PROOF OF INSURANCE (2004) CLOSED11/24/2003 14:31 9099201087 UPSCO
AC= CERTIFICATE OF LIABILITY INSURANCE
POOOLMR (9690-0—S-1200 FAX ("9)305-1205 * CERTIFICATE IS ISSUE
iSU RDS Insurance Brokers ONLV AND CONFERS NO RN
0606461
P.O. Box 159
San Dimas, CA 91773
WSURED UPSCO Powersafe Syst
Attn: Martin Holiday
44 N. Central Ave.
Upland, CA 91796
INSURERS AFFORDING COVERAGE
INSUREnx, Colony Insurance Coll
INSURERS: Mercury Insurance
INSURER C:
INSURER Dr
INSURER E:
PAGE 01
DATE iMM/IDDIYYYY)
11/13/2003
OF INFORMATION
CERTIFICATE
NAIL 4
I Ht rOLK;IES OF 94WRANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDINI
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 COND(TIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ADIn
TYPE OF EIBURAMCE
POLICY NUMBER
POLICY EFFEC
DATE i
BIMION
LIMI7g
10/15/2004
OEMERALLNYnPV
MP3151354
10/15/2003
EACHOCCURRENDE
$ 1,000 0
X COMMERCIAL OENERAL LIABILITY
CLAIMS MADE X❑ OCCUR
DAMAGE TO RENTED
M E D EXP IAAy ON PNeen)
S $0 00
$ 110
A
PERSONAL; ADV UAIURY
$ 1 0" r d
GENERAL AGGREGATE
f 2,000,0001
G AGGREGATE LIMIT APPLIES PERT
POLICY jE aCT LOG
PRODUCTS - COMPIOP AGO
S 119100010010
AUTOMOBILE LIABILITY
ANY AUTO
COMBINED NGLE LIMIT
S
1100-0-1000
B
ALL OWNED AUTOS
X SCHEDULED AUTOS
TBD
11/01/2003
1110112004
BODILY INJURY
IF- Oel+lel+)
f
HIRED AUTOS
NON -OWNED AUTOS
BoDILVIwuRY
(Per wak6 e)
A
PROPERTY DAMAGE
(Per aeoderu)
S
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
S
R ANY AUTO
OTHER THAN EA ACC
f
f
AUTO ONLY: AGG
EXCEEENMBRELLA LIABILITY
OCCUR E-1 CLAM MADE
EACH OCCURRENCE
f
AGGREGATE
f
t
DEDUCTIBLE
S
RETENTIDN S
S
WORKERS COMPENSATION AND
WC STATU• 0TH•
EMPLOYERS` LIABILITY
E.L. EACH ACCIDENT
$
ANY PROPRIETOIVPARTNERXXECVT"IVE
OFFICER/MEMSER EXCLUDED?
11 yyes, descr7OF umor
SPeCIAL PROVISIONS below
E.L DISEASE - EA EMPLOYEE
S
R.L DISEASE -POLICY LIMIT
S
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUAIONS ADDED BY ENDORSEMENT! APEOIAL PROVILSHM
City Of E1 Segundo
Attn: Patti Kigbt
350 Main Streot
E1 Segundo, CA 90245 -3995
ACORD 25 (2001104)
INGULD ANY OF THE ABOVE OESCRWED POLICIES BE CANCELLED BEFORE THE
EIIPIRAYKHN DATE TNEREOP, THE MUM MIBINIlR WILL ENDEAVOR TO MAIL
_ 10 DAYS WRITTEN NOTICE TO "OR CERTIFICATI HOLDER NAMO TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THR,N/Unenr Ire AOCNTR OR RCPRCEOHTATney.
"CORD CORPORATION 1988
.. /-) �. _7_