PROOF OF INSURANCE (2017 - 2017) CLOSEDHIGHPOO -01 MCDTO1
A'wL.r/R- DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 11/8/2016
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(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 License # OF97770 NNA E.,- Auto Club Services, LLC
Auto Club Services, LLC PHONE 888 416 -2402 FAX 714 850 -3511
2601 S. Figueroa St AIC, No E)s ( (fir �?"I'
MS H302 -MAIL
Los Angeles, CA 90007 ADDRESS:
INSURERIS)AFFORDNoCoVEPA09 ,,,,., 1111, r ,,,,,,,,NAIC#
1,111, ,
m 1111 ............... _... INSURERA :Sentinel Ins Company Ltd. 11000
INSURED
INSURER a: Financial lndemnity„ .19852
High Point Strategies LLC INSURER .c : Hartford Underwriters Insurance Company 30104
23720 Posey Lane INSURER D
_ _ „,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
West Hills, CA 91304
INSURER E
INSURER F: _
COVERAGES CERTIFICATE NUMBER: 1 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.
......... ............................... �AODL SUER _........ POLICY 3 °FF j ii'OLICY EX 1111 1111.
LTR - TYPE OF INSURANCE POLICY NUMBER MMIODdYYYY MwDOIYYYY LIMITS
4-71 'COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE Is 1,000,0
^C7AMAGE T"0 RENTECS
Business CLAIMS -MADE OCCUR X �72SBAAR6200 11/19/2016 11/19/2017 PREMISES (Ea q rrq!”) ; $ 300,0
siness Owners
MED EXP (Any one person) Is 10.0 10.0
L AGGREGATE LIMIT APPLIES PER:
POLICY 0 .IPRO- ❑X LOC
'EOT
AUTOMOBILE LIABILITY
B ANY AUTO X
ALL OWNED X..I SCHEDULED
AUTOS AUTOS
HIRED AUTOS
NON-OWNED
AUTOS
:AUTOS
UMBRELLA LIAB OCCUR
EXCESS LIAB CLAIMS- MADE X
DED RETENTIONS
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
C ANY PROPRIETOR/PARTNER/EXECUTIVE NIA
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
PERSONA . & �. ..A....D.. ...V ... INJURY
_111.1
GENERAL AGGREGATE $
PRODUCTS COMP /OPAGG I S
1$
K7673 11/19/2016 11/19/2017 E.L EACHACCIDENT $
E L DISEASE - EA EMPLOYEE, $
A Prof. Llab 72SBAARS200 11/19/2016 11/1912017 LIMIT
._�...._._......
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more apace la required)
rho City of El Segundo Is named as Additional Insured.
'10 DAY NOTICE OF CANCELLATION APPLIES FOR NON - PAYMENT OF PREMIUM ONLY."
1
1
1,000
1,000
1_,000
1,000
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CI of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City 9 ACCORDANCE WITH THE POLICY PROVISIONS.
Attn: City Clerk
350 Main Street
El Segundo, CA 90245 -0989 AUTHORIZED REPRESENTATIVE
46`" //1'"
®1988.2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
00 This Spectrum Policy consists of the Declarations, Coverage Forms, Common Policy Conditions and any
62 other Forms and Endorsements issued to be a part of the Policy. This insurance is provided by the stock
AR insurance company of The Hartford Insurance Group shown below.
SBA
INSURER: SENTINEL INSURANCE COMPANY, LIMITED
ONE HARTFORD PLAZA, HARTFORD, CT 06155
COMPANY CODE: A THEX
Policy Number: 72 SBA AR6200 DX TJr
SPECTRUM POLICY DECLARATIONS
Named Insured and Mailing Address: HIGH POINT STRATEGIES LLC
(No., Street, Town, State, Zip Code)
23720 POSEY LN
CANOGA PARK CA 91304
Policy Period: From 11/19/16 To 11/19/17 1 YEAR
12:01 a.m., Standard time at your mailing address shown above. Exception: 12 noon in New Hampshire.
Name of Agent/Broker: AUTO CLUB INSURANCE AGENCY LLC /PHS
Code: 253682
Previous Policy Number: 72 SBA AR6200
Named Insured is: LIMITED LIAB CORP
Audit Period: NON - AUDITABLE
Type of Property Coverage: SPECIAL
Insurance Provided: In return for the payment of the premium and subject to all of the terms of this policy, we
agree with you to provide insurance as stated in this policy.
TOTAL ANNUAL PREMIUM IS: $1,610 MP
IN RECOGNITION OF THE MULTIPLE COVERAGES INSURED WITH THE HARTFORD, YOUR
POLICY PREMIUM INCLUDES AN ACCOUNT CREDIT.
Countersigned by
Authorized Representative
08/29/16
Date
Form SS 00 0212 06 Page 001 (CONTINUED ON NEXT PAGE)
Process Date: 08/29/16 Policy Expiration Date: 11/19/17
SPECTRUM POLICY DECLARATIONS (Continued)
POLICY NUMBER: 72 SBA AR6200
ADDITIONAL INSUREDS: THE FOLLOWING ARE ADDITIONAL INSUREDS FOR BUSINESS
LIABILITY COVERAGE IN THIS POLICY.
LOCATION 001 BUILDING 001
TYPE VENDOR
NAME SEE FORM IH 12 00
Form SS 00 0212 06 Page 006 (CONTINUED ON NEXT PAGE)
Process Date: 08/29/16 Policy Expiration Date: 11/19/17
POLICY NUMBER: 72 SBA AR6200
"'L"
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - VENDOR
CITY OF EL SEGUNDO, IT'S OFFICERS, OFFICIALS, EMPLOYEES,
AGENTS, AND VOLUNTEERS
350 MAIN ST
EL SEGUNDO CA 90245
CITY OF SOUTH PASADENA
1414 MISSION ST
SOUTH PASADENA CA 91030
LOS ANGELES COMMUNITY
COLLEGE DISTRICT
770 WILSHIRE BLVD
LOS ANGELES CA 90017
MERCURY PUBLIC AFFAIRS, LLC
ATTN: MARY ULBRICH
14502 N. DALE MABRY STE 104
TAMPA FL 33618
VALLE PRESBYTERIAN HOSPITAL
15107 VANOWEN ST
VAN NUYS CA 91405
Form IH 12 00 11 85 T SEQ. NO. 001 Printed in U.S.A. Page 001
Process Date: 08/29/16 Expiration Date: 11/19/17