PROOF OF INSURANCE (2007) CLOSEDIPRODUCER
MARSH USA Inc.
601 MERRITT 7
NORWALK, CT 06856
CHRISTINE CAYO/ FAX 203 -229 -6970
XEROX.CERTREQU EST @MARSH. COM
X Fail
CERTIFICATE NUMBER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE
POLICY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
AFFORDED BY THE POLICIES DESCRIBED HEREIN.
COMPANIES AFFORDING COVERAGE
COMPANY
A ACE AMERICAN INSURANCE COMPANY
INSURED COMPANY
XEROX CORPORATION AND ITS SUBSIDIARIES B INDEMNITY INSURANCE COMPANY OF NORTH AMERICA
800 LONG RIDGE ROAD
STAMFORD, CT 06904 COMPANY
C INSURANCE COMPANY OF NORTH AMERICA
COMPANY
D ACE INSURANCE COMPANY
i?VI1tf1ES This trtificatc sLtersedes and replaces art; prev(DU §ly m tlef cleCt(15ca1e far #lie fxal id d 11 Q1�tl #�e(tW 4
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY
PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS AND EXCLUSIONS OF SUCH POLICIES. AGGREGATE
LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE(MMIDD/YY)
POLICY EXPIRATION
DATE(MMIDDIYY)
LIMITS
A
D
C
C
GENERAL
LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE FX OCCUR
OWNER'S& CONTRACTOR'SPROT
XSL G21713910 (AOS)
41- PR -0200810(PR)
705 -00187 (GUAM)
705- 00188(SAIPAN)
"EXCESS OF A $250,000 EACH-
"OCC. SELF - INSURED
01/01/06
01/01/06
01 /01/06
01/01/06
01/01/07
01/01/07
01 /01/07
01/01/07
GENERAL AGGREGATE
$ 10,000,000
X
PRODUCTS - COMP/OP AGG
$ INCLUDED
PERSONAL & ADV INJURY
$ 1,750,000
EACH OCCURRENCE
$ 1,750,000
FIRE DAMAGE (Any one fire )
$ N/A
MED EXP (Any one person)
$ N/A
A
C
C
D
B
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
ELF INSURED COMP /COLE
ISA H08022112 (AOS)
FAP04710 (GUAM)
FAP04711 (SAIPAN)
28 -PRB- 200215 (PR)
US 200353 -6 (US - VI)
01/01/06
01/01/06
01/01/06
01/01/06
01/01/06
01/01/07
01/01/07
01/01/07
01/01/07
01/01/07
COMBINED SINGLE LIMIT
$ 2,000,000
X
BODILY INJURY
(Per person)
$
BODILY INJURY
(Per accident)
$
X
PROPERTY DAMAGE
$
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
OTHER THAN AUTO ONLY:
EACH ACCIDENT
$
AGGREGATE
$
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
EACH OCCURRENCE
$
AGGREGATE
$
$
B
A
A
WORKERS COMP I NAND
EMPLOYERS LIABILITY
THE PROPRIETOR/ INCL
PARTNERS/EXECUTIVE
OFFICERS ARE: R EXCL
WLR C44338300 (AOS)
WLR C44338312 (CA & ID)
SCF C44338324 (WI)
I
01/01/06
01/01/06
01/01/06
01/01/07
01/01/07
01/01/07
H.
X TORYLIMITS ER
EL EACH ACCIDENT
$ 1,000,000
EL DISEASE - POLICY LIMIT
$ 1,000,000
EL DISEASE -EACH EMPLOYEE
$ 1,000,000
C WORKERS COMPENSATION 601 N 00366 (SAIPAN) 01/01/06 01/01/07 SEE ABOVE WORKERS COMP LIMITS
C CONTINUED 601 N 00367 (GUAM) 01/01/06 01/01/07 n
A EXCESS WC OHIO ONLY XWC 044338294 (OH ONLY) 01/01/06 01/01/07
DESCRIPTION OF OPERATIONS /LOCATIONSMEHICLES/SPECIAL ITEMS
THE CITY OF EL SEGUNDO ITS OFFICIALS AND EMPLOYEES IS ADDITIONAL INSURED UNDER THE GENERAL/AUTOMOBILE LIABILITY POLICY
BUT ONLY TO THE EXTENT REQUIRED BY WRITTEN CONTRACT. AS RESPECTS WORKERS' COMPENSATION COVERAGE APPLIES IN THE
UNITED STATES, EXCLUDING THE STATES OF ND, WA, WV, WY AND OH.; COVERAGE PROVIDED TO THE ADDITIONAL INSURED IS PRIMARY &
NON CONTRIBUTORY.