Loading...
PROOF OF INSURANCE (2009) CLOSEDPolicy Number: 72 SBA TV5673 Date Entered: 7/28/2009 DATE (MWDD/rM) ACORDL CERTIFICATE OF LIABILITY INSURANCE 7/28/0909 PRODUCER nsurance center, Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 27001 La Paz Road Suite #248 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Mission Viejo, CA 92691 ALTER THE COVERAGE O AMEND COVERAGE A FORDED BY THEPOLIC ES BELOW. (949) 460 -9700 NAIC # INSURERS AFFORDING COVERAGE INSURED Scanning Service Corporation INSURER A: Hartford Casualty Insurance Co c/o A INSURER B: 15513 Cleveland Dr INSURER C: Fontana, CA 92336 INSURER D: INSURER E: CAVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUKtu NAMMU ADUV c r-, 1 r—... ,. • .• - •• - -• -• - -- - - DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFFECTIVE POLICY EXPIRATION LIMITS INSR ADD'L POLICY NUMBER TYPE OF INSURANCE 1,000,000 EACH OCCURRENCE $ GENERAL LIABILITY A X 72 SBA TV5673 11/28/2008 11/28/2009 A PREMISES Eaoccurence $ 300,000 COMMERCIAL GENERAL LIABILITY $ 10,000 CLAIMS MADE � OCCUR MED EXP (Any one person) PERSONAL 8 ADV INJURY $ 1,000,000 0,0 GENERAL AGGREGATE $2,0 PRODUCTS - COMP /OPAGG $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY M PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 (Ea accident) A ANY AUTO ALL OWNED AUTOS BODILY INJURY (Per person) $ BODILY INJURY SCHEDULED AUTOS 72 SBA TV 11/28/2008 11/28/2009 HIRED AUTOS 72 SBA TV5673 11/28/2008 11/28/2009 (Per accident) $ NON -OWNED AUTOS PROPERTY DAMAGE $ (Per accident) LIABILITY AUTO ONLY - EA ACCIDENT $ GARAGE EA ACC $ ANY AUTO OTHER THAN AUTO ONLY: AGG $ EXCESS /UMBRELLA LIABILITY 72 SBA TV5673 11/28/2008 11/28/2009 EACH OCCURRENCE $ 1,000,000 AGGREGATE 1,000,000 $ A OCCUR CLAIMS MADE $ DEDUCTIBLE $ RETENTION $10,000 WORKERS COMPENSATION AND WC STATU- OTH- T I ER E.L. EACH ACCIDENT $ 1,000,000 EMPLOYERS' LIABILITY 72 WEC TZ4907 11/28/2008 11/28/2009 1,000,000 A ANY PROPRIETORIPARTNERIEXECUTIVE E.L. DISEASE - EA EMPLOYEE $ OFFICERIMEMBER EXCLUDED? $ 1,000,000 If yes, describe under E.L. DISEASE - POLICY LIMIT SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIA4ROV�A � I r�- U� q eL4 IIVVI� TE City of El Segundo L 350 Main Street E1 Segundo, CA 90245 -3895 ACORD Z5 (ZUUT /un) StI8ULD ANY OF THE ABOVE DESCRIBED POLICIES • BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL 411D 0yyMAAILL y330�0yy DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, eklYFl�ttlN� AUTHORIZED REPRESENTATIVE M ACORD CORPORATION 1988 POLICY NUMBER: 72 SBA TV5673 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) i City of El Segundo, Its Officials and Employees Insurance will be deemed "primary" such that any other insurance that may be carried by the City will be excess thereto. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for bodily injury", property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 © ISO Properties, Inc., 2004 Page 1 of 1