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PROOF OF INSURANCE (2016) CLOSEDClient#: 299388 LIBRARY
DATE (MM /DD/YYYY)
ACORD,M CERTIFICATE OF LIABILITY INSURANCE 7127/z015
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.
ly holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS IMPORTANT: If the certificate 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 andorsement(s),
PRODUCER CONTACT Maria Morales
HUB International PHONE 805- 879 -9525 805 -617 -1767
Arr Nn
HUB Int'I Insurance Serv. Inc. em°A°L s maria,,morales@hubinternational.com
40 East Alamar Avenue - -
coveaacE NAIC p
Santa Barbara, CA 93105 INSURE'R(S'�_A��r�OrkDINffi
INSURER A: Philadelphia Indemnity Insuranc '..18058
INSURED INSURER B
Library Associates, Inc.
51 Monroe Street, Suite PE-04
Rockville, MD 20850 -2442
COVERAGES
CERTIFICATE NUMBER:
INSURER C ;
INSURER D:
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 CONTRACTOR 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.
I LT AR GENERAL LIABILITY OF INSURANCE ADD PHPK1336101 UMeE6 /011 015 06/071201i-
COMMERCIAL EACH OCCURRENCE uMITS$1.000:000 ...
A UMBRELLA LIAB OCCUR
..._ EXCESS LIAB CLAIMS
—u - DED T XrRETENTION E1 0000
E
;Ns IS1
X�
PERSONAL 8 ADV INJURY
GENERAL AGGREGATE
GLAIM$-MADE
ER OCCUR
$2.000.000
GrN'L AGGREGATE LIMIT APPLIES PER:
POLICY 2L-1:1
r.00
A
AUTOMOBILE LIABILITY
LE'L'IM °v
0,000.000
ANY AUTO
BODILY INJURY (Per person)
$
ALL OWNED
SCHEDULED
BODILY INJURY (Per aceldenl)
AUTOS
X
NON-OWNED
HIRED AUTOS
AUTOS
A UMBRELLA LIAB OCCUR
..._ EXCESS LIAB CLAIMS
—u - DED T XrRETENTION E1 0000
E
;Ns IS1
S
AND EMPLOYERS' LIABILITY °'-"'
ANY' PROPRIETOR/PARTNER/EXECUTIVE YIN E_,L EACH ACCIDENT
OPFIOER/MEMBER EXCLUDED? N/A ..
( ry ) $
rifaaldelo In NH E.L. DISEASE -EA EMPLOYEE.
Ifyes, describe under
DESCRIPTION OF OPERATIONS below E.L„ DISEASE- POLICY LIMIT $
A Professional Liab PHPK1336101 6/01/2015 06/01/2016 Limit $1,000,000
A Erisa Bond PHSD1036378 0610112015 'i06/011201 Limit 3,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
Certificate Holder is named as additional insured under the general liability policy as required by written
contract per form CG2026 0704 attached.
�il-
RL110,111011qLA
City f El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
y o g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
350 Main St. ACCORDANCE WITH THE POLICY PROVISIONS.
El Segundo, CA 90245
AUTHORIZED REPRESENTATIVE
©19BB -2010 ACORD CORPORATION. All rights reserved„
ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S36284011M3548883 MM496
PERSONAL 8 ADV INJURY
GENERAL AGGREGATE
$1.000.000
$2,000,000
PRODUCTS - COMP /OPAGG
$2.000.000
PHPK1336101
6/0112015
06/01/2016
LE'L'IM °v
0,000.000
BODILY INJURY (Per person)
$
BODILY INJURY (Per aceldenl)
$
PROPERTY DAMAGE
$
Per accident
$
PHUB499513 --1610112015*/01/2010
EACH OCCURRENCE
54,000,000
S
AND EMPLOYERS' LIABILITY °'-"'
ANY' PROPRIETOR/PARTNER/EXECUTIVE YIN E_,L EACH ACCIDENT
OPFIOER/MEMBER EXCLUDED? N/A ..
( ry ) $
rifaaldelo In NH E.L. DISEASE -EA EMPLOYEE.
Ifyes, describe under
DESCRIPTION OF OPERATIONS below E.L„ DISEASE- POLICY LIMIT $
A Professional Liab PHPK1336101 6/01/2015 06/01/2016 Limit $1,000,000
A Erisa Bond PHSD1036378 0610112015 'i06/011201 Limit 3,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
Certificate Holder is named as additional insured under the general liability policy as required by written
contract per form CG2026 0704 attached.
