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PROOF OF INSURANCE (2011) CLOSEDA E ORD,. CERTIFICATE OF LIABILITY INSURANCE OP ID MIBO DATE(MM /DD/YYYY) PRODUCER TREEM -1 0 6 14 10 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ISU /The Olson Duncan Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 25550 Hawthorne Blvd., Ste 203 Torrance CA 90505 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone: 310-373-6441 Fax:310- 378 -5336 -- INSURERS AFFORDING COVERAGE INSURED Non - Profits. Insurance Alliance --- .— _�__NAIC # INSURER A IC # -- -- INSURER B: — Tree Musketeers - - - -- -- - --- - - - - -- 305 Richmond Ave. INSURER C - - El Segundo CA 90245 INSURER D: - - -- INSURERE: �- -- — 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 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. TR NSR TYPE Of INSURANCE �— POLICY NUMBER j POLICY EFfE0T1V ip6pOyE3(�I t�pON — FGENERAL LIABILITY A X COMMERC IAL GENERAL LIABILITY CLAIMS MADE X OCCUR GEN'L AGGREGATE LIMIT APPLIES PER IX POLICY PE LOC AUTOMOBILE LIABILITY i i ANY AUTO ALL OWNED AUTOS r SCHEDULED AUTOS I A X HIRED AUTOS A I X NON -OWNED AUTOS �- - GARAGE LIABILITY ANY AUTO EXCESS /UMBRELLA LIABILITY 1 OCCUR n CLAIMS MADE DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? if yes, describe under SPECIAL PROVISIONS below 2010 - 00486 -NPO 2010 - 00486 -NPO 2010 - 00486 -NPO __ -.._ .- .....__... ..,,� mmIuVrTT LIMITS EACH OCCURRENCE 04/13/10 04/13/11 $ 1, 000, 000 -- 1 PREMISE ce) $� 500 000 MED EXP (Any one person) $, 20,000 1 PERSONAL S ADV INJURY $ 1 r UU r 000 GENERAL AGGREGATE $2,,000,000 j PRODUCTS - COMP /OPAGG [ $ 2 , Q00 , 000 04/13/10i 04/13/11 04/13/10 04/13/11 COMBINED SINGLE LIMIT (Ea accident) $11000,000 BODILY INJURY person) BODILY INJURY— (Per accident) $ PROPERTY DAMAGE $ (Per accident) AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: r All $ EACH OCCURRENCE $ AGGREGATE Is i$ E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE�$ E.L. DISEASE - POLICY LIMIT $ -- -� -•-• • • � -• • In LFa r CAULUMONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Certifiate holder is an Additional Insured (GL) per form CG2026(07/04) attached as follows: City of El Segundo, its officers, officials, employees, agents and volunteers ". Cancellation Clause: except 10 day notices for nonpayment of premium. Policy terms and conditions apply. CERTIFICATE HOLDER CANCELLATION ELSEG -2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIC DATE THEREOF, THE ISSUING INSURER WILL GNDiAVQR;® MAIL 30 _ DAYS WRITTEN City of El Segundo NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, 01 IT r 350 Main Street IMPnQF Nn nwi irAnQKOgj IAAUjnf. N�R0 City Clerk's Office QFOOFaeureny�c. E1 Segundo CA 90245 T EDJ?AwRFSCUrenue ACORD 25 (2001 ACORD CORPORATION 1 POLICY NUMBER: 2010 - 00486 —NPO 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 Personls) Or Organization Any person or organization that you are required to add as an additional insured on this policy, under a written contract or agreement currently in effect, or becoming effective during the term of this policy. The additional insured status will not be afforded with respect to liability arising out of or related to your activities as a real estate manager for that person or organization. CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS, EMPLOYEES, AGENTS AND VOLUNTEERS Information required to complete this Schedule if not shown above will be shown in the Declarations. Section ti — Who Is An Insured is amended to in- clude as an additional insured the person(s) or organi- zations) 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 omis- sions 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 0 ISO Properties, Inc., 2004 Page 1 of 1 p Page 1 of 1 Shilling, Mona From: Gail Church [gail @treemusketeers.org] Sent: Monday, June 14, 2010 2:51 PM To: Ramos, Vina; Shilling, Mona Subject: New liability insurance certificate Attachments: El Segundo Cert.pdf Ok, here's a new certificate with the language change. Gail Church Executive Director Tree Musketeers 305 Richmond St. El Segundo, CA 90245 310/322 -0263 fax: 310/322 -4482 www. treemusketeers. o ra Your Internet searches are worth a pretty penny to Tree Musketeers. Please visit http: / /www.goodsearch.com /, select Tree Musketeers as your charity and set GoodSearch as your default search engine. 