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PROOF OF INSURANCE (2012) CLOSEDCERTIFICATE OF LIABILITY INSURANCE OP ID Co MARTIN2 04/08/11 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION LIABILITY PIASC Insurance Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Lic. # 0747420 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 910936 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. X Los Angeles CA 90091 -0936 AWF 9033498 00 02/18/11 Phone: 323- 728 -9500 Fax: 323- 728 -0483 INSURERS AFFORDING COVERAGE NAIC # ����� "..,.0 ,000 ............. ....����._ .... ... ..........- ...__.— - ...... . - -- . mINSURER^A The Hanover Insurance Grou���������� p 36064 1 ........__.__._— - -- ... - - - -- ..........�....... INSURER B: Preferred Employers Ins. Co 10900 Martin & Chapman Company Martin INSUR " " -. INSURER C: BODILY INJURY Attn: Scott 1951 Wright Circle _ INSUR ERD Anaheim CA 92806 -6028 n INSURER E: COVERAGES 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, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ .... — INSR CJC9" .._ .,...,... m.. ...... _ .... POLICY PON.fCY' F 0'11 "POiiC"� "EXPIM''ho'k LIMITS LTR NSR TYPE OF INSURANCE UMBER DgTE MM220[y'q"YY DATE MM /DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A X..., COMMERCIAL GENERAL LIABILITY ZDF 9102496 00 02/18/11 02/16112 PREMSES(EOaotccu�ence) $1,0.00,000 P (Any one person) $ 10 OCCUR PERSONAL 000 CLAIMS MADE X i NAL &ADVINJURY $ 1 000 000 GENERAL AGGREGATE ..._ $ 2 , � 0 � „O O .......... FORM END 0 IX GL BROAD 00, PRODUCTS COM IES PER: COMP/OP AGG s2,000,000 GENT AGGREGATE LIMIT APPLIES " "._.__.. X POLICY PRO - JECT LOC Em 1. Ben 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT A X ANY AUTO AWF 9033498 00 02/18/11 02 /18/12 accident) ,000 ALL OWNED AUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS - . ..........., X HIRED AUTOS BODILY INJURY $ X NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ —..... (Per accident) GARAGE LIABILITY AUTO ONLY- EAACCI _ DENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: qGG $ CESS / UMBRELL A. LIABILITY EACH OCCURRENCE -- - -, -._ _- s3,000 , 000 - - - - -- A XEXCESS � OCCUR _ CLAIMS MADE UHF 8989976 00 02/18/11 02/18/12 AGGREGATE $ DEDUCTIBLE _...... .. $... .. _ X RETENTION $ O $ WORKERS COMPENSATION ORY LIMITS AND EMPLOYERS' LIABILITY � w B ANY dROt'RIE'I'ORIPARTNER /EX CtlJTdVFY /N WKN122873 -7 06/01/10 06/01/11 OFFIICEWMEMBER EXCLUDED? x E ^ ACH ACCT � _ NT $1,000,000 (Mandatory In. NH) E_L DISEASE E EMPLOYEE $ - - if yes, describe under SPECIAL PROVISIONS below E, L. DISEASE - POLICY LIMIT $ OTHER A PRINTERS ERRORS ZDF 9102496 00 02/18/11 02/18/12 Limit: $1,000,000 & OMISSIONS -- SPECIAL FORM-- Ded.: $25,000 DESCRIPTION OF OPERATIONS' / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ 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 CITYOFI City of E1 Segundo Attn: Office of the City Clerk 350 Main Street 45 -3389 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 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 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE n. - it ACORD 25 (2009/01) f ©1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD