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PROOF OF INSURANCE (2012) CLOSEDDATE (MMIDDNYYY) CERTIFICATE OF LIABILITY INSURANCEdm, 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 E: CeX_ti.fic.at:.es _. Rutherfoord PHONpr!��llcT.'X- �� -.��__ 222 Central Park Avenue E-MAIL Suit Virginia 4 nia S )ABeach VA 23462 DpR 1 :C Tt INSURER ORDINGCOVERAGEmO NAIC # INSURED INSURERB :Fidtx,...i..t ilepQuit COe.U1L2any— SJ..f.--'M.�:Jn' Muni Services, LLC INSURER C:Aii6 .................. Attn: Patricia Dunn INSURE 'Amer 01j '.ante _ and Liabil t;y....IrL- x.2.47 ph: 559- 271 -6852 7335 N. Palm Bluffs Ave, INSURERE: ''. Fresno CA 93711 INSURER F: COVERAGES CERTIFICATE NUMBER: 14ArAt I A71 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. 'IN LTR TYPE OF INSURANCE ...................POLICY NUMBER..,.., POLICY EFF POLICY EXP ,.,, . ............ ......... .........., ......................_ MMIDDAYYYY ) IMM/DD/YYYYI LIMITS ly C GENERAL LIABILITY y CP0982903BOI 10/31/2011 0/31/2012 EACHOCCURRENCE $1.,000,000 X RaE F D I GENERAL PRM FE�SO MADEI X OCCUR MEDEXP(AnonCLAIMS- ym on) $1000000 PERSONAL & ADV INJURY $1,000,000 — - GENERAL AGGREGATE $2,000,000 _., _.,..1 I'll ................ GEN I AGGREGATE EGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $2,000,000 PROW POLICY LOC $ C AUTOMOBILE LIABILITY BAP982902101 10/31/2011 0/31/2012 LEa accident) .,.,,. 1, 000, 000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED - ' SCHEDULED AUTOS AUTOS — _ ,,,,. ..... ... BODILY INJURY (Per accident) .. .... ........... $ X X NON -OWNED _ °._ ERTY DAMAGE $ HIREDAUTOS AUTOS _(Per-acpident)_ .,....... $ �D X UMBRELLA LIAB X OCCUR UMB982 907 9 01 ',10/31/2011 0/31/2012 EACH OCCURRENCE $10.,000,000 .�, EXCESS LIAB CLAIMS -MADE ,... _, - - -. AGGREGATE $10 00 , 000 DED RETENTION $ $ C WORKERS COMPENSATION y WC982903901 10/31/2011 10/31/2012 X WC STATU- OTH- AND EMPLOYERS' LIABILITY YIN — T.OR.Y „LIMIITS .... ER__ ..... °...... ........ ANY PROPRIETOR/PARTNER/EXECUTIVE EACH ACCIDENT $ 1 000 000 OFFICE /MEMBH) EXCLUDED? N NIA 10 . E.L. EMPLOYE : $ 1,000,000 If yes, describe under �_ ................. DESCRIPTION OF OPERATIONS below E.L.. DISEASE - POLICY LIMIT $1,,. 000,000 A Professional Liab(E &O) G21671G30008 10/31/2011 0/31/2012 $5,000,000 Limit B Crime CCP006253306 '10/31/2011 10/31/2012 $5,000,000 Limit $25,000 Ded DESCRIPTION OF OPERATIONS ILOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Per the cancellation wording listed on this form, the policy provisions include at least 30 days notice of cancellation except for non - payment of premium. The City of E1 Segundo, its agents, officers, servants and employees are named as additional insureds under the General Liability policy with respect to the operations and work performed by the named insured as required by contract. City of E1 Segundo Attn: City Clerk 350 Main Street E1 Segundo CA 90245 -0989 UANI:tLLA I IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. REPRESENTATIVE © 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: CP09829038 01 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Any person or organization from whom you are required by written contract or agreement to be added as an Additional insured on your policy, provide , e Injury or damage occurs subsequent to the execution of the contract or agreemen insurance provided to this Additional insured is on a Primary & Non - Contributory Basis„ Information reauired to complete this Schedule. if not shown above. will be shown in the Declarations. Section II — Who Is An Insured is amended to in- clude as an additional insured the person(s) or organi- zations) shown 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 omis- sions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 © ISO Properties, Inc., 2004 Page 1 of 11 0 POLICY NUMBER: CP09829038 01 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization Any person or organization from whom you are required by written contract or agreement to be added as an Additional Insured on your policy, provide a 'n jury or damage occurs subsequent to the execution of the contract or areemen Insurance provided to this Additional Insured is on a Primary & Non- Contributory Basis. Information reauired to complete this Schedule. if not shown above. will be shown in Section II — Who Is An Insured is amended to in- clude as an additional insured the person(s) or organi- zations) shown 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 omis- sions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 0