6/21/2010 06/09/2010 00:31 ISSUE DATE: 06- 01-2010 POLICYHOLDER COPY #0207 P.001/001 SC P.Q. BOX 420807, SAN FRANCISCO,CA 94142 -0807 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE GROUP: POLICY NUMBER: 1382285 -2010 CERTIFICATE ID: 4 CERTIFICATE EXPIRES:, 06-01 -2011 06 -01= 2010/06 -01 -2011 CITY CLERK CITY OF EL SEGUNDO 350 MAIN ST EL SEGUNDO CA 90245 -3813 Sc This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the — California Insurance Comm- - ission- er to fhe employer n5med' tielpw for the policy eriod•indic at' ed: This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein, Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded. by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. orized Representative Interim President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 06 -01 -2009 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER TREE MUSKETEERS (A NON - PROFIT CORP) SC 305 RICHMOND ST EL SEGUNDO CA 902455 M0409 (REv.1 -2010) PRINTED : 05 -17 -2010 Page 1 of 1 Shilling, Mona From: Gail Church [gait @treemusketeers.org] Sent: Wednesday, June 09, 2010 12:41 PM To: Ramos, Vina; Shilling, Mona Subject: TM Workers Comp Attachments: NA_100609_277980648.pdf Vina and Mona, I have attached our file copy of TM's current workers comp certificate that was sent to the City. We thought having these certificates go to the City Clerk would cover all our bases within the City of El Segundo. However, every time we apply for a grant or have a booth, etc. we get asked for proof of insurance. Just yesterday the Recreation department asked for it. Should we ask our carrier to send them somewhere else? I have asked the Liability folks to issue a new certificate with the correct cancelation language. Happy spring, Gail Gail Church Executive Director Tree Musketeers 305 Richmond St. El Segundo, CA 90245 310/322 -0263 fax: 310/322 -4482 www. treemu_s_keteers . org Your Internet searches are worth a pretty penny to Tree Musketeers. Please visit http: / /www.goodsearch.com /, select Tree Musketeers as your charity and set GoodSearch as your default search engine. 6/21/2010 ACCP CERTWICATE OF LIABILITY INSURANCE D03 /08;2 ' PRODUCER State Farm Insurance ED BARNHART AGENCY 502 MAIN ST, EL SEGUNDO, CA 90245 THIS CERTIFICATE IS ISSUED AS 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. TYPE OF INBURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDD INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA:State Farm Mutual Auto Insurance Company 25178 GENERAL LIABILITY TREE MUSKETEERS AND GAIL CHURCH 146 MAIN STREET INSURER B: PREMISES Ea occurrence $ EL SEGUNDO, CA 90245 INSURER C: INSURER D: MED EXP (Any one person) INSURER E: 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 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 LTR ADWq TYPE OF INBURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDD POLICY EXPIRATION DATE MWDDIYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ PREMISES Ea occurrence $ COMMERCIAL GENERAL LIABILITY MED EXP (Any one person) $ CLAIMS MADE Fl OCCUR PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GENLAGGREGATELMTAPPLESPER PRODUCTS - COMPADPAGG $ PRO ElPOLICY JECT LOC X AUTOMOBILE LIABILITY 142 3003- C08 -75A 2003 TOYOTA TUNDRA 03/08/2010 09/08/2010 COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ 250,000 ALL OWNED AUTOS X SCHEDULED AUTOS BODILY INJURY (Per accident) $ 500,000 HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ 100,000 GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ ANY AUTO $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE $ OCCUR FI CLAIMS MADE $ DEDUCTIBLE $ RETENTION $ STATU- OTH- WORKERS COMPENSATION AND TORWC Y LIMITS ER E.L. EACH ACCIDENT $ EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTNE OFFICER/MEMBER EXCLUDED? EL DISEASE - EA EMPLOYEE $ EL DISEASE - POLICY LIMIT $ K es, describe under SPECIAL. PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS TREE MANAGEMENT ADDITIONAL INSURED: CITY CLERK CITY OF EL SEGUNDO 350 MAIN STREET EL SEGUNDO, CA 90245 132849 03- 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 DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR