PROOF OF INSURANCE (2014) CLOSEDLIABILITY INSURANCE
L CERTIFICATE OF
PRODUCER Tom
License 0479986 E
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StafeFarrn El Segundo, CA 90245 A DD1t Sy )vrpi YWwJod III S19tef "Itcorn T
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General Insura16,1
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INSURED COMMANDSTAT ANALYTICS INC Irsa B
ATTN: EDWARD J BURNETT It1SUt�c
1199 PACIFIC HWY UNIT 1601 IHx !me..p;...�.�.W ..�_..������........... - - -- - -- ..._.... ... -
SAN DIEGO CA 92101 -8419 INauRE
INSURER F
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE P I CIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOT"WVITHSTAFONS 6 AANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT V1ATH RESPECT TO WHICH THIS
CERTIFICATE MAY BE pSS OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONC T OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
INSR �............ ...... .... ... w �_ _ ..___ ......_._ AOOL S00, .,... .' TP'OLICY EI F': POLGCY EEp
L,TR , TYPE OF NSURANCE POLICX NUMBER MMdODdXYYY , MiM 4JYYYY , LIMITS
.. ..............._..,..,..._.,I' ,....... . .... _. .
GENERAL LIAR
A ,X_ � E-1 -CB-W314-8 07/70!2013 01/1012014 EACH OCCURRENCE 5 1.000.000
DAMA'G`E "iiSC$clCi""". S „mm 50.000,
CERC SE x OCCUR MEDMISES,.(Ea q"T. ,. ..._
�p COMMERCIAL GENERAL ABILITY
�.x. Y .EXPf_..µ.P!rstml S 5,000
OM PR
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PERSONALBADVINJURY S 1,000,000
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GENERAL AGGREGATE $ 2,000,000
GEN1 AGGREGATE LIMI-w. W
7 APPLIES PER PRODUCTS - C . PIOP A.... � � .�. ....
GG E 2,OOD,000
PRO,
PC LIC,�Y -� LOC
AUTOMOBILE LIABILITY (Ea accident) I S
ANY AUTO BODILY INJURY (Per person) E
�....._.. ALL OWNED ._......... SCHEDULED u.�U
AUTOS AUTOS BODILY INJURY (Per accident) E
_. O AON- WNED PROPERTY' UAM ., ..
HIRED AUTOS IP'�.. f)...DAVE S
_ I S
UMBRELLA (JAB OCCUR d EACH OCCURRENCE
EXCESS LUAB
CLAIMS MADE AGGREGATE S -11-1-1111
DED RE'4'EN'I[IONS S
®.. N"YI-ORKERSCOMPEN�S,A'TION _ STKrU orH-
AND EMPLOY S BI YIN
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ANY PROPRIETO ARTN ECUTIVE
OFFICE/MEMBER EXCLUDED? NIA E.L. EACH ACCIDENT S
(Mandatory in NH) E.L. DISEASE • EA EMPLOYEE E��
SP'Wrus dessvobsa ue�dsx E.L. DISEASE - POLICY LIMIT S
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DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more space is required)
CERTIFICATE HOLDER ��� � CANCELLATION
City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
350 Main St, Rm 5 ACCORDANCE WITH THE PO ICY PROVISIONS.
El Segundo, CA 90245 AUTII lsE'N'rATIVC'
ri k
8-2010 ACORD CO ON. AI 'I IAN erYed.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 1001486 849,8 01 -23 -2013
UL1M Policy No.: 92 CBW314 8
N7A �M
SECTION II ADDITIONAL INSURED ENDORSEMENT
Policy No.: 92 CBW314 8
Named Insured: COMMANDSTAT ANALYTICS INC ATTN: EDWARD J BURNETT
Additional Insured (include address):
CITY OF EL SEGUNDO, ITS OFFICIALS, AND EMPLOYEES
350 MAIN ST RM 5
F
EL SEGUNDO, CA 90245 0
WHO IS AN INSURED, under SECTION II DESIGNATION OF INSURED, is amended to include as
an insured the Additional Insured shown above, but only to the extent that liability is imposed on that
Additional Insured solely because of your work performed for that Additional Insured shown above.
Any insurance provided to the Additional Insured shall only apply with respect to a claim made or a
suit brought for damages for which you are provided coverage.
The Primary Insurance coverage below applies only when there is an "X" in the box.
® Primary Insurance. The insurance provided to the Additional Insured shown above shall be
primary insurance. Any insurance carried by the Additional Insured shall be noncontributory
with respect to coverage provided to you.
All other policy provisions apply.
FE -6609 Printed in U.S.A.
State Form General Insurance Company
900 Old River Rd
Sakamfield, CA 93311-9501
Location: 11►9 PACIFIC HWY UNIT 1602
SAN DIEGO CA
92101-8419
1
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Coverages and Limits
Section I
A Buildings Excluded
B Business Personal Property 1,100
C Loss of Income Actual Loss
Deductibles - Section I
Basic 500
Other deductibles may
apply - refer to policy
L Business Liability $500,00f
M Medical Payments 5 , 001W
Gen Aggregate (Other than PCO) 1,000 00i
Products -Completed Operations 1,000: 001
(PCO Aggregate)
Annual Premium
Fo woftfon__,_Q�W
Premium Reductions
Enclosed Building
Prot. Devices Discount
Sprinkler Discount
Cov. A - Inflation Index: N/A
Cov. B - Consumer Price: 231.4
_r Moving? See your State Farm agent.
2;6/so�vl See reverse for important information.
4588 2 ®1E I Agent TOM BRUNDIDGE Prepared
E * EEC NOV 01 2012
013 Telephone (310) 322-5840 or (800) 603-0303