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PROOF OF INSURANCE (2010) CLOSEDPolicy Number: 72 SBA TV5673 Date Entered: 12/9/2009 ACORD,M CERTIFICATE OF LIABILITY INSURANCE 12 /9MI2009Y) 12/9/2009 PRODUCER BOB NIMTZ Insurance Center, Inc. 27001 La Paz Road Suite #248 Mission Viejo, CA 92691 (949)460 -9700 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 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 NAIC # INSURED Scanning Service Corporation 15513 Cleveland Dr Fontana, CA 92336 INSURERA:Hartford Casualty insurance Co c/o ATM POLICY EFFECTIVE INSURER B: LIMITS INSURERC: INSURER D: INSURER E: r r%11=DAn=Q 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 T ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A %< COMMERCIAL GENERAL LIABILITY 72 SBA TV5673 11/28/2009 11/28/2010 PREMISES (Ea occurence $ 300,000 CLAIMS MADE ® OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 POLICY PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT A ANY AUTO (Ea accident) $1,000,000 BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS 72 SBA TV5673 72 SBA TV5673 11/28/2009 11/28/2009 11/28/2010 11/28/2010 PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG EXCESS /UMBRELLA LIABILITY 72 SBA TV5673 11/28/2009 11/28/2010 EACH OCCURRENCE $ 11000,000 • OCCUR EI CLAIMSMADE AGGREGATE $ 11000,000 $ DEDUCTIBLE RETENTION $10,000 $ WORKERS COMPENSATION AND WC SITU- OTH- • EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBEREXCLUDED? 72 WEC TZ4907 * 11/28/2009 11/28/2010 E.L. EACH ACCIDENT $ 11000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 110001000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS 193-4 17L -7-1a i110MlR9 4M City of E1 Segundo 350 Main Street E1 Segundo, CA 90245 -3895 25 (2001 /081 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BEECANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL Z4MAAR *0 MAIL 3 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, yF1ALKMyS4XIWLx ���1x�L� /J�1���,xCN�[��►�XII�i,' �iXi�l�6�� AUTHORIZED REPRESENTATIVE n arnQn rnO9)n9)ATln41 4000 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001/08) 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) 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