEDACORD,M CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 10/21/2009 PRODUCER Phone: 757 -456 -0577 Fax: 757- 456 -5296 Rutherfoord 222 Central Park Avenue 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. Suite 1340 POLICY NUMBER POLICYEFFECTIVE ID Dlyyl_ DATE (MM Virginia Beach VA 23462 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA: Hart ford Casualty Ins Co 27120 INSURER B: Pennsylvania Manufacturers' A 1 QQQ 0 MuniServices, LLC Attn: Patricia Dunn ph: 559 - 271 -6852 7335 N. Palm Bluffs Ave. INSURERC:Westchester Suriplus Lines Ins 10172 INSURER D: Fidelity & Deposit Company of AUTHORIZED REPRESENTATIVE - Fresno CA 93711 INSURERE: Hart ford l Ins Co 127120 CLAIMS MADE ,'X —_ J! OCCUR COVERAGES 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. INSRADD'L LTR IN5RD TYPE OF INSURANCE POLICY NUMBER POLICYEFFECTIVE ID Dlyyl_ DATE (MM POLICY EXPIRATION LIMITS i A GENERAL LIABILITY 114UUNJC3281 Clerk 10/31/2009 10/31/2010 EACH OCCURRENCE 1 QQQ 0 __$ DA MA 0 RENTED PREMISES Ea occurence $300,000 X COMMERCIAL GENERAL LIABILITY AUTHORIZED REPRESENTATIVE - __. MED EXP (Anyone person) $ 10, 000 CLAIMS MADE ,'X —_ J! OCCUR PERSONAL & ADV INJURY $ 1 000,000 GENERAL AGGREGATE $2,000,000 PRODUCTS- COMP /OPAGG $ 2 000 OQO__,_ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- LOC A AUTOMOBILE LIABILITY 14UUNJC3281 10/31/2009 10/31/2010 COMBINED SINGLE LIMIT (Ea accident) $ 1, 000,000 }{ ANY AUTO BODILY INJURY $ _ ALL OWNED AUTOS (Per person) SCHEDULEDAUTOS BODILY INJURY $ X HIRED AUTOS !, X NON - OWNEDAUTOS (Per accident) PROPERTYDAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY -EA ACCIDENT $ OTHERTHAN EAACC $ ANYAUTO $ AUTO ONLY: AGG E EXCESSIUMBREL LIABILITY 14XHUJC2284 10/31/2009 10/31/2010 EACH OCCURRENCE $ 10 QQQ 000 AGGREGATE $ 10, 000, 000 IA X I OCCUR _ I CLAIMS MADE DEDUCTIBLE $ _ $ RETENTION $ i B WORKERS COMPENSATION AND 16614663B200900 10/31/2009 10/31/2010 X WCSTATU- OTH- E.L. EACH ACCIDENT $ 1, 000, Q Q Q -- EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE E.L. DISEASE- EA EMPLOYEE $ 1 000,000 OFFICEPUMEMBER EXCLUDED? if yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ C OTHER EONG21671630006 10/31/2009 10/31/2010 $5,000,000 Limit $100,000 Ded Professional Liab(E &0) CCP006253304 10/31/2009 10/31/2010 $5,000,000 Limit $25,000 Ded Crire DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Ihe: "ity of E1 Segundo, its agents, officers, servants and employees are named as additional insureds under the General ity policy'with respect to the operations and work performed by the named insured as required by contract. (`COTICl/`ATC unl nFR CANCFLI._ATION ACORD 25 (2001/08) © ACORD CORPORATION 1988 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER City of E1 Segundo WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE Attn: City Clerk CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO 350 Main Street SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON E1 Segundo CA 90245 -0989 THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE - I ACORD 25 (2001/08) © ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) 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 endorsement(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 (2001108) POLICY NUMBER: 14 UUN JC3281 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE" PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) "ANY PSRSON OR ORGANIZATION FROM WHOM YOU ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT TO BE ADDED AS AN ADDITIONAL INSURED ON YOUR POLICY, PROVIDED THE INJURY OR DAMAGE OCCURS SUBSEQUENT TO THE EXECUTION OF THE CONTRACT OR AGREEMENT. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: A. In the performance of your ongoing operations; or B, In connection with your premises owned by or rented to you. CO 20 26 07 04 (D ISO Properties, Inc., 2004 Page 1 of 1