PROOF OF INSURANCE (2009) CLOSEDSep 10 08 12 :560 The Omega Group 8584500239 p•2
ACORD_ CERTIFICATE OF LIABILITY INSURANCE T OP OP IO In _ DATE (MMIDDNYri)
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PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Alliant Insurance ServiC:es Inc HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
701 9 Street, 6th Floor ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
San Diego CA 92101
Phone:619 -238 -1828 Fax:619- 849 -4731
weucr.n
The Omega GX0vP Inc
San arroll 9C2 2J.n1 Rd St Fl
INSURERS AFFORDING COVERAGE I NAIC 0
...........
INSURER A: Federal_ T_nsurance Company__. - ._,_...
INSURER B: .. .._ C11vbb Oro.p, oP, rww, rr,.pww:.w
INSURER C: .... - .. -
1NSUHeH D _
(INSURER C __
COVERAGES
OF INSURANCC LISTI-0 RFLOW HAVC BCCN ISSUCD TO THE INSURED NAMED ANOvf, FOR THE POLICY PERIOD INDICATED. NOTYUTHSTANDINC
THE POLICIES
ANY RFQI)IRFMENT, TERM OR CONDITION OF ANY GUN I'HAC) OK OTHER DOCUMENT WITH RESPECT TO WHICH THIS CF AllFICATF MAYBE ISSUED OR
IS SUBJECT TO ALL THE TERMS, EXCLUSION$ AND CONDITIONS OF SUCH
MAY MFHTAIN, THE INSURANCE ArrORDCD BY THE POLICIES DESCHIHkI) HfkFIN
vOLICIES. AGGREGATE LIMITS SHOWN MAY HAVE FIEFN HFMICED RY PAD CLAIMS.
__ . - ....... - - .
-' "'
'PO0CY'CFFECTIV POETCYEXPIRATION LIMITS
fN. 00' " " POLIGYNVM9ER
LTR NSR TYPE OF INSURANCE
DATE MMIDD/YY GATE MMIDBIYY
F..ACI4OCCURRENCE
11,000,000
GENERAL LIABILITY
35797495
_
RENTED
08/27/08 08/27/09 rREMIsFti(Fnnrulmn
'
;, 1, 000 , 000
.......
A X COMM CRCIALGENERALLIABILITY
GLAIMSMAD� � OCCUR --
JX
PERSONAL 6 AOV INJURY
T-1,000,000
._,_. . - .._.._
GENERALAGGREC,ATF.
S 2, 000,000_
PRODUCTS : COMPIOF' AGG
$2,000,000
GCN'L AGGRCG_AT_E lIM1T Ai'I'L_I_tS I+kH;
i POUGT !,ZA LOC :
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
(Eeeeoaenu
S1,000,000
74991759
08/27/08
06/27/09
A
ANY AUTO
ALL OWNW1AIJiOA
BODILYIWURY
(Pnr pnrmn)
S
SCHEDULED AUTOS
i X
HIRED AUTOS
BODILY INJURY
(per =Went)
=
X
NON- OWN") AIITOS
- - -"
PROPCRTY DAMAGE
S
(PW acaUanl)
AIfr00NI.Y - f NT n ACCIDENT
S
GARAGE
GA
- _•• ANY AUTO
OTFIER THAN LA ACC
S
S
AUTO ONLY: ACC
OGGUNHFNCF .
$ 1 , 000, 000
EXCESSNMORCLLA LIABILITY
IAIM;MADE
I. I
79822226
08/27/08
08/27/09
AGGREGATE:
_... -
1, 000,000 _
A
DEDUCTIBLE
--
—
S
RETENTION i
WORKFyRS COMPENSATION AND
_
C.L. EACH ACCIDENT
EMPLOYERS' LIABILITY
I
S _
ANY PROPRIETORrPARTNER"ECLMVE
OFFICFNIMCMOIRC%CLUDCO'J
E.L . DISFASF:- I!AF;MPI -OYFF
S
I)I$fn;f.. POLICY LIMIT
11 Yoe. OMC1100IIIMAr
S
ti I, —QAI. VHOVI&IONS 0010W
A
OTHER
IPROF, LTAS. ECO 35797495
08/27/08
08/27/09: AGGREGATE
1000000
CLAIMS MADE
I DEDUCT.
25000
DESCRIPTION OF OPFRATN)NS I LOCATIONS I VkHICLlS I EkCLUSIONS ADDED BY ENDORSEMENT
I SPECIAL PROVISIONS
Certficate holder is named as additional as respects to General Liability
subject to the terms and conditions of the policy. RE: Software
Development.
*10 Day notice of cancellation for non - payment of premium
a.cnl Ir•wnl c nvwcn - - - -- -
CYTYOFE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES OC CANCELLED BEFORE THE EXPIRATION
City of E1 Segundo DATE THEREOF, THE ISSUING INSURER WILL ENOFAVOR TO MAIL *30 GAYS WRIYTEN
Police Department NOTICE TO THE CERTIFICATE HOLDER NAMED TO THC LEFT, OUT FAILURE TO DO SO SMALL
David Gray, Technical Sery M93C IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
348 Main Street
E1 Segundo CA 90245 REPRESENTATI ES.
