PROOF OF INSURANCE (2003) CLOSEDFILE No . 244 05/07 '03 12:52 ID:
Mimi: Jl/
FAX:
CERTIFICATE OF INSURANCE
U1J3308(9.82)
UNIVERSAL UNDER'VNMTERS INSURANCE COMPANY
7045 College Boulevard — Overload Park, Kansas 66211
hereby certifies that the following insurance policies have been issued on behalf of:
Name of Insured Iry Seaver Motorcycles
Address of Insured 607 W. KatcIIA, Orange, CA 92677
KIND OF INSURANCE
POLICY NUMBER
POLICY PERIOD
OUR LIMITS
Auto inventory Physical Damage which inchtdes
137326
0801102- 08/01/03
$1,617,000
Garagekeeper's Legal Liability
Ded. Collision $2500
Ded. Comp. $2500
Garage Operations and auto Hazard including
137326
0801/02- 08/01/03
$300,000 CSL
General Liability
Umbrella
137326
0801/02- 08/01/03
$2,000,000
The City of EI Segundo
is named as Additional Insured
On the above coverage parts but only
as respects he negligent acts of our Insured
This Certificate of insurance neither affirmatively nor negatively amends, extends or alters the coverage affor&4 by the policies listed
above which have been issued by this Company.
In the event of any material change in, or cancellation of, said policies, the undersigned company will give 30 days written notice to
whom this certificate is issued.
Certificate of insurance prepared for; Name
Address
This certificate is not valid unless countersigned by an authorized representative oCthe: Cwgp Y.
Date 05/07/03 Countersigned
Account No.48376 -00
Authorized Representative
. � �' "2--.
ACORV CERTIFICATE OF LIABILITY INSURANC
,—.en we
HRH North American Ina Agency
A Div of Hilb,Roga1 & Hamilton
p,0. Box 6700
Rancho Cucamonga CA 91729
Phone:909- 476 -3300 Fax:909- 484 -5176
Iry Seaver Mot9rcycles
Attn: Evan B 11
Orange CAt92867Ave.
DATE (MMIDDIYY)
06/23/03
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
INSURER A: State
INSURER S:
INSURER C:
INSURER D:
INSURER E:
ensation Fund
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 AG, THE INSURANCE
E LIMITS SHOWN MAY HAVE BEEN POLICIES DESCRIBED ED BY PAID CLAIMS. SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.
LTR TYPE OF INSURANCE
POLICY NUMBER DATE MMIODIYY DATE MMIDD LIMITS
EACH OCCURRENCE $
GENERAL LIABILITY FIRE DAMAGE (Any one fire) $
COMMERCIAL GENERAL LIABILITY MED EXP (Any one person) $
CLAIMS MADE E OCCUR
PERSONAL 6 ADV INJURY $
GENERAL AGGREGATE $
PRODUCTS - COMP/OP AGG $
GEN'L AGGREGATE LIMIT APPLIES PER
POLICY PRO SEC T1- lOC
COMBINED SINGLE LIMIT $
(Ea accident)
BODILY INJURY $
(Per person)
BODILY INJURY $
(Per accident)
PROPERTY DAMAGE $
(Per accident)
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
AUTO ONLY - EA ACCIDENT $
GARAGE LIABILITY EA ACC $
OTHER THAN
3=—� AUTO ONLY: AGG $
EACH OCCURRENCE $
EXCESS LIABILITY
AGGREGATE $
OCCUR E7 CLAIMS MADE $
s
DEDUCTIBLE $
RETENTION $
TORY LIMITS ER
WORKERS COMPENSATION AND
A EMPLOYERS'LIASILITY IN ISSUE 06/01/03 06/01/04 E.L. EACH ACCIDENT $1000000
E.L. DISEASE - EA EMPLOYEE $1000000
E.L. DISEASE - POLICY LIMIT $ l 6O 0 O O O
)ESCRIPTION OF OPERA710NS /LOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENnsrrWAL rnv.-o,.+ -
*in the event of cancellation for non payment, 10 days notice will be given
CERTIFICATE HOLDER N 11 ADDITIONAL INSURED; INSURER LETTER: _ CANCELLATION
ELSEG -1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO
DATE THEREOF, THE ISSUING INSURER WILIIL *30 DAYS WRITTEN
City of El Segundo NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT
Attn: Patti Kight office of I e.
the City Clerk
350 Main Street
El Segundo CA 90245 -3895
254(7/97)
-3lfA