PROOF OF INSURANCE (2007) CLOSEDACORDM CERTIFICATE OF LIABILITY INSURANCE j 0DATE
3/22/2006)
PRODUC'cR (971)812 -9855 FAX (973)812 -9860 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
C &H Agency, Inc . ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
PO BOX 324 Al TFR THE COVFRAGE AFFORDED BY THE POLICIES BELOW.
783 North Riverview Drive
Totowa, N] 07512
INSURED
472 South Salina Street, Suite 400
Syracuse, NY 13202 -2481
INSURERS AFFORDING COVERAGE NAIC #
INSURERA: American Home Assurance Co. (AIG ) 19380
INSURERS: Arch Insurance Company (Hartan) 11150
INSURER C:
INSURER D:
INSURER E:
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTW ITHSTANDIN,
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
DO'
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
POLICY XP RATION
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 2,000,00(
DAMAGE TO RENTED
$ 50,00(
X COMMERCIAL GENERAL LIABILITY
GL1773568
03/17/2006
03/17/2007
$
CLAIMS MADE FXJ OCCUR
MED EXP (Any one person)
PERSONAL & ADV INJURY
$ 1,000,00(
A
GENERAL AGGREGATE
$ 4,000,00(
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP /OP AGG
$ 4,000,000
POLICY X E LOG
AUTOMOBILE LIABILITY
CA8262321
03/17/2006
03/17/2007
COMBINED SINGLE LIMIT
$
X ANY AUTO
(Ea accident)
1,000,000
BODILY INJURY
$
X ALL OWNED AUTOS
X SCHEDULED AUTOS
(Per person)
A
X HIRED AUTOS
BODILY INJURY
$
X NON -OWNED AUTOS
(Per accident)
PROPERTY DAMAGE
$
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
H
AUTO ONLY: AGG
EXCESS /UMBRELLA LIABILITY
R/0 ULP0005384 -00
03/17/2006
03/17/2007
EACH OCCURRENCE
$ 10,000,000
AGGREGATE
$ 10, 000, 00
X OCCUR r_1 CLAIMS MADE
$
B
$
DEDUCTIBLE
$
X RETENTION $ 10,00
WC STATU- OTH-
WORKERS COMPENSATION AND
E.L. EACH ACCIDENT
$
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
E.L. DISEASE - EA EMPLOYE
$
E.L. DISEASE •POLICY LIMIT
$
If yes, describe under
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
E: City of E1 Segundo, Residential Sound Insulation Program - GROUP 8, Contract No. 3545
G2010 (11/85) Additional Insured - Owners, Lessees or Contractors (Form B) (attached)
"*See attached for cancellation clause" ;.
M.�.. y.._ a�
City of E1 Segundo
City Hall
350 Main Street
E1 Segundo, CA 90245
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL *)MOOM MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
KOWKXMIOOBWPX)WXKXXXCOWJWLXK4(MKXOOiKLVMU)bXXKMXXX
AUTHORIZED REPRESENTATIVE
Michael Culnen /CAI
ACORD 25 (2001108) VAGVKU t;VKrVKAI1Vn -IVOO
City of E1 Segundo
Certificate issued to City of E1 Segundo 03/22/2006
C &H Agency,Inc
08/26/2005
"Should any of the above - described policies be cancelled before the expiration dates thereof, the
issuing company will mail within 30 days written notice to the certificate holder. "