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PROOF OF INSURANCE (2013) CLOSED• CERTIFICATE OF LIABILITY INSURANCE °04/02/ 013Y' 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 policy(ies) 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 endorsement(s). PRODUCER CRNTACT eca �_. HCC Specialty _� ... P ty PHONE MQ1­ a, ................................... 401 Edgewater Place, Suite 400 ADDRESs: ODU Wakefield, MA 01880 " INSURER(S) AFFORDING COVERAGE NAIC # - - - - - -- - - - -- .. -.. - -- ........... m,. INSURED INSURER A: New Hampshire Insurance" Company 23841 DOobies Inc. INSURERB: 19101 Olympic Crest Dr. Canyon Country , CA 91351 INSURERc INSURER D : INSURER E : '. INSURER F: 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 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LI N SR TYPE OF INSURANCE LIMBS 11 IWVD POLICY NUMBER MWDD/YYYY M/ MDDIYYYY GENERAL LIABILITY 000 000 EACH OCCURRENCE $ 1, A SEL082845872 04/17/2013 07/22/2013 -DAMA cTo may- COMMERCIAL GENERAL LIABILITY 300,000 X ....... rr n $ _.. '_._.. -MADE [:X] OCCUR CLAIMS gq,EXGM Y ❑ Mpg n1...... 5 000 ++ Host Liquor PERSONAL & ADV INJURY $ 1,000,000 A r-P NERAL AGGREGATE S 2,0'00,000 GEN'L AGGREGATE LIMIT APPLIES PER: ODUCTS - COMP /OP AGG $ 1,000,000 POLICY Jr9 T: LOC $... AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) " " ". ANY AUTO � .. BODILY INJURY (Per person) $ ALL OWNED AUTOS I BODILY INJURY (Per accident) $ SCHEDULED AUT03 •� PROPERTY DAMAGE HIRED AUTOS (Per accident) NON -OWNED AUTOS $ .. _ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAO CLAIMS -MADE AGGREGATE $ DEDUCTIBLE $� -� RETENTION is WORKERS COMPENSATION I T 010 1 A T U_ AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE F7 E.L. EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE - EA EMPLOYE is If es, describe under RIPTI N O OPERATIONS tolo& E,L DISEASE - POLICY LIMIT is DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more space Is required) The Certificate Holder is added as Additional Insured with respects to our Insured's operations only. This insurance is primary and non - contributory as required by written contract. This coverage is with respect to El Segundo Summer Concert Series event to be held 7/21/2013 - 712112013 at Library Park El Segundo CA City of El Segundo, its officers, officials, employees, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED agents, and volunteers w q" ' BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED 350 Main Street IN ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo, CA 90245 �,^ w i„ AUTHORIZED REPRESENTATIVE p ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 82845872 COMMERCIAL GENERAL LIABILITY CG 20 11 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designation Of Premises (Part Leased To You): City of El Segundo, its officers, officials, employees, agents, and volunteers, 350 Main Street, El Segundo, CA, 9 Name Of Person(s) Or Organization(s) (Additional Insured): City of El Segundo, its officers, officials, employees, agents, and volunteers, 350 Main Street, El Segundo, CA, 9 Additional Premium: Included Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to 2. If coverage provided to the additional insured include as an additional insured the person(s) or is required by a contract or agreement, the organization(s) shown in the Schedule, but only insurance afforded to such additional insured with respect to liability arising out of the will not be broader than that which you are ownership, maintenance or use of that