PROOF OF INSURANCE (2014) CLOSED�= CERTIFICATE OF LIABILITY INSURANCE DATE
�,,.. 09!01!2013
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 certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. It 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 CON A.
JSl FINANCIAL SERVICES, INC
PHONE E l ��1.( ' 5 B RICE, JR � ���.N�I (818) 436-5988
_
AME ROBERT ......._ .. ,
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�°L, _ @ rgeantinsurance.com
JOHN SARGE4NT INSURANCE AGENCY robert sa ... ..
300
WEST LENOAKS BLVD. SUITE 1042985 � InsuRSSZ a AMERICAN STATES Vtq r�EeacE. - l NAIC #
S COMPANY 19704
INSURED
INDIAN HARBOR INSURANCE COMPANY 36940
41 S, LLC
BOREL AVENUE INSuRER
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SAN MATEO CA 94402 -3525
URER F
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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,
BEEN REDU _
EXCLUSIONS AND CONDITIONS OF REDUCED BY PAID CLAIMS. _
SUCH POLICIES. LIMITS SHOWN MAY HAVE BE
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INSR UM �
TYPE OF INSURANCE � � .......POLICY -NU POLiGY EFF 'd�NIORt yy f
L NUMBER MMJ'iJ`..' MMIDOI'YYYY
RAL LIABRAY i
EACH OCCURRENCE $ 1,000,0
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- II ItF"Fi1"Ft"r 1.000,000......
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0910112914, ERSON INJURY 1,000 000
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If yes, describe under
DESCRIPTION OF OPERATIONS below
E.C.. DISEASE • POLCY LIMIT 3 1,000,000
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MISC. PROFESSIONAL LIABILITY
M 09/01!2013 09/0112D14 $2,000,000 PER CLAIM
ANNUAL AGGREGATE
y
i�$4,000,000
DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is requlred)
CERTIFICATE HOLDER IS HEREBY NAMED AN ADDITIONAL INSURED ON POLICY #25CC124429 -8 AS RESPECTS OPERATIONS OF THE NAMED
INSURED ONLY. SEE ATTACHED FORMS CG8672. COVERAGE UNDER POLICY #25CC124429 -8 IS PRIMARY & NON - CONTRIBUTORY ABOVE ANY
OTHER INSURANCE THE CERTIFICATE HOLDER(S) MAY CARRY. 30 DAY NOTICE OF CANCELLATION.
UF-K I I'1-IGA I:E MULUtK unlsw.r -I r r I r evrM
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CITY OF EL SEGUNDO THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ATTN: DEBORAH CULLEN, DIRECTOR OF FINANC ACCORDANCE WITH THE POLICY PROVISIONS,
350 MAIN STREET
Fe
aurRORCZED REPRESENTATIVE
EL SEGUNDO CA 9024 � -
ROBERT B. RICE, JR.
ernon �c r�n�nnuc► ®1988 -2010 ACORD CORPORA ION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
92
NM
Bartel-Associates 2 LLC
CG 86 72 10 02
POLICY NUNIBEP,: 25CC124429-8
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - COMPLETED OPERATIONS
This endorsement modifies irsurance provided under the following:
COMMERCIAL GeNEFa UABury COVERAGE PART
SCHEDULE
Name of Person or Oraanlz Von:
CITY OF EL SEGUNDO
Location and Description of Completed OPeradons:
All operations of the Named Insured
Adddional Pr6rniurn:
Included
(If no entry appears above. information required to complete this endorsement adG be spawn in the Declarations
as applicable to this endorsement) '
SECTION it — WHO IS AN INSURED is amended to include as an Insured the PersOn or organization shown
in the Schedule, but only to the rodent you are held Irable due to °j+our work" at the location designated and
described in the schedule of this endorsement for that insured and included in the 'product- comPleted
operations hazard°.
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