PROOF OF INSURANCE (2011) CLOSED+ DATE (MMIDOIYYYY)
AV CERTIFICATE OF LIABILITY INSURANCE 4,4,2011
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terns and conditions of the policy, certain policies may require an endorsement. A statement on this certficate does not confer rights to the
certificate holder in lieu of such endorsement(s).
NAME: Kathy Macias
. (949) 857 -4500 NQY. (949) 837 -4800
Millennium Corporate Solutions ft,,Lb-
License # OC13480 SS:
PRODUCER 0013918
5530 Trabuco Road SMTOM
Irvine CA 92620 INSURE S AFFORDING COVERAGE NAIC4
INSURED INSURERA Mt Hawley Insurance Cc , 7974
Trueline INSURERD:im csriu+u + =+ou +a•••+®
1651 Market Street, Ste. B INSURERE:
Corona CA 92880 INSURER F:
__. nrvrQlAa1 6111aAR�R•
COVERAGES
CERTIFIGAIt:NUMOCK;
IS TO CERTIFY THAT THE POLICIES
NOTWITHSTANDING ANY REQUIREMENT,
MAY BE ISSUED OR MAY PERTAIN,
AND CONDITIONS OF SUCH
OF INSURANCE
POLICIES.
THE
LISTED BELOW HAVE BEEN
TERM OR CONDITION OF ANY
INSURANCE AFFORDED BY
LIMITS SHOWN MAY HAVE BEEN
ISSUED TO
CONTRACT
THE POLICIES
REDUCIED BY
THE INSURED
OR OTHER
DESCRIBED
PAID I Y AI S.
NAMED ABOVE FOR THE
DOCUMENT WITH RESPECT
HEREIN IS SUBJECT TO
POLICY PERIOD
TO WHICH THIS
ALL THE TERMS,
THIS
INDICATED.
CERTIFICATE
EXCLUSIONS
INSM
LTR
TYPE OF INSURANCE
POLICY NUMBER
IFF
1/25/2010
MM110 WYY
/25/2011
LIMITS
S 1,000,000
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE
M(4L0172908
EACH OCCURRENCE
E TO RE
PREMISES o, wren
$ 50,000
MEDEXP An one person)
$ 10,000
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
s 2,000,000
PRODUCTS - COMP/OP AGG
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
xX POLICY PRO- LOC
AUTOMOBILE LIABILITY
COMBINED SINGLE OMIT
(Ea accident)
s
$ 1,000,000
BODILY INJURY (Per person)
s
B
X ANY AUTO
ALL OWNED AUTOS
81/3317273
/21/2010
/25/2011
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
SCHEDULED AUTOS
X HIRED AUTOS
X NON - OWMED AUTOS
X COMP & COLL . $1, 000 DIED
X UMBRELLA LIAB X OCCUR
EXCESS LIAR rl CLAIMS -MADE
payments
s
HIRED
HIRED
EACH OCCURRENCE
$
$ 1,000,000
AGGREGATE
S 1,000,000
S
C
DEDUCTIBLE
X I RETENTION $ 10.000
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNER/EXECUTIVE �
oFMCERIMEMBER EXCLUDED?
(Mandatory in NH)
K yyess dsauiba under
DESC WPTION OF OPERATIONS below
N I A
NBA227149
O1DXFda- 2009 -173
1/25/2010
/25/2010
/25/2011
/25/2011
WC STATU OTH-
X
s
D
E.L. EACH ACCIDENT
$ 1,000, 000
E L DISEASE - EA EMPLOYEE
S 1,000,00
E.L. DISEASE •POLICY OMIT
$ 1.000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
Certificate holder is included as an additional insured as respects to the insureds operations and only if required by
written contract per the attached endorsement.
City of El Segundo
Attn: CIty Clerk
350 Main St.
El Segundo, CA 90245 -098
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Gilmore /NB
., e age _ennn Ai'f%an enRPAROTIAN- All riahts reserved.
ACORD 25 (2008108) '
INS025 (soowo) The ACORD name and logo are registered marks of ACORD
Policy Number. MGLO172908 N t. Hawley Insurance Ccopwiy
THIS MDORSEMIDIT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED -- OWNERS, LESSEES OR CONTRACTORS
(FORM C)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
(If no entry appears below, Information required to complete this endorsement will be shown In the Declarations as appli-
cable to this endorsement,)
WHO IS AN INSURED (Section In Is amended to Include as an insured the person or organization shown In the Sdhed-
ule, but only with respect to Nabllity arising out of "your work' for that insured by or for you.
To the extent required under contract, this policy will apply as primary Insurance to additional insureds scheduled betoW
and other Insurance which may be available to such additional insureds will be non-corrMbutory.
Section IV.. Condition 4., of this policy is amended aoaordingly.
SCHEDULE
Name of Person or Organisation:
All persons or organizations where required by written contract.
The City, its officers, officials, employees, agents and volunteers.
ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED.
CGL 218 (04M) Page 1 of 1
Insured