PROOF OF INSURANCE (2006) CLOSED...................... :::::::::::::::::::::.... .....:::...: :.... ;: ::. .. .: »:.:;::.:<.: DATE (MM /DD/VY)
AC
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
PRODUCER 818 - 986 -8200
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOFFMAN BROWN COMPANY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
15233 Ventura Blvd., ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
West Plaza COMPANIES AFFORDING COVERAGE
Sherman Oaks, CA 91403 COMPANY One Beacon Insurance
A
INSURED
COMPANY
National Liability &Fire f�
Prosum, Inc.
B
2321 Rosecrans Ave. Ste 4225
COMPANY Steadfast Ins. Co.
El Segundo CA 90245
C
COMPANY
D
ccs~ _
LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE
TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
INDICATED, NOTWITHSTANDING ANY REQUIREMENT,
INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE
LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
POLICY EFFECTIVE
POLICY EXPIRATION
LIMITS
CO
TYPE OF INSURANCE
POLICY NUMBER
DATE (MM /DD/YY)
DATE (MM /DD/YY)
LTR
A
GENERAL LIABILITY
7110051890001
6/19/05
6/19/06
GENERAL AGGREGATE
$ _2000000
PRODUCTS - COMP /OP AGG
$ 2000000
X COMMERCIAL GENERAL LIABILITY
PERSONAL& ADV INJURY
$ 1000000
CLAIMS MADE 1XI OCCUR
EACH OCCURRENCE
$ 1000000
OWNER'S & CONTRACTOR'S PROT
FIRE DAMAGE (Any one fire)
$ 1000000
MED EXP (Any one person)
$ 10000
A
AUTOMOBILE
LIABILITY
71 10051890001
6/19/05
6/19/06
COMBINED SINGLE LIMIT
$
1000000
ANY AUTO
ALL OWNED AUTOS
BODILY INJURY
(Per person)
$
SCHEDULED AUTOS
X
HIRED AUTOS
BODILY INJURY
(Per accident)
$
X
NON -OWNED AUTOS
PROPERTY DAMAGE
$
AUTO ONLY - EA ACCIDENT
$
GARAGE LIABILITY
OTHER THAN AUTO ONLY:
ANY AUTO
EACH ACCIDENT
$
AGGREGATE
$
LIABILITY
71 10051890001
6/19/05
6/19/06
EACH OCCURRENCE
$ 1000000
EXCESS
AGGREGATE
$ 1000000
X UMBRELLA FORM
S
FB
OTHER THAN UMBRELLA FORM
0100017309 -051
12/31/05
12/31/06
WC STATU- OTH-
X TORY LIMITS ER
'
WOR KERS COMPENSATION AND
EMPLOYERS' LIABILITY
EL EACH ACCIDENT
$ 1000000
THE PROPRIETOR/ INCL
EL DISEASE - POLICY LIMIT
$ 1000000
PARTNERS /EXECUTIVE
EL DISEASE - EA EMPLOYEE
$ 1000000
OFFICERS ARE: EXCL
C
OTHER
E00589446900
4/22/05
4/22/06
$1,000,000 Limit
Technology
$ 25,000 SIR
Liability
Includes Personal Injury Liab
DESCRIPTION OF OPERATIONS /LOCATIONS/VEHICLES /SPECIAL ITEMS
City of El Segundo, Its Officers, Officials, Employees, Agents &
Certified Volunteers are named as Additional Insureds with
respects to the Named Insured's Operations.
Cancellation notice is 10 days in the event of non - payment of premium.
Cii'#'l#CA'IE HtLi7rl; .... CNlr,l.fii ..... ...:::::..:.. .....
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City of El Segundo City Clerk EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL EM&VW* MAIL
Attn: Administrative Services 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
350 Main St. Room 5 XR"X�K7FA*XM`X'W'�'�Lx' K JbXXX9FX% xR) TT X
El Segundo, CA 90245 AUTH RI D REPRES VE
i.• (l
e
1 ..................................:.:..::::::.:::::::::::::::::::::.::::::.;:.>;:.;:.>:.;:.;:.:.:::«:: .::::::::::.:::::::::::.:.::::: ::::. :. ;:. :. ,..,(��—
O 1t
PROSUM, INC. POLICY #7110051890001
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSUREDS BY CONTRACT, AGREEMENT
OR PERMIT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
The WHO IS AN INSURED section is amended to include as an insured any person or organization with whom you
agreed in a written contract, written agreement or permit to provide insurance such as is afforded under this
Coverage Part, but only with respect to your operations, "your work" or facilities owned or used by you.
This provision does not apply:
1. Unless the written contract, agreement or permit has an effective date and has been issued prior to the "bodily
injury", "property damage ", "personal and advertising injury" or "personal injury" or "advertising injury"
(whichever definitions are used in your policy);
2. To any person or organization included as an insured under the Additional Insured - Broad Form Vendors
provision of this endorsement;'
3. To any person or organization included as an insured by an endorsement issued by us and made part of this
Coverage Part;
4. To any lessor of equipment;
a. After the equipment lease expires; or
b. If the "bodily injury", "property damage ", "personal and advertising injury" or "personal injury" or "advertising
injury" (whichever definitions are used in your policy), arises out of the sole negligence of the lessor;
5. To any person or organization if the "bodily injury", "property damage ", "personal and advertising injury" or
"personal injury" or "advertising injury' (whichever definitions are used in your policy), arises out of the rendering
of or failure to render professional services by or for you;
6. To any:
a. Owners or other interests from whom land has been leased; or
b. Managers or lessors of premises if:
(1) The "occurrence" takes place after you cease to be a tenant in that premises; or
(2) The "bodily injury", "property damage ", "personal and advertising injury" or "personal injury" or
"advertising injury" (whichever definitions are used in your policy), arises out of structural alterations, new
construction or demolition operations performed by or on behalf of the owners or other interests from
whom land has been leased.
VCG 21110 98 includes copyrighted material of Insurance Services Office, Inc. Page 1 of 1
®, Atlantic Mutual Insurance Gompany, 1998
<*> Hoff man Brown Company
15233 Ventura Blvd. • West Plaza - Sherman Oaks, California 91403 -2201 • (818) 986 -8200 • FAX (818) 986 -8510
March 22, 2006
Mr. Richard Hogate
City of El Segundo City Clerk
350 Main St., Room 5
El Segundo, CA 90245
RE: Prosum, Inc.
Policy #711051890001
Dear Mr. Hogate:
The insurance carrier, One Beacon Insurance Company, is unwilling to allow any
modification to the standard certificate of insurance, to amend their standard cancellation
clause. However, as the agent, we are willing to accept the charge of 30 days written
notification, via US certified mail of the carrier's intent to non -renew the policy.
Sincerely,
Lina Rosholt, CIC
Account Manager
INSURANCE
License No. 0814758
www.hoffmanbrown.com