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PROOF OF INSURANCE (2015) CLOSEDPolicy Number: 72 SBA TV5673 Date Entered: 12/2/2014 ACORD OF LIABILITY INSURANCE COVFRAGFS THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING DATE 12 /4 //2014Y) 12/4/2014 PRODUCER 95N RIM Insurance Center, er, nc, _:a THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 25108 Marguerite Pkwy #A527 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Mission Viejo, CA 92692 -2400 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (866)643 -3808 ACH OCCURRENCE g 1, 000, 000 INSURERS AFFORDING COVERAGE NAIC # INSURED OI1 Scanning Service Corporation INSURANCE �.0 URANCE COMPANY, iIMITED INSURER A. Michael Friedman WWINSURANCEWWWCOMPANYWWWWWWWWWWWWWWW WWWW ............................................ INSURER B:HARTFORD FIRE INSURER C: DAMAGE TO RENTED PRFMISFSlEeorcl'Ipnce) 15513 Cleveland Dr Fontana, CA 92336 INSURER D: CLAIMS MADE M OCCUR INSURER E: COVFRAGFS 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 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 CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1_01R AD. .`. �� ................... ��........ ��.......... ......��....................... ... ��.......................... ....�_......................... ...POLICYmEFFECTIVE POLICY EXPIRATION . �.. ��.. ��.. �� .........�..�................. LTR POLICY NUMBER DATE imwDniyYi DATE fMWDDIYYI LIMITS GENERAL LIABILITY ACH OCCURRENCE g 1, 000, 000 A \,/ COMMERCIAL GENERAL LIABILITY 72 SBA TV5673 11/28/2014 11/28/201 DAMAGE TO RENTED PRFMISFSlEeorcl'Ipnce) �.� $ 1,000,000 CLAIMS MADE M OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000mmm000 GENT AGGREGATE LIMIT APPLIES PER: '.. PRODUCTS - COMP /OP AGG $ 2 , OOO , OOO PRO- ✓''N' POLICY T`.. LOc ............................._ ....._.w AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1 000 00 A ANY AUTO (Ea accident) ....................................................................................... $ , , ............................... �. ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS . Per person) x HIRED AUTOS 72 SBA TV5673 11/28/2014 11/28/2015 ✓ ., NON AUTOS 72 SBA TV5673 11/28/2014 1 11/28/201 ODILY INJURY (Per accident) $ -OWNED PROPERTY DAMAGE ''.... (Per accident) '.. GARAGE LIABILITY ''. AUTO ONLY- EA ACCIDENT I OTHER THAN.. EA ACC .. $ ........... ............. .................. ANY AUTO AUTO ONLY: ADD ''.EXCESSIUMBRELLALIABILITY 72 SBA TV5673 11/28/2014 11/28/201 EACH OCCURRENCE $1,000,000 1 000 , , O.O OCCUR CLAIMS MADE A ..._____.._ _____GGREGATE _. ........._............_. $ .. .. ._......tl .._.. DEDUCTIBLE $ RrTENFirIN $10,000 $ WORKERS COMPENSATION AND WC STA7U- OTH- X I IMI7g _ER ��,�,�,�,,.., ��_� EMPLOYERS' LIABILITY 1, 000,C)i)bm�m '..B ANY PROPRIETOR /PARTNERIEXECUTIVE ''.72 WEC TZ4907 11/28/2014 11/28/201 E L EA.._.�. C HACCIDENT $ OFFICER/MEMBER EXCLUDED? El DISEASE - EA EMPLOYEE $ 1 , 000 , 000 If yes, describe under 1 000 000--- - - - - -� SPECIAL PROVISIONS below E L DISEASE - POLICY LIMIT $ , , OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Certificate Holder named additional insured per attached Endorsement HA 99 02 01 87 CERTIFICATE HOLDER CANCELLATION City of E1 Segundo 350 Main Street E1 Segundo, CA 90245 -3895 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL*W0VA%V,*W'*10 MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, UUMMMMU49 YYYYYYYYYY 'REPRESCiP'rRTf b�'9' AUTHORIZED REPRESENTATIVE ACORD 25 (2001/08) © ACORD CORPORATION 1988 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 contract 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. ACORD 25 (2001108) POLICY NUMBER: 72 SBA TV5673 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NAMED PERSON(S) OR ORGANIZATION(S) AS INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM TRUCKERS COVERAGE FORM This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below, Endorsement effective 11.28.14 Named Insured Scanning Service Corporation Countersigneel b3,,t/,2 Lf-Iax;& (Authorized Represent " e,) Named Person(s) or Organization(s): City of El Segundo (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Each person or organization named above is an "insured" for LIABILITY COVERAGE, but only to the extent that person or organization qualifies as an "insured" under the WHO IS AN INSURED provision of SECTION II - LIABILITY COVERAGE. Form HA 99 02 01 87 Printed in U.S.A.