PROOF OF INSURANCE (2008) CLOSED04/09/2008 03:03 7148080916
911VEHICLE PAGE 0
DATE (MMOOM"M
OP ID
ACORD_ CERTIFICATE OF LIABILITY INSURANCE 911VE -1 __12L20/00
Pttoau�ER THIS CERTIFICATE IS tssus AS A MATTER OF [NFdRMATION
I4V inTi{1raLCA Services- ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
MOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
The P.0g er Stone Agency ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
5015 Sirch Street
Newport Beach CA 92660
Phone:949- 757 -0270 rax:949 -157 -0576
911 vehicle
Jeanie Attawaay ext206
Anaheim CA 92806 ad
INSURERS AFFORDING COVERAGE
INSURER A: Allied Ins CO /I
INSURERS: 6ee,14y"" Caayawatian
INSURER C:
INRI IRER D:
INSURER E:
NA1C 9
;OVERAGES
11E POLICICS uF INSURANCE LISTED BELOW h4AVE BEEN ISSUED TO THE'NSURCD NAMED ABOVE FOR TM@ POLICY PERIOD INDICATED. NOTW THSTANDING
ANY REgUiREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAYYI PFRTAIN, THE
D GATE LIMBS SFIOVJN -FORCED DY 11 BEEN CREDUCED 8 AID CLAIMS. SUB ACT To ALL ME TERMS, E�CCIi 510u5 AND (.ONt1 TIONS OF SUCH
TR TYPE OF INSURANCE POLICY NUMBER DATE 'IM
DATE MIDW UAIITS
EACH OCCURRENCE 5 1000000
eENERALLIABLITV $ 300000
ENEALABILITY pCPSP?7802534450 06/21/07 06/21/08 PREMISES DsA X X COMMERCIAL � �wm) 15000
CLAMS MADE CCCUR PERSONALtAOVINJAY $1000000
—
RE: All covered operations
The City of El aegundo,,its officials and employees are named Additional
Insured. Endorsement to follow from the Carrier.
*10 day notice of cancellation for non - payment of premium.
CERTIFICATE HOLDER CANCELLATION
CiTYFLg SHOULD ANY OF TI,-6 ABOVE DuC*IBj6 POLICIES BE CANCEL LED BEFORE THE E KATION
DATE TNEREoF, ?WE 199UNG INSURER WILL ENDEAVOR TO MAIL *10 DAYS WRITTEN
NoTTCE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE -70 DO SO SHALL
City of El Segundo IMPOSE NO OBLIGATION OR LIAAILRY OF ANY KW UPON THE INauW% ITS AGOTTS OR
350 main Street REPRESENTATIVES.
El Segundo CA 90245 AuT;,iwzE5 RrrRE FF4TTVE
CORD CORPORATION 1"R
GENERAL AGMEOATE
$ 2000000
PRCDUCT9- COMPfOPAGG
12000000
ge,rL AGGREGATE LIMIT APPLIES PER:
% POLICY PRO- 7 LOC
COMBINED SINGLE LIMIT 1$1,000,000.0
AJTONOBLL.E LIABILITY
ACPBPA7802534450
06/21/07
06/21/08
(Eescferc)
A
X ANY Auro
=
ALL OWNED ALMS
POp1ci�^J)UP.Y
SCHEDIAED AUTOS
I
g0D0. V INJURY
1
X HIRED AUTOS
(Per 80CIOer )
NON- CF^15D AUTOS
PROPERTY DAMAGE
1
(Par ecdder> )
AuroONLY - EA ACCIDENT
$1000000
GARAGEUABILTTr
ACPBPA7902534450
06/21/07
06/21/08
EA ACC
OTF�RTHAN
11000000
A
X ANY
AUTO ONLY: AGG
i$3.000000
X OTTILER THAN AUTO
EACH OCCURRENCE
$
FJUESS SRELLA LIABILITY
AGGREGATE
S
OCCUR CLAIMS MADE
S
s
DCDUCTIBLE
I
=
ft-EN ION S
T'JRr LiM�TS ER
WORKERS COMPENSATION AND
EMPL°YEO'LIABLITY
ZIG102649801
03/28/08
03/28/09
C EPAkACCIDR7JT _
S SOOOGOC
9
ANY pROpgIETOWPARTNERIEXECUTIVE
E. .DISEASE -EA EMPLOYEE
SIOOOOOO
OFFICERRv1EMBER I=XCLUDED?