�il-
RL110,111011qLA
City f El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
y o g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
350 Main St. ACCORDANCE WITH THE POLICY PROVISIONS.
El Segundo, CA 90245
AUTHORIZED REPRESENTATIVE
©19BB -2010 ACORD CORPORATION. All rights reserved„
ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S36284011M3548883 MM496
PI•MANU -1 (OiIDU)
wl. 1 7 Iti�i dpi r I•Icwt 1 1 Pty LIDS ". d�fml s d� d fa t7° t 1 1 "t Ll „y
CG2026 Additional .insured - Designated Person Or Oruan-eation
POLICY InJ)(OCR c'OIa1LacU� culr£nnL
A OISPICL0279 L 2 „. CG 20 26 07 T 04
°
THLS CIr0.'1R5'e1SEtl2 CHIttG�c •r11k BOLICV. PLSASr• Re:S+ IT CARCFJ e.L1.
ADDITIOMM, IHSUSeu - O- esIclLkriRO
[?Pit—( M ORGAITFZATIO)T
TU-1, ondorme.nenr a.oiisias IluuCallca ProvidcI under the EoUcwLlgr
COMMACIA.b Ge11139AL I;YIOILt17 COVELFmc• PAR? •
SCUMTE
Name of Additional Itleurcd pLrooll Is) o= oruRniasUon (a)
Ally paisoh or ozr�enixntiml otiior than a joint kOnLuYa tillon you lice caqul_ -od
to add as an additional
insured on this policy uudur tt I'MiL'ten ealttroet of agraomont: provided L•hmt
the contract or agrooment Ls
In effect: during this policy period and Ma axaeucad price me tha occurrellce
Idlich souses '•.Ijed$ly injury ",
"pronerty daraga" or "ps =send injttry and advertising inju_ -y”.
thhan also raeuirad by rrcitbcn Conlrset or Agraeman:, this ivaeranco allal.l be
primary and
ron- contributory r:l.`..11 rvypocc ro etllar insurance,
Seccicn Ll - 61ho Is pn InSUt2d is 5randed Lo inclltde, is an•aadiL•ional
in "red LI1•a parach(s) or
orgbVk- ,htiar,(s) sim4n ifl the Sehadule, buL only Mid] respect to 11mbiltty
£or "bodily lojery ', °p= operLy .
dnM. ;GO' or "Porronrl. mud advettising llljurp" ceased, l.n 1411010 01 ilt (tart, 1,1,
Your rota or anis.m-M,-
or talc arcs or Oaiasions of Cilesc meting oa your 1uha1F:
In tut lls,r?orr,ance c: yaur onnoing operatio%l.^: or
6. sn c0000CLion with 2, l,ur Ilaygniss cwncc by or ranted to you.
'rha Insur6ticc. d0• ?s .lot a pp"Ay t0 "11aJSiy injury" or "proparty dr.maga'
.wiling out n_ or SeSUlt -thq, CE''04
structural alcar:.t.ioalK, new eonst'ruek o11 or d ?,,0j L.on 000ratiens parP.oraW
by or. Ear lint• eddit;.onnl
insured.
This insllranca cloov nee apply Lo "l+cdily injur;" a:' "r,= gerty danaye
All other leans and condi((ons of II 'Nubby remain uroha' aged.
Page l or x
PHdAl4U,l (01100)
arlz-'lv out of or X&DUlting from
ally 41MICAllicnN Verfacmed by or fol- any CtILIX'CO-1, mm'),-.4PALLY,
entity or otljor pub2la
ThiM biumthncz cjo*s not aMj2.y p
cut Or 09 VesuUlnq frft - .0 bodily injv-,ry,, or "PropQrLy da%l;Wl arlsiAg
wsy Optratinaz percormd by cc fou any Lalomari::rin0. CH-I:ect "Oil CX
cc 20 20 07 04
0 ISD PropartAor., Inc.,
All olhar Terms and concilliont; ofilik'PoUcy remain u4hsnqLa
rage 2 of 2
Client #: 299388 LIBRARY DATE (MMIDDIYYYY)
ACORD., CERTIFICATE OF LIABILITY INSURANCE 11121/2014
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 cart&fioate hoNder is an ADDITIONAL INSURED, the laolicy(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 COI�iIA T Maria Morales
NON
Hub International FIIONE FAX -1 7i TI AIC rao, EYD: 805- 879 -9525 Inm N 805- 617 -1767
HUB Int'I Insurance Serv. Inc. EMAIL maria.moralles@fiubinternaional.com
40 East Alamar Avenue
INSURER(S) AFFORDING COVERAGE'. NAIC #
Santa Barbara, CA 93105
INSURERA :Philadelphia Indemnity Insuranc 18058
INSURED
INSURERS; Hartford Casualty Insurance Com 129424
Library Associates, Inc. � IER
INSURRER C
51 Monroe Street, Suite PE -04
INSURER D
Rockville, MD 20850 -2442
INSURER E
INSURER F:
COVERAGES CERTIFICATE NUMBER: 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.