ACORO 25 (2001/88) 0 ACORD CORPORATION 1988
Sep 10 08 12:45p
cNU�ra
The Omega Group
Liability Insurance
Endorsement
Policy Period
Effective Daft)
Policy Number
Insured
Name of Company
Date lssund
8584500239
AI RIUST 27.200K TO AUGUS1 27, 2009
AI 1GUNT 27.201M
3579 -74 -95 WUC
I'111?,)MEGA 6ROI W. INC.
HDFRAI, IMS1IRAN(1{ COMPANY
JULY 25. 2008
p.4
sMw1.w. �ewA1l�+ "M•r'�' W'MM•IIrLiIMNMaSYfrllt':111r(:
' GMMM�. �11�' �R. O% N. i'/ A�MA3BN. VPIi.'. 41MIIM .S(•YINMiN•'xMN1!•F•k+Mlll V }M•�••��°n✓nwx
l his lindorsenwnt i,pplics Io the Hallowing lurn>,s:
(iliNFRA1, LIAMISI'Y
l Indcr Who Is An Insured, tlic li•lllowing provision is atlJcd:
Who Is An Insured
Scheduled Person Or Sohiect w :all tit' the teens :w(I cuntlilionsul' this insuruarc, any person or orl!aniisnion shown in the
Organization scltcclule, acting pursuant to written omirsel air uluccment between you :Ind such person w
organizwiuu. is ilia insarvrd; but Ihcv :arc insuruds only with reseed to liability arising out of your
opennious, or vuur premises. it you are uhligated, pmsuunt w such cont.r:lct ur agreement, Ila pnwide
(heat) with well IUSLIOUCC as is a(littdcd by this policy.
However. nu such person ur orp.:mizatiun is ao insured with respect iu unv,
• asstullpluan of hilbilily by then, ill a wittract or agrccallent.'I his liMilaliou dues rwl apply In
Ihr liahility fur r mimtws fur injury or dafflaga, Ira whil0i this insurance: app lit's, (11ol (lit'. person
ur organir.:t ion world how in the ilhscnce t4 such contract or :,I!rCe mt'n1.
• eliln$lt'.es wising out of their sole rleghrGlGe.
nrrrraslaaxuMrew ,.ws.�.+e...w +w»mw..x.. rerun... rro�.. a. �. �oirw+ �ua�«.. ml. we. xnrw' saM• er. �c��rl. �. rsswa. aataa�rea�.. a. aa• ra.. rrv. annwwwwrm +wr�rwmrw+�"r""m" "'�'^''"'
Schedule
TIBURON
h200 STt)NFRlDGF MAI J, RI A ), S fat 400
111.1 "ASANTON. CA 94589
--- I(N I' titN 'I'1 ?'I'1 ?('lINC11.UC.;I1�.J
197o A. FU M)A ST.
6Altl)FNA. CA 9020
c'ITY 01 :0111411AM. NORTH CAROLINA
101 CITY HALL PLAZA
Liability Insurance Additional Insured • Scliedulad Person Or Organization continued
Page 1
Form 60-02 -2367 (Rnv. 8-04) Endorsement ��~
Sep 10 08 12:45p The Omega Group 8584500238 P•5
Liability Endorsement
(continued)
I)111111AM. N('27701
l l': SOF I W ARI i 171 :Viii ,OPMI ?N'I'
OF EL SEGUNDO
I)lil'Alt'fMEN'(
I)AVII) (i1tAY,11?(:1TNT('AT, SFRV MGR
349 MAIN STf(1 =.FT
H. SI.(;I INDO, CA 1)0245
All other terms a.nd condition: remain w1eli,i"IM1.
Authorizod Reorasentadve
I ronuin. Additional Irivured - Schodulod POM017 Or Orgonizatlon
Form 80.02 -2367 (Rev. B-04) Endors?ment
/asl page
age r
Sep 10 OB 12:45p The Omega Group
8584500239 P
POLICYHOLDER COPY
STATE P.O. BOX 420807, SAN FAANCISCO,CA 94142 -0807
COMPENSATION
I N S U R A N C E
FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 07-28 -2008 GROUP:
POLICY NUMBER: 1302649 -2007
CERTIFICATE ID: 157
CERTIFICATE EXPIRES: 10-01 -2008
10 -01- 2007/10 - 01-2008
CITY OF EL SEGUNDO SD
POLICE DEPT,
348 MAIN ST
EL SCGUNDO CA 90245 -3813
This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the
California Insurance Commissioner to the omployer named below for tho policy period indieatod.
This policy is not subject to cancellation by the hund except upon 30 days advance written notice to the employer.
We will also qlvo you 30 days advance notice should this policy be cancelled prior to its normal oxpiration.
This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded
by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document
with respect to which this certificate of insurance may be issued or to which It may pertain, the insurance
afforded by the policy described horuin is subject to all the terms, exclusion-., and conditions, of such policy.
THORIZED REP%SENTATI PRESIDLNT
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE.
ENDORSEMENT #1600 - MILAN MUELLER PRESIDENT - EXCLUDED.
ENDORSEMENT 5 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10- 01-2003 Is
ATTACHED AND
EMPLOYER RECEIVED Jul. 's
THE OMEGA GROUP, INC SO
_ 5160 CARROLL CANYON RD STE 6
SAN DIEGO CA 92121
(CKS,CNI
PRINTED : 07-28 -2008
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