PROOF OF INSURANCE (2005 - 2005) CLOSEDCOVERAGES n,Anncn AcxnvG Pna TWP Pnl ICY PFRIOD INDICATED. NOTWITHSTANDIN
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED I U I niz 11 o Kw 14r�wn ✓ �- •� • •- • • •_ . __._ .. _. -.
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.
TYPE OF INSURANCE
POLICY NUMBER
DATE MM /DD/YY
DATE MM/DD/YY
LIMITS
LTR
NSR
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE OCCUR
72SBAAD9365
02/12/2004
02/12/2005
EACH OCCURRENCE
$ 1 +000,00 0
A
PREMISES Ea occurence
$ 300, 00
MED EXP (Any one person)
$ 10,00
PERSONAL & ADV INJURY
$ 1 + 000 + 00
GENERAL AGGREGATE
$ 2,000 +QQ
PRODUCTS - COMP /OP AGG
$ 2 , 000 + 00
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO LOC
SECT
A
AUTOMOBILE
LIABILITY
ANY AU. .
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
72SBAAD9396
02/12/2004
02/12/2005
COMBINED SINGLE LIMIT
(Ea accident)
$
, 000 + 00
1,000,00
BODILY INJURY
(Per person)
$
BODILY INJURY
(Per accident)
$
X
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
AUTO ONLY: AGG
- -°
$
$
EXCESS /UMBRELLA LIABILITY
OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION $
EACH OCCURRENCE
$
AGGREGATE
$
$
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR /PARTNER /EXECUTIVE
OFFICER /MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
TORY LIMITS ER
E.L. EACH ACCIDENT
Ms
E.L. DISEASE - EA EMPLOYE
E.L. DISEASE - POLICY LIMIT
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
ertificate holder is named as additional insured.
°10 day notice of cancellation shall apply for non - payment of premium.
CERTIFICATE HOLDER
City of E1 Segundo
Attn: Patti Knoght
350 Main Street
E1 Segundo, CA 90245
ACORD 25 (2001/08)
t:AIVI.CL.LA I IUN
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON]•HE INSURER, ITS AGENTS OR REPRESENTATIVES.
CORPORATION 1988
DATE (MWDDIYY)
CERTIFICATE OF LIABILITY INSURANCE MAR 25 04
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
TIFICATE
PRODUCER IRS No
GELKER 8r ROHRER INSURANCE AGENCY HOLDER. T H SNCERTIFI ATE DOES OT AMEND, EXTEND OR
18551 VON KARMAN, STE. 120 __ -____- s ^+ 1,1cc ail nW_
IRVINE CA 92612
PHONE: 949 - 862 -4900
FAX: 949 -752 -2950 Anencv Lic #: C
INSURED
ROSENOW SPEVACEK GROUP, INC.
C/O DEBBIE WEINSTEIN
217 NORTH MAIN STREET SUITE 300
SANTA ANA CA 92701 -4822
INSURERS AFFORDING COVERAGE
INSURER A: EVEREST NATIONAL INS. CO
INSURER B. LANDMARK AMERICAN INS. CO
INSURER C:
INSURER D:
INSURER E:
COVERAGES
THE POLICIES OF ANY REOUIREMENTNTERMNOR CONDITION ON OF ANYECO TRACTUOR OTHER DOCUMENT WITH RESPECT O WHICH THIS CERTIFICATE AMAY BE ISSUED OR
DING D HEREIN
MAY PERTAIN. THE IN LIMITS SHOWN MAY HAVE POLICIES ESCRIIBPAID CLAIMSS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICY BbMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
INS TYPE OF INSURANCE DATE MMIDD/YY DATE MMIDDIYY $
LT EACH OCCURRENCE
GENERAL LIABILITY DAMAGE TO RENTED $
COMMERCIAL GENERAL LIABILITY MED. EXP (Any One Person) $
CLAIMS MADE I] OCCUR
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
PRODUCTS- COMP /OP AGG. $
NAIC #
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY
COMBINED SINGLE LIMIT $
AUTOMOBILE LIABILITY
(Ea accident)
ANY AUTO
BODILY INJURY
ALL OWNED AUTOS
(Per person) $
SCHEDULED AUTOS
BODILY INJURY $
HIRED AUTOS
(Per accident)
NON -OWNED AUTOS
PROPERTY DAMAGE $
AUTO ONLY - EA ACCIDENT $
GARAGE LIABILITY
OTHER THAN EA ACC $
ANY AUTO
AUTO ONLY: AGG $
EACH OCCURRENCE $
EXCESS / UMBERELLA LIABILITY
AGGREGATE $
OCCUR El CLAIMS MADE
$
DEDUCTIBLE
$
RETENTION $
AND 3900008166 -041
WC STATU- OTHER
MAR 1 04 MAR 1 05
1+000
WORKERS COMPENSATION
E.L. EACH ACCIDENT $
+000
EMPLOYERS' LIABILITY
PROPRIETORMARTNERIEXECUTIVE
E.L. DISEASE -EA EMPLOYEE $
1,000,000
A ANY
OFFICERIMOMBER EXCLUDED?
E.L. DISEASE- POLICY LIMIT $
1,000,0
if yes, describe under
SPECIAL PROVISIONS below
MAR 1 04 MAR 1 05 AGGREGATE $2,000,000
OTHER: PROFESSIONAL LIABILITY LHR802531
EACH OCCURRENCE $2,000,000
BI i
DESCRIPTION OF OPERATIONSILOCATIONNEHICLES /EXCLUSIONS ADDED ENDORSEMENTI SPECIAL PROVISIONS
CITY OF EL SEGUNDO IS A NAMED ADDITIONAL INSURED
CITY OF EL SEGUNDO
350 MAIN STREET
EL SEGUNDO, CA 90245
ADDITIONAL INSURED; INSURER LETTER: CANGELLA I IUN
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION THE CERTI
AT FI ATETHE ISSUING COMPANY ILL MAIL 30 DAYS WRITTEN
NOTICE O
AUTHORIZED REPRESENT
Attention: PATTI KNIGHT
Certificate
ACORD 25 (2001/08) # 20509
J90