PROOF OF INSURANCE (2012) CLOSEDACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY)
11/03/2011
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 ADD'fTIONAL INSURED, the pollcy(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 CONYA0
NAME:
PHONE 8..__ 2155 _ lFAArc,nlray 805 379 4198
ISU Insurance Services License #0650569 818.889.
Stanton & Associates E-MAIL
ASiDRElS :
3625 Thousand Oaks Blvd #319 PRODUCER 00017748
W+11-1— v; l l — 4-A 012C') _ ... I
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.
ILTR ---
----✓- TYPE OF INSURANCE
�NSR
WVD
v,�.......+u- POLICY NUMBER ....... u�..�.�
POLICY ' IEFF
MMIDDfYYYY
IPOUCYIEXP_
MMIDDIYYYY
_.__............,eeeee,�. ..LIMITS.
��,. .... .. ....
GENERAL LIABILITY
EACH OCCURRENCE
$
DAMAGE Ti7t�Ef�I °ERA
COMMERCIAL GENERAL LIABILITY
CO
� .. � r ry
$ _
i
MED EXP (Any one person)
$
- -------- ------ —
CLAIMS -MADE OCCUR
L..
PERSONAL & ADV INJURY
�.
$
GENERAL AGGREGATE
$
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP /OP AGG$
POLICY Ll JEC'T Ll LOC
$
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
$
(Ea accident)
ANY AUTO
-.._ .- ...........................
.................. ............................... ......... ....
BO DILY INJURY Pe r person)
$
ALL OWNED AUTOS
BODILY INJURY (Per accident)
$
SCHEDULED AUTOS
Oa DAMAGE.
..................... ...............................
HIRED AUTOS
( Per accident) )
$
NON -OWNED AUTOS
.... ... . .. .........
$
UMBRELLA LIAR OCCUR
EACH OCCURRENCE
$
EXCESS LIAB CLAIMS -MADE
AGGREGATE
____________
$
DEDUCTIBLE
$
RETENTION $
$
WORKERS COMPENSATION
EIG1056715 -0
11/01/2011
11/01/2012
X WO C S.Tt DTH
AND EMPLOYERS' LIABILITY Y / N
ER
° -- .....
ANY PROPRIETOR/PARTNER/EXECUTIVE
E]
NIA
E.L. EACH
EA H ACCIDENT
$ 11000,000
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
E.L. DISEASE EA EMPLOYEE
$ 1.000.000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
T_
DESCRIPTION OF OPERATIONS /LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of El Segundo Parks & Rec ACCORDANCE WITH THE POLICY PROVISIONS.
Ms. Vina Ramos
Administrative Analyst AUTHORIZED REPRESENTATIVE
350 Main St
E1 Segundo, CA 90245
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