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PROOF OF INSURANCE (2015) CLOSEDClient #: 299388 LIBRARY
DATE (MMIDDIYYYY)
ACORD,. CERTIFICATE OF LIABILITY INSURANCE 11/2112014
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 pollcy(les) must be endorsed. 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 endorsernent(s),
PRODUCER NAE' CONTACT Maria Morales
Hub International PHONE Fn
A/C No Ext,..805- 879 -9525 7 -1767
No.805- 61
HUB Int'I Insurance Serv. Inc. E-MAIL
DRU S: maria.morates@hubinternaional.com
A
40 East Alamar Avenue INSURER(S) AFFORDING COVERAGE NAIC M
Santa Barbara, CA 93105 INSURERA: Philadelphia Indemnity Insuranc 18058
INSURED INSURER 0: Hartford Casualty Insurance Com 29424
Library Associates, In '
t
51 Monroe Street, Suite PE -04 INSURER C
Rockville, MD 20850 -2442 INSURER D:
INSURER E
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT 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 CONTRACTOR 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.
LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
�,^ TYPE OF INSURANCE
ITR
POLICY . �.m....... POLICY EFF POLICY'Ek1 � ., _ ......_... _ ...................
NUMBER IMMIDDIYYYY IMMIO IYYYY LIMITS
A GENERAL LIABILITY
PHPK1027414 6/0112014 06101/2015 EACH OCCURRENCE $1,000,000
.X. COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
8 'Mt F.S Ea nc'm n $100,000
CLAIMS -MADE Fx� OCCUR
MED EXP (Any one person) $5000 -,
PERSONAL & ADV INJURY $11000,000
GENERAL AGGREGATE $2,000,000
GLNLAGOREGATE LIMIT APPLIESPER:
PRODUCTS - COMP /OPAGG $2,000,000
POLICY PRO LOC
$
A
AUTOMOBILE LIABILITY
PHPK1027414
6101!2014
061011201
CGYMBVNE'D SINGLE' LIMIT
Ea acsdaenl
$1,000,000
BODILY INJURY (Per person)
$
X ANY AUTO
BODILY INJURY (Per accldeni)
$ •.
ALLOWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
X HIRED AUTOS X '', AUTOS
4
PROP�FtTTY DAMAGE
Por accwdcell.
$
A
UMBRELLA LIAR OCCUR
PHUB422451
6/01/2014
06/01/2015
EACHoccURRENCE
54,0001000
EXCESS LIAB OLAIMS•MADE
AGGREGATE
$4 000 OOO.
D NTION $10000
5
B
WORKERS COMPENSATION
72WECFY5736
2f0112013
121011201
WC STATU- '0TH
X TOR
EMPLOYERS' LIABILITY
ANDS YIN
EL EACH ACCIDENT
$1 000 000
ANY PROPRIETOR /PARTNER/EXECUTIVE
ICE
RIMEMBEREXCLUDED? I NJ
(Mandatory In NH)
,..NIA
--�--•
EEL. DISEASE - EA EMPLOYEE
S1,00AIM
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L DISEASE. POLICY LIMIT
,000,000
A
Professional Liab
PHPK1027414
6/0112014
0610112015
Limit $1,000,00
P A
Erisa Bond
PHSD848634
6/0112014
06/0112015
Limit $3,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
Certificate Holder is named as additional insured under the general liability poilcy under written contract
per form CG2026 attached.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
t:lt of El Segundo
Y g
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
350 Main St.
ACCORDANCE WITH THE POLICY PROVISIONS.
EI Segundo, CA 90
AUTHORIZED REPRESENTATIVE
©1988 -2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S32006881M2900952
MM496
PI- MANU -1 (01100)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
CG2026 Additional Insured - Designated Person Or Organization
POLICY NUMBER COM- 11ERCIAL GENERAL LIABILITY fir'
PHPK1027414 CG 20 26 07 04'
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL _INSURED - DESIGNATED
PERS0I4 OR ORGANIZATION
This endorsement modifies insurance provided under the followings
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organization(s)
Any person or organization other than a joint venture whom you are required
to add as an additional
insured on this policy under a written contract or agreement provided that
the contract or agreement is
in effect during this policy period and is executed prior to the occurrence
which causes " bcdily injury ",
"property damage" or "personal injury and advertising injury ".
When also required by written Contract or Agreement, this insurance shall be
primary and
non- contributory with respect to other insurance.
Section II - Who Is An Insured is amended to include as an additional
insured the person(s) or
organization(s) shorn 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 omissions of those acting on your behalf:
A. In the per** "ormance of your ongoing operations; or
B. In connection with your premises owned by or rented to _you.
This insurance does not apply to "bodily injury" or "property damage"
arising out of or resulting from
structural alterations, new construction or demolition operations performed
by or for any additional
insured.
This insurance does not apply to "bodily injury" or "property damage"
All other terms and conditions of this Policy remain unchanged.
Page 1 of 2
PI- MANU -1 (01/00)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE TREAD IT CAREFULLY
arising out of or resulting from
any operations performed by or for any railroad, municipality, governmental
entity or other public
authority.
This insurance does not apply to bodily injury" or "property damage" arising
out of or resulting from
any operations performed by or for any telemarketing, direct mail or
internet advertising
organizations.
CG 20 26 07 04
© ISO properties, Inc., 2004
All other terms and conditions of this Policy remain unchanged.
Page 2 of 2
n14
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF OUR RIGHT TO RECOVER FROM
OTHERS ENDORSEMENT - CALIFORNIA
Policy Number: 72 WEC FY573 ,/ Endorsement Number: 01
Effective Date: 12/01/14 Effective hour is the same as stated on the Information Page of the policy.
Named Insured and Address: LIBRARY ASSOCIATES, INC
51 MONROE ST STE PE04
ROCKVILLE, MD 20650
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not
enforce our right against the person or organization named in the Schedule. (This agreement applies only to the
extent that you perform work under a written contract that requires you to obtain this agreement from us.)
You must maintain payroll records accurately segregating the remuneration of your employees while engaged in
the work described in the Schedule.
The additional premium for this endorsement shall be
premium otherwise due on such remuneration.
Person or Organization
CITY OF EL SUt,D
350 MAIN ST. /`m
EL SEGUNDO, CA 505
SCHEDULE
2 % of the California workers' compensation
Job Description
TEMPORARY LIBRARIAN
Countersigned by
Authorized Representative
Form WC 04 03 06 (1) Printed in U.S.A.
Process Date: 12/02/14 Policy Expiration Date: 12/01/15