PROOF OF INSURANCE (2016) CLOSEDY)
ATE (MMIDD/YYY
ACORD CERTIFICATE OF. LIABILITY INSURANCE D02/04/DDIYYY
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 poll y(les) 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 CON CT NAME: Ken Noden
Wi more Insurance Agency, Inc. A/c NA Ext 714.979 6543 (nrc Ntu 714. 5 _
9 9 y� PHONE" 49 2943
2970 Harbor Blvd. #215 A-NI ADDRESS: )c
ADDRESS: commercial @wigmoreins:com
License #0811959 ER(S) AFFORDING COVERAGE NAIC #
Costa Mesa, CA 92626 INSURE
RA: AMCO
ERA 19100
INSURED STEVEN.... ENTERPRISES, INC. . ....._.__ ........_ ............ ...._... ....... .... ....�._.... .... _.
INSURERS. Nationwi de Mutual Insurance Co 23787
S U .. .. , , ,.... ,.. ,,,. ,,. ... ... ..,.
17952 SKY PARK CIR STE E
IN R ERC:
INSURE ... w ,,,, .--- .. �,,.,. ... ......._ „...
IRVINE CA 92614 -6411 ERD„
RE:
INSURER F .
COVERAGES CERTIFICATE NUMBER: 2015 GL, Umbrella Auto
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,.
IN Sk ,.. .., ADDLISU'BR I�bLICti OFF POLICY EXP
-
..............
TYPE OF INSURANCE
LTR INSR WVD POLICY NUMBER MMIDD/YYYY) MMIDD/YYYY)
m^
LIMITS
GENERAL LIABILITY ACPBPW7825932976 02/14/2015 02114/2016
EACH OCCURRENCE
$ 1,000,000
X COM E LIABILITY
DAMAGE TO
PREMISES (Ea occurrence)
$ 300, 000
CLAIMS-MADE X OCCUR
MED EXP An one
$ 5,000
PERSONAL & ADV INJURY
- ,- - - - - --
$ 1 ,000 ,, 00
.. 0x
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP /OP AGG
$ 2,0 0 0 , 000
POLICY HF(' LOC
$
AUTOMOBILE ACPBA782593297 ` 02/14/2015 02/14/2016
SINGLE LIMIT
au
(Ensp
$ 1,000,000
ANY AUTO
BODILY INJURY (Per person)
$
........ ...` ALL OWNED SCHEDULED
...... NON -OWNED
PIC,)PI°9"tT Y"CliN7)10E
$
HIRED AUTOS AUTOS
X AB X OCCUR ACPCAA7825932976 02/14/2015 02114/2016
RRENCE
A EXCESS LAB AIMS -MADE
.
-- °AGGREGATE ...
$ 5,000,000
--
X
DED RETENTION $
$
WORKERS COMPENSATION'iTYT
T �'
AND EMPLOYERS' LIABILITY Y / N
TORY I IMITS , ER
ANY PROPRIETOR /PARTNE;VE,XI'Ck,I'8'I'VH �, /
OFFICCR /h1EMBEREkCWD Dr
E L EACH ACCIDENT
$
(Mandatory In NH)
E1 DISEASE EA EMPLOYEE
$
If yes, describe under
---- ........
,.° °° °• -° °
DESCRIPTION OF OPERATIONS below
E L DISEASE - POLICY LIMIT
$ ....- ......... .........
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (A ttach ACORD 701, Additional Remarks Schedule, if more space Is required)
ERTIFICATE HOLDER IS INCLUDED AS ADDITIONAL INSURED.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
CITY OF EL SEGUNDO AUTHORIZED REPRESENTATIVE
350 MAIN STREET
ELISEGUNDO, CA 90245 Timothy Wi more /G128
@ 1988 -2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
BUSINESSOWNERS
PB 60 04 04 11
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - SERVICES PERFORMED ON
REMISES OF ADDITIONAL INSURED
This endorsement modifies insurance provided under the following:
PREMIER BUSINESSOWNERS LIABILITY COVERAGE FORM
A. The following is added to Section Il. WHO IS AN
INSURED.
The person or organization designated in the
Schedule of this endorsement is also an
insured, but only with respect to their liability for
"bodily injury" or "property damage" caused, in
whole or in part, by your acts or omissions or the
acts or omissions of those acting on your behalf
in connection with acts or services normal and
usual to your business described in the
Declarations, performed by you or on your
behalf for the person or organization designated
in the Schedule of this endorsement on
premises owned, leased, maintained or used by
such person or organization.
B. ADDITIONAL EXCLUSION
This insurance, including our duty to defend
"suits ", does not apply to "bodily injury",
"property damage" or "personal and advertising
injury" arising out of any active negligence of the
person or organization designated in the
Schedule of this endorsement.
All terms and conditions of this policy apply unless modified by this endorsement.
SCHEDULE
Name of Person or Organization:
CITY OF EL SEGUNDO
350 MAIN ST
EL SEGUNDO CA 902453813
PB 60 04 04 11
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ACP BPW 7825932976 INSURED COPY 78 03743