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PROOF OF INSURANCE (2012) CLOSED
0 ACC>R" CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY 4/4/2012 � I 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. 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 C T Kathy NAM9� Macias-Ramirez Millennium Corporate Solutions PHONE (626)275-3000 FAX Iezelz7s -oi3o tiz FXjj License # OC13480 E. ffi i, ADDRESS; 550 N Brand Blvd #1100 INSURER S AFFORDING COVERAGE NAIC # Glendale CA 91203 INSURER A Mt HawleV Insurance Co 37974 INSURED INSURER B:Golden Eagle Ins. Co 10836 INSURER C'RSUI Indemnity Compa.n 22314 Trueline INSURER D -Granite State Insurance Co 23809 1651 Market Street, Ste. B INSURER E: jCorona CA 92880 INSURER F: COVERAGES CERTIFICATE NUMBER: 2011 2012 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 Y HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLISUBIR Rd 4 ifFF POLICYEXP LTR TYPE OF INSURANCE IN5R Wyn POLICY NUMBER IMWDDIYYYYI fmuppryYyy) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 E TO 3E 4TED X COMMRCIALGENERALLIANUtY P EMAGISg,5JEjoccurrence) $ 50,000 A CLAIMS•MADE [i] OCCUR X MGLO173590 7/25/2011 7/25/2012 MED EXP (Any one person) $ 5,000 _uu PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 7X POLICY 7 !,7r?j El LOC $ AUTOMOBILE LIABILITY COMI)INED NGLE L IT �Eaaocldanll . ..... t--- 1 000 L00 '.0 B X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED !SCHEDULED BA3317273 7/25/2011 7/25/2012 BODILY INJURY (Pe accident) $ AUTOS AUTOS "y; NON-OWNED MAGE_ X HIRED AUTOS AUTOS �PP"a?,P=dene $ 71 — "i COMP - $1,000 X COLL -$1,000 Medical payments $ .X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 C EXCESS LIAB CLAIMS-.MADE AGGREGATE $ 1,000,000 DED liI X I RETENTION $ 10,00C NHA228591 1/25/2011 7/25/2012 D WORKERS COMPENSATION WC STATU- AND EMPLOYERS' LIABILITY YIN X U OPV I IUITQ ANY PROPRIETOR/PARTNER/EXECUTIVE [::] E.L, EACH ACCIDENT $ 11000,000 OFFICER/MEMBER EYCLUD NIA (Mandatory In NH) 001646185 7/25/2012 E L DISEASE - EA EMPLOYEE $ 1, 000, 000 Ues, describe under E D ; _..RESCR!Ej1ON OF OPERATIONS below E.L DISEASE - POLICY LIMIT $ 1a000 000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) City of El Segundo, its officers, officials, employee, agents, and volunteers are included as an additional insured on the Gen Liability, primary workding, as respects to the insureds operations and only if required by written contract per the attached endorsement. 30 days NOC except non-payment/10 days given. 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 ACCORDANCE WITH THE POLICY PROVISIONS. Recreation and Parks 350 Main Street AUTHORIZED REPRESENTATIVE El Segundo, CA 90245 Margaret Gilmore/NB ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. py imsrigs o7ntnp�o ni Tha Arrion nnma =nri Inn^ ara raniata—A mnrlea ^f Arrion 4" /x jf- Policy Number. MGLO173590 Mt Hawley Insurance Company: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. L ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS S (FORM C) This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART (If no entry appears below, Information required to complete this endorsement will be shown in the Declarations as appli- cable to this endorsement.) WHO IS AN INSURED (Section II) Is amended to include as an Insured, the person or organization shown In the Sched- ule, but only with respect to liability arising out of "your work" for that insured by or for you. To the extent required under contract, this policy will apply as primary Insurance to additional Insureds scheduled below and other insurance which may be available to such additional insureds will be non - contributory. Section IV., Condition 4., of this policy is amended accordingly. :. SCHEDULE Name of Person or Organization: All persons or organizations where required by written contract. ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. CGL 218 (04198) Page 1 of 1 Insured