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PROOF OF INSURANCE (2011) CLOSED
ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID AD DATE(MM /DD/YYYY) JONES -3 05/28 10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Poole Professional Ltd. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 107 Audubon Rd. #2, Ste. 305 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, Wakefield MA 01880 Phone: 781- 245 -5400 Fax: 781- 245 -5463 I INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A. Phoenix Insurance ComZanr 25623 — - INSURER B: Charter Oak Fire Ins. Co. 25615 C 12 Washingtn Street INSURER D: m ^w w W °dam "ltY co America 25666 Q INSURER C Travelers I Boston nMA Payne 2114 Grou� ._ ...... INSURER E: COVERAGES 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 AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. BR ........... LTR TYPE OF INSURANCE DATE (MM DD/Y Y DA (MWDDl1 Y m _ _. LIMITS GENERAL, LIABILITY EACH OCCURRENCE $1,000,000 X X COMMERCIAL GENERAL LIABILITY tYATv1A�GE TO RFN TE'O PREMISES( m $1 000,000 CLAIMS MADE X OCCUR _. MED EXP An one person) $5,000 A 680-2331L213 06 01/10 06/01 11 __ PERSONAL &ADVINJURY 0 000 INSURANCE IS PRIMARY �.... ,,, GENERAL AGGREGATE $2,000,000 GENT AGGREGATE LIMIT APPLIES POECR _ PRODUCTS COMP /OP AGG s2,000,000 POLICY K] A .. TOMOBILELIABILITY COMBINED SINGLE LIMIT $ 1 000 000 X ANY AUTO (Ea accident) r r ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY B X NON -OWNED AUTOS BA- 2341L323 06/01/10 06/01/11 (Per accident) ........_ _--- ---------, ----- PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO EA - ... OTHER THAN ACC _ $ AUTO ONLY: AGG $ EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE $3,000,000 C X X OCCUR CLAIMSMADE UP- 6568Y159 06/01/10 06/01/11 AGGREGATE ..... —.._ $ 3, 000, 000 .,....,..__ DEDUCTIBLE $ ..... RETENTION $ $ WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS' LIABILITY �, _ .. ...... . — ------ ,. ANY PROPRIETOR/PARTNER/EXECUTIVE E. L, EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E L DISEASE - EA EMPLOYEE' $ If yes, describe under I ....... _ ........ __,,,,._ SPECIAL PROVISIONS below E,L DISEASE -POLICY LIMIT $ OTHER A Business Owners 680- 2331L213 06/01/10 06/01/11 valuable Package papers $100,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS The certificate holder is included as additional insured under the general liability policy, subject to all policy terms and conditions. w City of E1 Segundo Office of City Clerk 350 Main Street El Segundo CA 90245 -3813 ACORD 25 (2001/08) 1+N1461CLLH 1 IUN " CIELS -1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANC LED BEFORE THE EXPIRAT'p�Y DATE THEREOF, THE ISSUING INSURER WILL EN MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT iiiiiiiiiiiiiiiiiiiiiilillill w w. r ■ c • ii ;. . lei TInN 19RR OP ID AD DATE (MM /DD/Y(YY) ACORD CERTIFICATE OF LIABILITY INSURANCE JONES -3 05 28 10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Poole Professional Ltd. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 107 Audubon Rd. #2, Ste. 305 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Wakefield MA 01880 Phone:781- 245 -5400 Fax:781- 245 -5463 INSURERS AFFORDING COVERAGE NAIC# Irvs" INSURER .._... pecialt _.. .......... .. ..r._ _, ... _ mmInsurance Co. 37885 URED A XL $ eC INSURER B: __._.. _ ... The Jones Payne Grou INSURER C: 123 Washington Stree INSURER D: Boston MA 02114 _.. ............ ... .., INSURER E: COVERAGES 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, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IL7R NSR ' ....------ - TYPE ... O . . F -- -- PoYOw"t«ii'v POtT";IAY10.... INSURANCE POLICY NUMBER DATE iMMIDDIYYI, DATE (MMIDD/YYJ LIMITS GENERAL LIABILITY EACH OCCURRENCE $ � DA7h�AG D. .... ., COMMERCIAL GENERAL LIABILITY PRFC�VgSES Ea mccume CLAIMS MADE OCCUR MED EXP ( Any one pe rson ) $ ..� PERSONAL & ADV INJURY $ GENERAL AGGREGATE TE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/ OP AGG $ RD LOC POLIC Y PECT J AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHERTHAN ^EA ACC $ _ AUTO ONLY: AGG $ EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE DEDUCTIBLE ...... ...,,..., ........................ - - --- -.. RETENTION $ $ WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS' LIABILITY EL EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ If yes, describe under SPECIAL PROVISIONS below E L DISEASE POLICY LIMIT $ OTHER A Arch. /Engr. DPR9685523 06/01/10 06/01/11 Per Claim $2,000,000 Prof. Liab. I I Aggregate $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVI- SION!$ For professional liability coverage, the aggregate limit is the total insurance available for all covered claims presented within the policy period. The limit will be reduced by payments of indemnity and expense. CERTIFICATE HOLDER City of E1 Segundo Office of City Clerk 350 Main Street E1 Segundo CA 90245 -3813 CANCELLATION CIELS -1 DATE THEREOF, THE ISSUING INSURER WALL B Rm A'E BEFORE THE WRITTEN SHOULD ANY OF THE ABOVE DESCRIBED POLICfES DE CANC L ��dL 3O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, NT FAfeU T"O'SC'SHAT ACORD 25 (2001108) " " _ ©ACORtrCORPORATION 1988