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PROOF OF INSURANCE (2014) CLOSEDV FMTHOMA -01 CERTIFICATE, OF LIABILITY INSURANCE F OLVI DATE (MMIDDIYYYY) 12/30/2013 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. 'UK IAN 1: It the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the .tificate holder in lieu of such endorsement PRODUCER 888 825.4'322 OG EAT Michelle Vedas ) 7 ( ) NAPS _ ............. [ A X -- -- 14' P.O. Box 6026 c No 714-733-6229 FAx 53 DRESS: mvedas poWe 252 82 A /IaNE 3 6229 rmaster.com 10805rHolder Streeto Suite 350 A� . -- � � ..... __... .. Cypress, CA 90630 IU - &JRERIS),AFFORDIN COVERAGE NJ46C k INSURED 2 M Thomas Air Conditioning, Inc. INNSURER A olden Eagle In Insurance C,o a Corporation - -- 28053 Brea m ni Ave. INSURER C :IInsuranceCompan Com an 31 Gemini Av Company of the West 27847 ' IN,SI7RER D , INSURER E: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 001 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. Ct+AF ,we.. - ----- — ._......... ...... _. ,,,,,,, „ LTR TYPE OF INSURANCE POLICY NUMBER MMiN17DfYYYY lVM OCIYYY l „� LIMITS WVID GE LIABILITY EACH OCCURRENCE $ 11000,00 A X COMMERCIAL GENERAL LIABILITY X X CBP8636340 4/1/2013 4/1/2014 DAMAGr t`O1'"W N 5b i, "�3f ISES jEq oca,osy ;9) $ 500,00 CLAIMS -MADE X OCCUR MEDEP (Any one eus rp $ . 10,,000 X.­...L.. . ..... — _PERSONAL &ADVINJURY $ 11000,000 _ GENERAL AGGREGATE $ 2,000,000 ... GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP /OP AGG $ 2,000,001 POLICY - PRO. X LOC 41 �m .. $ 4UTOMOBILE LIABILITY COMBINED SINGLE l IM111` 1,0tI0,011 K ANY AUTO X BA8636640 4/1/2013 4/1/2014 c� (E afdent) S BODILY INJURY (Per person) $ ALL OWNED SCHEDULED _ AUTOS AUTOS BODILY INJURY (Per accident) $ NON -OWNED HIREDAUTOS X AUTOS PR4I'F R I Y'CAI IAI�I (F?�rdenl) $ UMBRELLA LIAB X OCCUR OCCURRENCE OCCURRENCE $ 1„ , 00 B X EXCESS LIAB CLAIMS -MADE R,XSLRU00134400 4/1/2013 4/1/2014 ��H $ 4,000 000,00 p COED P X H4 TENTVON None $ WORKERS COMPENSATION WC STATIJ, OTGf X ' AND EMPLOYERS' LIABILITY Tw0C (1MI) Ei C ICERtMEMBE!R EXCLUDED? ECUTfV'I � N / A X W D5tI 54 4 1/1/2014 1I1I2015 E L EACH ACCIDENT $ 1 000 00 n (Mandatory IP'es,descnbeunder E L DISEASE - EA EMPLOYEE 11000,000 O E S _._ .,�... ...._--- ......m, .... .... .......... T7�SORIPTI81N OF OPERATIONS bellow I .La DISEASE - POLICY LIMIT $ 1 000 00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 1101, Additional Remarks Schedule, if more space is required) ity of El Segundo, its officials and employees are additional insured, to the extent provided by the attached endorsements GECG 970 01/11 Including Waiver of Subrogation), CG2037 07/04, 22-11101/07 & GECA701 01/07, Workers' Workers' Compensation Waiver of Subrogation IItVC99063408/00 attached. CERTIFICATE City of El Segundo - City Clerk 350 Main Street El Segundo, CA 90245- 1 AUTHORIZED REPRESENTATIVE (iCJ ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD E SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ACORD 25 (2010/05) The enclosed Certificate issued to your company is for EVIDENCE OF WORKERS COMPENSATION ONLY. Any prior Certificates and Endorsements that you may have received for FM Thomas Air Conditioning, Inc. are still active and valid. For questions concerning the enclosed document, please call: Michelle Vedas Bowermaster & Associates Insurance Agency, Inc. (714) 733 -6229 — Direct Line mvedas@bowermaster.com Thank you, Michelle Vedas