PROOF OF INSURANCE (2003) CLOSEDACORD CERTIFICATE OF LIABILITY INSURANC�P�D J DATE(MMIDD/YY)
A 1 07/07/03
PROOucER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
1 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Valley Global Ins . Brokers HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
84 S. First Street, 2nd Floor ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
San Jose CA 95113
Phone:408- 947 -7111 Fax:408- 947 -7115 INSURERS AFFORDING COVERAGE
INSURED INSURER A: Hartford Insurance Company
INSURER B: Lloyds of London
Randall Funding Company Inc . INSURER C:
Three Harbor Drive, Sure 315 INSURER D:
Sausalito CA 94965
I INSURER E:
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.
INSR
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MWDD/YY
POLICY EXPIRATION
DATE MM/DD/YY
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE FxI OCCUR
57SBAKQ6229
09/15/02
09/15/03
FIRE DAMAGE (Any one fire)
$300,000
MED EXP (Any one person)
$ 10,000
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GENT AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP /OP AGG
$excluded
POLICY PRO T LOC
JEC
A
AUTOMOBILE
LIABILITY
ANY AUTO
57SBAKQ6229
09/15/02
09/15/03
COMBINED SINGLE LIMIT
(Ea accident)
$1000000
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per person)
$
HIRED AUTOS
NON -OWNED AUTOS
X
BODILY INJURY
(Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
ANY AUTO
EA ACC
OTHER THAN
$
AUTO ONLY: AGG
$
A
EXCESS LIABILITY
OCCUR CLAIMS MADE
57SBAKQ6229
09/15/02
09/15/03
EACH OCCURRENCE
s2,000,000
AGGREGATE
$2,000,000
DEDUCTIBLE
RETENTION $
$
A
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
57WECJU5904
09/15/02
09/15/03
X TORY LIMITS ER
E.L. EACH ACCIDENT
$ 1000000
E.L. DISEASE - EA EMPLOYEE
$ 1000000
E.L. DISEASE - POLICY LIMIT
$ 1000000
OTHER
B
Professional
AHJM010654
09/20/02
09/20/03
Per Claim 1000000
Liability
Aggregate 1000000
DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS
See attached CG2010 for Additional Insured.
CERTIFICATE HOLDER
N
ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
ELSEUND
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO
El Segundo Police Department
Attn: Carlos Mendoza,
Administrative Sergeant
350 Main Street
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL * 3 0 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
El Segundo, CA 90245
REPRESENTATIVES. L
AUTHORIZED REPRESENTATIVE
Debbie A. Millar x Q
UACORD'CT7RATION 1988
J 1/ �
POLICY NUMBER: 57SBAKQ6229 COMMERCIAL GENERAL LIABILITY
INSURED: Randall Funding & Development, Inc.
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, its officials, and employees
(If no entry appears above, information required to complete this endorsement will be shown in
the Declarations as applicable to this endorsement.)
WHO IS AN 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 work"
for that insured by or for you.
Project: Services provided under Contract
It is further agreed that such insurance as is afforded by this policy for the benefit of the above
Additional Insured(s) shall be primary Insurance as respects any claim, loss or liability arising
out of the Named Insured's operations, and any other Insurance maintained by the Additional
Insured(s) shall be excess and non - contributory with the insurance provided hereunder.
CG 20 10 11 85 Copyright, Insurance Services Office, Inc., 1984