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PROOF OF INSURANCE (2012) CLOSEDCERTIFICATE OF LIABILITY INSURANCE EDOATE20 /-201)1 THIS CERTIFICATEIS 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 SUBROGATIONIS WAIVED, subject to 0— terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the `icate holder in lieu of such endorsement(s). CONTACT R NAME: NL,,ASH ADVANTAGE AMERICA /PHS HON W W (,) a _(e77) 905IT o45 543148 P: (877) 616 -7474 F: (877) 905 -0457 ' PO BOX 33015 ADDRE:ss SAN ANTONIO TX 78265 OUST" M4iD #, - ..... ... .a. - -- INSURER(S) AFFORDING COVERAGE NAIC k INSURED INSURER A ; 14al7tford Casualty InS CO POWERPLAN CORPORATION INSURER B 2130 MAIN ST. STE 245 INSURER C HUNTINGTON BEACH CA 92648 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 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. �----------- - - - - -- ._. - ._ ._... ..... . PtY1� "�' LT I" FOU''"y -" __ ....... ........... LTR TYPE OF INSURANCE NN SR two vD POLICY NUMBER (MWDD(YYYYI (MMFDD1YVYY) I LIMITS GENERAL LIABILITY EACH OCCURRENCE 5 1 J,. 0001000 COMMERCIAL GENERAL LIABILITY PREMISES IEa occurrence) 5 300, 0 0 0 A I CLAIMS -MADE I X 1 OCCUR MED EXP IArcry one 5 10,000 X General Liab X 54 SBA TJ5158 09/16/2011 09/16/2012 PERSONAL &ADVINJURY $ 1, 000,000 .......... L _�... _....- .� ..... _ . GENERAL AGGREGATE S 2 0 0 0 O O O GENII'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG S 2, O 00,000 __....J POLICY L�...�I PRO, LOC _...�...���........... $ "UTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) 5 1, 000, 0 0 0 ANYAUTO ............_. _....... ..__... BODILY INJURY (Per person) $ ALL OWNED AUTOS °•° -�-°'• BODILY INJURY (Per accident) 5 _ SCHEDULED AUTOS PROPERTY DAMAGE• A X HIRED AUTOS 54 SBA TJ5158 09/16/2011 09/16/2012 (Per accident) $ .m.m.,.... ..._...._...m..� X NON -OWNED AUTOS $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB :MADE AGGREGATE $ p� DEDUCTIBLE $ g RETENTION 5 $ AND EMPLOYERS' LIABILITY Y / N u U TORY LIMITS. „ „_•(„"".E!? �, „ „.�� „ „ „... ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? N/A E L. EACH ACCIDENT _ _ $ (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ If yes, describe under ” "" ""”" " " " """""'"... "..... ' DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Technology E &O 54 SBA TJ5158 o9/16/2011] 09/16/2012 1,000,000/1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Those usual to the Insured's Operations. The City of El Segundo is an Additional Insured per the Business Liability Coverage Form SS0008 attached to this policy. Waiver of Subrogation applies in favor of the Certificate holder per the Business Liability Coverage Form SS0008 attached to this policy CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE TL ° City of El Segundo DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. MAIN ST AUTHORIZE PRESENTATIVE SEGUNDO, CA 90245 A'Z- -� © 1988 -2009 ACORD CORPORATION. All rights reserved„ ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD MARSH ADVANTAGE AMERICA /PHS PO BOX 33015 SAN ANTONIO TX, 78265 08532 The City of El Segundo 350 MAIN ST EL SEGUNDO, CA 90245 ACORD 25 12009/09) CERTIFICATE OF LIABILITY INSURANCE 10TE20/D201)1 THIS CERTIFICATEIS 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 SUBROGATIONIS WAIVED, subject to *hp terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the ficate holder in lieu of such endorsement(s). :R NAME: LvL1JLS FARGO INS INC /PAC NEP PHONE .................... -- - " " " " " " " " " " " " " "" A/C No' E:xrl. _ __._. � . 4AdLwC�a)� 715725 P: O - F: O - AIL PO BOX 33015 SAN ANTONIO TX 78265 CUSTOMER ID ° INSURED POWERPLAN CORPORATION 2130 MAIN ST. STE 245 HUNTINGTON BEACH CA 92648 CERTIFICATE NUMBER: INSURER(S) AFFORDING COVERAGE NAIC N INSURER A : Hartford Ins Co of the Midwest INSURER B INSURER C INSURER D a INSURER E INSURER F t REVISION NUMRFR- 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. w8w .... -,.... ®... R TYPE OF INSURANCE S. WVD � •••••••• POLICY NUMBER (MM nu a -u � L MM /DD/YYYY) gf11MtDDtYYYYb LIMITS GENERAI, LIABILITY EACH OCCURRENCE $ DWMW I°_7 " FN L) COMMERCIAL GENERAL LIABILITY PREMISES Ma a curfeme) $ CLAIMS -MADE u OCCUR VIED EXP CAnY one per q„N , $ _... PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN1. AGGREg&LE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ LiPOLICY PNiP• G_ ....._f LOC .... ......... $ 1U TOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO ....... BODILY INJURY (Per person) $ ALL OWNED AUTOS "•• BODILY INJURY (Per accident) $ --• SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) $ NON -OWNED AUTOS $ $ UMBRELLA LIAB u OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE �•ITmm�^^^^ITITmm $ RETENTION $ $... WORKERS COMPENSATION ( X OER - AND EMPLOYERS LIABILITY voN TORY LIMITS ANY PROPRIfTORJPAR "I'NR::&'�I /E;XCI:I.NTi'IVE— NIA A E.L. EACH ACCIDENT $ 1, 000, 000 A Mandao/ryinNHREXCLUDED7 Ll 41 WEG ZG3626 11/23/2011 11/23/2012 E.L. DISEASE EA EMPLOYE "$ Z,OI)0,000 If yes, describe under DESCRIPTION OF OPERATIONS below _.... _ .............. ...__........._............._.. E.L. DISEASE - POLICY LIMIT $ 1,6 0 0 , 0 0 0 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Those usual to the Insured's Operations. The City of El Segundo is an Additional Insured per the Business Liability Coverage Form SS0008 attached to this policy. Waiver of Subrogation applies in favor of the Certificate holder per the Business Liability Coverage Form SS0008 attached to this policy CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE 'TL ° City Of El Segundo DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. �se nTIVE SEGUNDO, CA 90245 AUTHORIZE �R MAIN ST A »� 0 f ' �5 1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) T'h. ORD name and logo are registered marks of ACORD WELLS FARGO INS INC /PAC NEP PO BOX 33015 SAN ANTONIO TX, 78265 08532 The City of El Segundo 350 MAIN ST EL SEGUNDO, CA 90245 ACORD 25 (2009/09)