part of the required by the contract or agreement to premises leased to you and shown in the provide for such additional insured. Schedule and subject to the following additional B. With respect to the insurance afforded to these exclusions: additional insureds, the following is added to This insurance does not apply to: Section III — Limits Of Insurance: 1. Any 'occurrence" which takes place after you If coverage provided to the additional insured is cease to be a tenant in that premises. required by a contract or agreement, the most we 2. Structural alterations, new construction or will pay on behalf of the additional insured is the demolition operations performed by or on amount of insurance: behalf of the person(s) or organization(s) 1. Required by the contract or agreement; or shown in the Schedule. 2. Available under the applicable Limits of However: Insurance shown in the Declarations; 1. The insurance afforded to such additional whichever is less. insured only applies to the extent permitted This endorsement shall not increase the by law; and applicable Limits of Insurance shown in the Declarations. CG 2011 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 IDS Property Casualty Insurance Company 3500 Packerland Drive De Pere, WI 54115 -9070 o David M Huffman Susan L Huffman 19101 Olympic Crest Drive ` Santa Clarita, CA 91351 COVERAGE/LIMIT RENEWAL DECLARATION CALIFORNIA POLICY NUMBER: BX05291420 POLICY PERIOD: 05/07/2013 - 11/07/2013 12:01 AM Standard Time LAPSE IN COVERAGE: NONE FOR CLAIMS SERVICE CALL: (888) 404 -5365 FOR CLIENT SERVICE CALL: 1- 888 - 404 -5365 SUBURBAN XTERRA PRI RN TOYOT S 1 1999 CI EV 2 2000 NISSA 4 2012 BODILY INJURY LIABILITY $37.00 $109.00 $142.00 $50,000 EACH PERSON $100,000 EACH ACCIDENT PROPERTY DAMAGE LIABILITY INCL INCL INCL $50,000 EACH ACCIDENT MEDICAL EXPENSE - EXCESS COVERAGE INCL INCL INCL $5,000 EACH PERSON UNINSURED MOTORIST BODILY INJURY $6.00 $17.00 $23.00 $50,000 EACH PERSON $100,000 EACH ACCIDENT UNINSURED MOTORIST PROPERTY DAMAGE $6.00 $3.00 $3.00 CAR 1 -LMT $3,500 CAR 2- WAIVER OF COLLISION DEDUCTIBLE CAR 4- WAIVER OF COLLISION DEDUCTIBLE COLLISION NONELECT $135.00 $341.00 DEDUCTIBLES CAR 2 -$500 4 -$500 COMPREHENSIVE NONELECT $19.00 $52.00 DEDUCTIBLES CAR 2 -$500 4 -$250 TOWING AND LABOR COSTS NONELECT $4.00 NONELECT $75 PER DISABLEMENT RENTAL EXPENSE NONELECT $13.00 NONELECT c2n PRR nAv / -T900 PF.R OC.CTTRRFNCE CONSOLIDATED VEHICLE ASSESSMENT FEE $0.90 $0.90 $0.90 TOTAL SEMIANNUAL PREMIUM PER VEHICLE $49.90 $300.90 $561.90 CONVENIENCE FEE* - $20.00 TOTAL SEMIANNUAL PREMIUM ALL VEHICLES - $932.70 Coverage is provided only when both a premium and limit are shown. * Convenience Fee is $4 per monthly installment if payment is made by credit/debit card or $1 per monthly installment for a preauthorized withdrawal method. adca0la(001) 03/23/2013 DRIVER INFORMATION 1. David M Huffman 2. Susan L Huffman * QUALIFIES FOR GOOD STUDENT DISCOUNT + QUALIFIES FOR MATURE DRIVER DISCOUNT # EXCLUDED DRIVER CAR INFORMATION CARS KEPT AT LOCATION OTHER THAN RESIDENCE 1999 CHEV 3GNEC16RIXG205218 2000 NISSA 5N1ED28TXYC575135 2012 TOYOT JTDKN3DU8C5401912 YOUR POLICY HAS THE FOLLOWING DISCOUNTS: MULTI -CAR, TENURE 1999 CHEV - DUAL AIRBAG, GOOD DRIVER 2000 NISSA - DUAL AIRBAG, GOOD DRIVER, 6 YR ACCD FREE 2012 TOYOT - DUAL AIRBAG, GOOD DRIVER, 6 YR ACCD FREE YOUR POLICY HAS THE FOLLOWING ENDORSEMENTS: AMENDATORY ENDORSEMENT SPECIAL EQUIPMENT /CUSTOMIZATION: NONE LIENHOLDER INFORMATION 2012 TOYOT PRIUS - Toyota Motor Credit Corp Atanta, GA cdec09 - CA