ERR".'- TYPE OF INSURANCE AD DL uUBR
- POLICY NUMBER ''— � IMMIDD{YYYV MMIDD YYYY LIMITS ." " "
PO
A GENERAL LIABILITY
PHPK1027414 6101/2014 06/01/2015 EACHOCCURRENCE 51,000;,000
X COMMERCIAL GENERAL LIABILITY
DAMAGTO "riLNTEL 5100-000
FNdLMI » S IWa oarutenret.....
CLAIMS -MADE rid OCCUR
MED EXP (Anv one Derson) S5.000
PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE s2.000,000
GENL AGOG EGATE'. LIMIT APPLIES PER:
PRODUCTS - COMPIOP AGG 52,000,000
POLICY.. LOC
$
A
AUTOMOBILE LIABILITY
PHPK1027414
610112014
061011201
COMBINED SINGLE L,IMI r
',F m "_ -,,.i
51,000,000
BODILY INJURY (Perpersan)
5
X ANY AUTO
BODILY INJURY (Per accident) S
ALLOWNED SCHEDULED
AUTOS NON-OWNED
X X
PROPER-77 UA_WAG _ ..�
$
HIRED AUTOS AUTOS
.a._..._.._.... "i
5 �
A
UMBRELLA LIAB OCCUR
PHUB422451
0610112014,0610112015
EACH OCCURRENCE 54000.000
EXCESS LIAR CLAIMS -MADE
4.000.000
AGGREGATE "L; s4.000.000
S.
ENTION 0000
5........._._.,
arc
B
72WECFY5738
12101/20
12/011201,,4
"YN' T OTH
AND EMPLOYERS' LI BILITY
NWORKERS P LOYERS'c��RrNI R�
YIN
'�OFFMERI10EMBER.E�.X�CLUDED. N
�
E.L. EACH ACCIDENT $1,000,000
I _.. _...
.NIA
EL DISEASE EMPLOYEE 51,000790'0
Mandatory in NH
( )
E.L. -E ... -- ._ ..,c_.
If yes, describe under
nFSCRIPTION OF OPERATIONS below
E.L DISEASE- POLICY LIMIT ,000,,000
•
Professional Liab
PHPK1027414
0610112014
06101/201
Limit $1,000,00
•
'Erisa Bond
PHSD848634
6/01/2014
06101/201
Limit $3,000,000
DESCRIPTION OF OPERATIONS! LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required)
Certificate Holder is named as additional insured under the general liability poiicy under written contract
perform CG2026 attached.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of El Segundo
Y g
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
350 Main St.
ACCORDANCE WITH THE POLICY PROVISIONS.
EI Segundo, CA 90 4
AUTHORIZED REPRESENTATIVE
©1988 -2010 ACORD CORPORATION. All rights reserved,
ACORD 25 (2010105) 1 of 1 The ACORD
name and logo are registered marks of ACORD
#S3200688/M2900952
MM496
niwk-
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
VVIs1kyjN X60&o1llJ 77 Eel: 11dt Eel 7 *0101TI 1 ;-a a:To]u1
OTHERS ENDORSEMENT - CALIFORNIA
Policy Number: 72 WEC FY573,/ Endorsement Number: 01
Effective Date: 12/01/14 Effective hour is the same as stated on the Information Page of the policy.
Named Insured and Address: LIBRARY ASSOCIATES, INC
51 MONROE ST STE PE04
ROCKVILLE, MD 20650
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not
enforce our right against the person or organization named in the Schedule. (This agreement applies only to the
extent that you perform work under a written contract that requires you to obtain this agreement from us.)
You must maintain payroll records accurately segregating the remuneration of your employees while engaged in
the work described in the Schedule.
The additional premium for this endorsement shall be
premium otherwise due on such remuneration.
Person or Organization
CITY OF EL SUD
350 MAIN ST.
EL SEGUNDO, CA( 02 45
SCHEDULE
Countersigned by
2 % of the California workers' compensation
Job Description
TEMPORARY LIBRARIAN
Authorized Representative
Form WC 04 03 06 (1) Printed in U.S.A.
Process Date: 12/02/14 Policy Expiration Date: 12/01/15