PROOF OF INSURANCE (2009) CLOSED04/09/2008 15:01 4158747199 EQUITY RISK PARTNERS PAGE 02/04
ACOR_D,� CERTIFICATE OF LIABILITY INSURANCE
4
81 Segundo, CA 90245-3995
/9( 20M"' a"
PRODUCER (415) 874 -7100 FAX: (415) 874 -7199
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
squity Risk partners, Inc.
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
License No. ODaS—ALTER
HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR
THE COVERAGE AFFORDED BY THE POLIaS BELOW,
101 1BOatgolESry Street, 14th F1
Bari Francisco CA 94104
INSURERS AFFORDING COVERAGE NAIC It
tNWREO
INSURr. A :America>n Home Assurance 19390
IN RB:Nartf0xd Fire, Ins. Co. 19692
LTS 8oldings DBAt Wyle Laboratories, Inc.
INSURER c:National Union Fire ins. 19445
1960 Z. Grand Avenue, Ste. 900
INSR •ins, Co- of the State of 119429
81 Segundo CA 90245
OF
INBuRERa:211incis National Zns.
THE POLICIIS OF INSURANCI LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED MOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY
REOUIREMENT, TERM OR COMMON CIF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY 61 ISSUED OR MAY PERTAIN.
THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
INN a T"10FINSURANCII POLICY NNMBBR
POLICY E POL N LIMITS
6NISSAL UABILRr
1,000,000
X COMMERCIAL GENERAL LIABILITY
reLmn= $ 1,000,000
A CLAIM MADE FX t=uR CL4973600
1/1/9008 1/1/2009 mgO p 10,000
1,000,000
AGaRfiQA3Z g 2,000,002
OWL AGGRtiOATE LIMIT APPLIES PER:
PROQUCTS 2,000,000
MICY x
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
X ANY AUTO
R"004100
i 11000,000
H
ALL OWNED AUTOS
67MM1.1134
1/1 /2008
1/1/2009
BODILY INJURY
BCHEDULGD AUTOS
(Per WWI
g
X MiREO AUTOS
BODILY INJURY
IPwserJdenq
g
Camp. Ded. $1,000
mxxNON�owmmAUT03
pR0►ERTYDAMAG4,
call, pod, $1,000
1
(Per LlM400
_
GARAGE LIABILITY
AUTO ONLY. FAACCIDENT
3
OTHER THAN _FAAC
R ANYAUTO
S
AUTO ONLY: A80
EILCESSIUMERBLLAWAenrtY
25 000,000
X OCCUR ❑ CLAIMS MPDE
25, 000 , 000
C
DEDUCTIBLE
Bt568b916
1/1/2008
1/1/2009
g
.X
RKJENTION 410.000
D
WORRBRSCOAIpENSAT10NAND
NC9909241 (408)
x
BMpLav2RV LIABILITY
A
11000,000
ANY PROPRIETORMARTNEReXECUTIVE
OFFICERIMEMSEREXCLUDED?
W9909242 (CA)
1/111008
1/1/2009
I
g 1,000 000
If real. doefte under
I . POLICY LW 1;--
1,000,000
8
OTHER Workers COSIp. (FL)
NCSO00243 (Fl)
1/1/2008
1/1/2009
Each aceLdent 110000000
B
Workers Comp. (TX)
NCOODS244 (TX)
1/1/1008
1/1/2009
Each ni..arf -rA Sep. 11000,000
Cinema Vc t 1,000,000
OESCIS I N OF OPERATION 9AACATIONEMENICLB$nMLUMCM ADDED BY ENOORSEMENT#SPWAL pnoVIBIONs
Certificate holder is included as additional insured as required by written contract per attached policy arose 61712,
subject to all policy torus ACS conditions.
CERTIFICATE HOI -nFR PAUAC, , Ar,nU
( 310) 640-0489
City of X1 Segundo
Public Works Depart:Beat
kttn t Jeff Stewart
330 main Street
SHOULD ANY OF THE AGO" DEBCRIEED POLICIES ae CANCELLED BEFORE THE
"FIRAT+ON DATE THEREOF. "a IBSVm INSURER WILL USAM ( MAIL
30 DAYS WRITTBN NOTICE TO THE CIL MRCATI HOLDER NAMED TO THE LIFT. *xx
�i W %j>4A6�41�RJfARIX
81 Segundo, CA 90245-3995
AU TNORRID REpWN(NTATIvt
Tony Marcon /PADILL
AWKL7 rs (ZVVIRRI)
IN3025 (O+OBI.tteu
0 ACORD CORPORATION 1858
Pegs I of 2
04/09/2008 15:01 4158747199 EQUITY RISK PARTNERS PAGE 03/04
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 eontraet 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.
25120011081
IN8025(esoe).osa Paso 4 a;
04/09/2008 15:01 4158747199 EQUITY RISK PARTNERS PAGE 04/04
ENDORSEMENT
This endorsement, offte:ft 3 12:01 A.M. 01 /01/ 2006 forms a part of
policy ND.GL 4572600 � issued to BSA: WYLZ LASORATOOESLTINC- p{ N6S, INC.
by AMERI CAN maKE ASSURANCE 0141"ANY
THIS ENDORSEMENT CFIANGES THE POLICY: PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - INHERE REO,UIRED UNDER CONTRACT OR. AGREEMENT
Ibis endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL UABIUTY COVERAGE FORM
Section Il - Who le :an Insured, 1., is amended to add:
f) Any person or orger►izm-tion to whom you become obligated to indlude as an additional insured
under this policy, as a result of any contract or agreement you enter into which requires you
to furnish insurance to that person or organization of the type provided by this policy, but
only with respect to liability :arising out of your operations or promises owned by or rented to
you. Howover, the insurance provided will not exceed the looser of'.
1. The co+ierage and /or limits of this policy, or
2. The coA {erage and/or limits raqulrad by said contract or agreement.
M
Author zed Repraaentaathre or
Countersi ®®nature tin States Where
Applicable/
61712 19101)