L, DISEASE- POLICY LIMIT
S 1000000
Tryy-�� �� I under
SI CIAL PROVISIONS below
FA
70rzovezty section
ACPSPA7802534450
06/21/07
06/21/08
DEDUCT
$1100000
RE: All covered operations
The City of El aegundo,,its officials and employees are named Additional
Insured. Endorsement to follow from the Carrier.
*10 day notice of cancellation for non - payment of premium.
CERTIFICATE HOLDER CANCELLATION
CiTYFLg SHOULD ANY OF TI,-6 ABOVE DuC*IBj6 POLICIES BE CANCEL LED BEFORE THE E KATION
DATE TNEREoF, ?WE 199UNG INSURER WILL ENDEAVOR TO MAIL *10 DAYS WRITTEN
NoTTCE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE -70 DO SO SHALL
City of El Segundo IMPOSE NO OBLIGATION OR LIAAILRY OF ANY KW UPON THE INauW% ITS AGOTTS OR
350 main Street REPRESENTATIVES.
El Segundo CA 90245 AuT;,iwzE5 RrrRE FF4TTVE
CORD CORPORATION 1"R
BUSINESSOWNERS
PB 04 48 08 03
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED -
DESIGNATED PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
PREMIER BUSINESSOWNERS LIABILITY COVERAGE FORM
SCHEDULE
Name Of Person Or Organization:
CITY OF EL SEGUNDO
350 MAIN STREET
EL SEGUNDO CA 90245
The following is added to Section II. WHO IS AN
a. "Bodily injury" or "property damage" that
INSURED:
arises out of, in whole or in part, or is a
Any person or organization shown In the Schedule
result of, in whole or in part, the active
negligence of the additional Insured shown
of this endorsement is also an Insured, but only with
in the Schedule of this endorsement.
respect to liability arising out of your ongoing
operations performed for such additional insured or
b. "Personal and advertising injury" that arises
arising out of premises owned by or rented to you,
out of any Independent "personal and
subject to the following additional exclusion:
advertising Injury" offense committed by the
This insurance, including any duty we have to
additional insured shown in the Schedule of
defend "suits", does not apply to:
this endorsement.
All terms and conditions of this policy apply unless modified by this endorsement.
Includes copyrighted material of Insurance Services Office, Inc., with Its permission.
Copyright, Insurance Services Office, Inc., 1997
PB 04 48 08 03
ACP BPA 700253U60
MENT COPY
Page 1 of 1
76 11022
3805•.:
Allied
N.Insurance AMCO INSURANCE COMPANY
a NationwkW cDmpaM
On ft r9de-
CHANGE OF DECLARATIONS ENDORSEMENT - PLEASE READ CAREFULLY.
4 • POLICY NUMBER ACP BPA 7802534450 PREMIER BUSINESS
NAMED INSURED: 9 11 VEHICLE
ALLIED SERIES
MAILING ADDRESS: 2130 E WINSTON RD
ANAHEIM, CA 92806.5534
AGENT NAME: I S U - THE ROGER STONE AGENCY 84 22292 NO CHARGE # .00
AGENT ADDRESS: NEWPORT BEACH CA 92660 001
POLICY PERIOD: FROM 06.21 -07 TO 06.2148 12:01 A.M. Standard Time
EFFECTIVE DATE OF CHANGE: 03 -05 -08 12:01 A.M. Standard Time TOTAL PREMIUM « .00
NOT A STATEMENT - YOUR BILLING WILL FOLLOW
i[ ifNNNiEiEifiEif *i(mifiElElfipEiElElEiEmmm ADDITIONAL INSURED 1ElE'J[lElElE* NO. 020000 # .00
CITY OF EL SEGUNDO
ADDED NAME
CITY OF EL SEGUNDO
ADDED ADDRESS
330 MAIN STREET
ADDED
CITY
EL SEGUNDO
ADDED
STATE
CA
ADDED
ZIP CODE
90245
ADDED
FORM NUMBER
P00448
MUNICIPALITY CHANGE
ENDORSEMENT
CHANGED ENDORSEMENT FORM
FORM P20449
A COPY OF THIS FORM IS ATTACHED
Q
y3
3
DIRECT BILL LNRW 08073
AGENT COPY
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