PROOF OF INSURANCE (2011) CLOSEDCERTIFICATE OF LIABILITY INSURANCE OP IDCO
oATE(MMmonyvY)
MARTIN2
0416 10
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
PIASC Insurance Services, Inc.
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Lic.# 0747420
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND
OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P.O. Box 910936
Los Angeles CA 90091 -0936
Phone: 323 - 728 -9500 Fax: 323 - 728 -0483
INSURERS AFFORDING COVERAGE
NAIC#
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MBU RLD
INSURER A: tr fl � 4 J Lmm
20621
-
INSURERS : E BmpT I rn—
10900
....
Martin & Chapman Company
Attn: Scott Martin
INSURER C:
1951 Wright Circle
INSURER
Anaheim CA 92806 -6028
-
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTIITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE
MAYBE 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 MA V HAVE BEEN REDUCED BY PAID CLAIMS.
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POLICY EFFECTNE
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POLICY NUMBER.....".....
DATE MM'DDIYYYY)
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LIMITS
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EACH OCCURRENCE
$ 1,000,000
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X COMMERCIALCENERALUABBITV
717009449 -03
02/18/10
02/18/11
DAMAGE TO RENTED
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§ l'090'000
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CLAIMS MADE d, OCCUR
V VVV X
MED EXP(Anyo Pe )
§ 10 ,000
PERSONALSADV INJURY
_
S 1,000, 000
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X GL BROAD FORM EN. D
GENERAL AGGREGATE
§ Z 000 000
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PRODUCTS - COMP /OP AGG
§ Z 000, 000
X LOC
Empl. Be.
1,000, 000
POLICY 'PRO
AUTOMOBILELIABILITY
COMBINED SINGLE LIMIT
E 500,000
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X
ANY AUTO
717009449 -03
02/18/10
02/18/11
(Ea aWdem)
I
ALL OVMIED AUTOS
BODILY INJURY
(Per peraan)
§
SCHEDULED AUTOS
_. X
HIRED AUTOS
BODILY INJURY
(PeramidenI)
§
X
NON -0WNED AUTOS
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PROPERTY DAMAGE
S
(Per accident)
GARAGE
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LIABILITY
AUTO ONLY - EA ACCIDENT
$
ANY AUTO
EA ACC
OT HERTHAN
§
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AUTU DNLY AGG
$
BX GDS "Bk1AMT}JC4"C I.FetIiMIBgLI'4mW
EACH OCCURRENCE
§ 3,000,000
A
X OCCUR L C MAWS
717009449-03
02/18/10
02/18/11
AGGREGATE
§
DEDUCTIBLE
S
X
RETENTION $ 0
S
WORKERS
COMPENSATION
Vr>r STATU- OTH-
X
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TORY LIMITS ER
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B
ANY PROPRIETORIPARTNERIEXECUTIVE
WKN122873 -6
06/01/09
06/01/10
EL EACH ACCIDENT
$ 1,000,000
........
OFFICERIMEMBER EXCLUDED?
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(Mandalory In NH) " ""
EL DISEASE - EA EMPLOYEE
..,... ... ----
$
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Iryea, d.—ibe under
SPECIAL PROVISIONS below
EL DISEASE - POLICY LIMIT
S
OTHER
A
Errors & Omissions
717009449 -03
02/18/10
02/18/11
Special
1,000,000
Form
25,000 Ded
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Certificate holder is named as ADDITIONAL INSURED with respects to liability
arising out of work performed by the Named Insured.
* *Workers' Compensation- -Proof of Coverage Only **
** *Errors & Omissions- -Proof of Coverage Only * **
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITYOFI
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
m DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
City of El Segundo
Attn: Office of the City Clerk
REPRESENTATIVES.
350 Main Street
��11
1 Segundo CA 90245 -3389
ACORD 25 (2009/01)
DRD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Reproduction of Insurance Services Office, Inc. Form
INSURER: ISO FORM CG 20 10 11 85: (MODIFIED)
POLICY NUMBER: COMMERCIAL GENERAL LIABILITY
ENDORSEMENT NUMBER: EXEIIBIT 1 -A
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED — OWNERS, LESSEES OR
CONTRACTORS (FORM B)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
The City, its officers, officials, employees, agents, and volunteers
(If no entry appears above, the information required to complete this endorsement
will be shown in the Declarations as applicable to this endorsement.)
WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization
shown in the Schedule, but only with respect to liability arising out of "your work" for that insured by or
for you.
Modifleations to ISO form CG 2010 1185:
1. The insured scheduled above includes the Insured's officers, officials, employees and
volunteers.
2. This insurance shall be primary as respects the insured shown in the schedule above,
or if excess, shall stand in an unbroken chain of coverage excess of the Named
Insured's scheduled underlying primary coverage. In either event, any other insurance
maintained by the Insured scheduled above shall be in excess of this insurance and
shall not be called upon to contribute with it.
3. The insurance afforded by this policy shall not be canceled except after thirty days
prior written notice by certified mail return receipt requested has been given to the
Entity.
4. Coverage shall not extend to any indemnity coverage for the active negligence of the
additional insured in any case where an agreement to in emn� the additional insured
would be invalid under Subdivision (b') of section,2 , �iv)l rA(
Address
CG 20 85 Insurance Services Office, Inc. Form (Modified)