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PROOF OF INSURANCE (2010) CLOSED
33 ACORD�, CERTIFICATE OF LIABILITY INSURANCE 10 /112o 9 ) PRODUCER (415) 788 -9810 FAX: (415) 248 -3534 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ISU /San Francisco ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE City Clerks HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 201 California St., Suite 200 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. License # 0778092 San Francisco CA 94111 -5098 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA Hartford Casualty Ins Co 29424 INNOVATIVE INTERFACES INCORPORATED INSURER B: INSURER C: PETER SKLAR 5850 SHELLMOUND WAY INSURER D: EMERYVILLE CA 94608 INSURER E: 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. AG REG,TELIMIT,55HQW N MAY HAVE BEE �R I!!I�_f&AlL. _ ��._....... INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER 2E EM DATE MM /DDIYII LIMITS GENERAL LIABILITY ,'IR $ 1,000,000 X COMMERCIAL GENERAL AL LIABILITY DAMAGE$i RENTED r Qqr $ 300,000 A CLAIMS MADE OCCUR t �� a 57UUNTL9438 10�1�2009 10/1/2010 MEQEXPI Any one Person) 1 $ 10,000 PER.S, t?,N.AL X�A.ravlr.. I RY ......,.$ _ 1, 000, 000 .._ .....v ..... ......... GENERALAGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 PRO 21 POLICY amy L1 LO" AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000' X ANY AUTO (Ea accident) BODILY INJURY A ALL OWNED AUTOS 57UUNTL9438 10/l/2009 10/1/2010 SCHEDULED AUTOS (Per person) $ X BODILY INJURY $ HIRED AUTOS X ,NON -OWNED AUTOS (Per accident) X PROPERTY DAMAGE COMP $1,000 X COLL 1 000 (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG EXCESS /UMBRELLA LIABILITY $ 5,000,000 X OCCUR EI CLAIMS MADE AGGREGATE Is 5,000,000 $ A 2ETENTIQN EDUCTIBLE 57XHUTL9505 10/1/2009 10/1/2010 110,000 WORKERS COMPENSATION AND WC STATU- -0TH- LIMITS EMPLOYERS' LIABILITY _T.4.8Y ANY PROPRIETOR /PARTNER /EXECUTIVE E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? E .. DISEASE - EA EMPLOYEE.. $ If yes, describe under ""'""' "'""°"_ °'"""""'° " "" ' ° """. " " " " " " " " " " " "' SPECIAL PROVISIONS Mow E.l, DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS IF required by written contract or agreement City of E1 Segundo is included as an Additional Insured respect General Liability as their intent may appear in connection with services provided by the Named Insured for the Additional Insured. CERTIFICATE HOLDER CANCELLATION ACORD 25 (2001/08) INS025 (0108),08a © ACORD CORPORATION 1988 Page 1 of 2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of El Segundo EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL City Clerks Office 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT Attn : Patti Kight 350 Main Street FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE Room 5 INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE �— E1 Segundo, CA 90245 -3895 Mark Uthe /MARKUT ACORD 25 (2001/08) INS025 (0108),08a © ACORD CORPORATION 1988 Page 1 of 2 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(es) must be endorsed. A statement n,.tois 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 (2001/08) INS025 (olos),oea Page 2 of 2