PROOF OF INSURANCE (2012) CLOSEDO DATE(MMIODNYYYJ
CERTIFICATE OF LIABILITY INSURANCE
, ID KT
"'kIr -5 03/29/11
PRODUCER CERTIFICATE ISSUED ASAMATTER OF INFORMATION
John Huttinger ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Pacific Unified Insurance MOLDER, THM C'ERTIFIC'ATE DOES NOT AMEND, EXT'E'ND OR
P.O. Box 68 ALTER THE COVERAGE AFFORDED BY THE POLICIES I ELO'WW.
Lawndale CA 90260
Phone: 310 - 370 -5000 Fax: 310 -370 -5454 INSURERS AFFORDING COVERAGE NAIC #
iwsuREO .. _.m ....
INSURER A Markel Insurance COTIVPeny
INSURERS Hartford Insurance Co81panr 22357
South Bala Children's Health wsu- b...,..... .. -..n
Center Association Inc. RERC
10 So. Camino Reai INSURER D
Redondo Beach CA 90277 __..... , �.
INSURER E
...................
COVERAGES
__ - .._ _ ......w
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
1LTR OL .. _m„.e.�_....e .... _ .................. .,.......,.�..�, PbC'fEPubIFE'I"'NyJ PD TE EMIDDJT''i0N ,� ...v _._ ..�,........
GENERAL RALLIA COMMERCIAL GENERAL LIABILITY 3602 S,s POLICY NUMBER OATIw, hkMtIDDIYY DATE MMfOD1YY LIMITS
LIABILITY E 311218 -3 03LY31/].� ....���
A X D X NE�� TYPE OF IrasuRANC, e - EACH OCCURRENCE ' $1,000,000
LTAMrA ECc
/ GETOTtENTEO� -
Eac.... ce} S1,000,000**
1 03 31/12 MEDE P (Any one pa son) x10,000 **
{ I
CLAIMS MADE �, OCCUR MED EX
PERSONAL uY. NJ ®........_.
&ADVINJURY S 1 2.9 000
I GENERAL AGGREGATE s3,000,000
C GEN1AGGRLGATE LIMIT APPLIES PER i PRODUCTS COMPIOPAGG s3,000,000
PLItic, 5 Q ,X LOG SEX_ MISC j
e
AUTOMOBILE LIABILITY � �� w..
COMBINED
A ANY AUTO 3602SS311218 -3 03/31/11 03/31/12 aaccidSINGLELIMIi $1,000,000
(Ea cctdenl}
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS ( Per person)
.._ ..... ,e, _.
HIRED AUTOS
BODIL
Y[NJURY $
(, NON-OWNED AUTOS i (Per ecctdenl)
s PROPERTY DAMAGE
_ . _._. , .... (Per accidant) S
GARAGE LIABILITY AUTO ONLY EA ACCIDENT $
ANY AUTO EA ACC S
OTHER THAN _
AUTO ONLY AGG S
A C (OCCUR cLAIMSMaDE 9602SST S1,000,000
EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE -11 0110101,9101101-
r 3479081 03/31/11 03/31/12 AGGREGATE _
.I DEDUCTIBLE
WORKERS
B KERSCOMPENSATIONAND 72WECPZ411Z 12/01/10 12/01 11 EaYrIIwIIT`�,,,
FeErENrION 5
FJNPLOYER9 LABILTlY
ANY PROPRIETORIPARTNERIEXECUTIVE / EACH ACCIDENT ' S 110001 000
OFFICEWMEMBEREXCLUDED? �� EL. DISEASE FAEMI10YFE S 1, 000, 000
cedar
S ECIAL PROVISIONS I10ow F L- DISEASE POLICY LIMIT 3 1 , 000 000
OTHER
• Loc. #1 /Repl Cost 72g 27773- SPECIAL POR4 03/04/11 03/04/12 BUILDING 306,100
• LOO #1 /Reel Cost 7253A.M7773 °SPECIAL FORM 03/04/11 03/04112 CONTENTS 83,400
DESCRIPTION OF OPERATIONS! LOCATIONS f VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS
*10 day notice IF cancelled for nonpayment of premium. Certificate Holder is
included as Additional Insured per the attached general liability extension
form #MGL232 (05/09). RE:The contract for assessment, case management, and
counseling children and their families who are referred to the South Bay
Youth Project. SEE HOLDER NOTES FOR ADDITIONAL, POLICY FORMS & CONDITIONS.
CERTIFICATE HOLDER CANCELLATION
CITYOFE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL VOCRIN A, *30 DAYS WRITTEN
City of El Segundo /Counseling NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Grant /South Bay Youth Project
35U Main SLreeti __.._�.
El Segundo CA 90295 AUTO Rr DREP TATIVE
AGORD 25 (II011I78) ObACORD CORPORATION 1988