HomeMy WebLinkAboutLiability Insurance^DATE(MM/DDIYY)
ACORDO
.. 6/30/10]
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ARTHUR J. GALLAGHER & CO. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
INSURANCE BROKERS OF CALIFORNIA, INC. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
505 N. BRAND BLVD., SUITE 600 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
GLENDALE, CA 91203-3944
CONTACT: S CORISSA STUCKEY INSURERS AFFORDING COVERAGE
DIRECT LINE: 818 539-1278, LICENSE NO. 0726293
INSURED
INSURER A: DISCOVER PROPERTY & CASUALTY INS. CO.
FOX ENTERTAINMENT GROUP, INC., TWENTIETH CENTURY FOX
INSURER B: FIDELITY & GUARANTY INSURANCE CO.
FILM CORPORATION, FOX TELEVISION STUDIOS, INC. AND THEIR
SUBSIDIARIES AND DIVISIONS
INSURER C: NATIONAL UNION FIRE INSURANCE CO.
P.O. BOX 900, BEVERLY HILLS, CALIFORNIA 90213
INSURER D: FIDELITY & GUARANTY INSURANCE
UNDERWRITERS INC.
INSURER E: U.S. SPECIALTY INSURANCE CO.
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.
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MMIDD/YY)
POLICY EXPIRATION
DATE (MM/DD/YY►
LIMITS
GENERAL. LIABILITY
D001LOO157
6130/10
6/30/11
GENERAL AGGREGATE $ 15,000,000
PRODUCTS—COMP/OP AGG $ 2,000,000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE I X1 OCCUR
PERSONAL&ADV INJURY $ 2,000,000
EACH OCCURRENCE $ 2,000,000
A
FIRE DAMAGE (ANY ONE FIRE) $ 50,000
GEN'L AGGREAGATE LIMIT APPLIES PER:
MED EXP—ANY ONE PERSON $ 10,000
POLICY JE4 LOC
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS';�
SCHEDULEAUTOS
DOOIA00387
n l� ' `
6130/10
P r'--1 .
1
"til i�t,.v-
6/30/11
(/ `
COMBINED SINGLE LIMIT
(Ea accident) $ 2,000,000
BODILY INJURY $
(Per person)
BODILY INJURY $
(Per accident)
HIRED AUTOS
NON -OWNED AUTOS
E
PHYSICAL DAMAGE
U-09/7001212
12/29/09
8/27/11
X
PROPERTY DAMAGE
(Per accident) $ INC. IN ME
GARAGE LIABILITY
AUTO ONLY — EA ACCIDENT $
OTHER THAN EA ACC $
ANY AUTO
I
AUTO ONLY: AGG $
EXCESSIUMBRELLA LIABILITY
15972377
6/30/10
6/30/11
EACH OCCURRENCE $ 5,000,000
AGGREGATE $ 5,000,000
O
E�qOCCUR F7CLAIMS MADE
UMBRELLA FORM
$
OTHER THAN UMBRELLA FORM
$
A
B
B
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED?
DODIWO0481 (NJ, NV)
D001 WO0482(AZ,OR, WI)
D001 WO0479 (AOS)
5130110
6/30/11
yyC gTg7LI. p
X TORY LIMIT ER -
E.L. EACH ACCIDENT $ 2,000,000
E.L. DISEASE—EA EMPLOYEE $ 2,000,000
E. L. DISEASE—POLICY LIMIT $ 2,000,000
D
If yes, describe under
SPECIAL PROVISIONS below
D001WO048D(HI)
EVIDENCE ONLY
OTHER (PRODUCTION PACKAGE)
E
THIRD PARTY PROPERTY DAMAGE
U•09/7001212
12/29/09
8/27/11
Limit: $5,000,000
MISCELLANEOUS EQUIPMENT
Limit: $5,000,000
PROPS/SETS/ WARDROBE
Limit: $5,000,000
DESCRIPTION OF OPERATK)NS/LOCATIONSIVEHICLES/SPECIAL ITEMS
CERTIFICATE HOLDER IS INCLUDED AS AN ADDITIONAL INSURED/LOSS PAYEE AS THEIR INTEREST MAY APPEAR, AS RESPECTS TO LOCATION/PREMISES/
VEHICLES & EQUIPMENT LEASED/RENTED BY THE NAMED INSURED WHILE USED IN CONNECTION WITH THE PRODUCTION ENTITLED: "BURN NOTICE" (SEASON 4)
_`MM
" .
SHOULD ANY OF THE ABOVE POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Miami
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
2700 South Bayshore Drive
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Miami, FL 33133
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
^'w 5
AUTHORIZED REPRESENTATIVE
ACORD 25 (2001/08) 0ACORD CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be
endorsed. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a
contract between the issuing insurer(s), authorized representative or producer, and the
certificate holder, nor does it affirmatively or negatively amend, extend or alter the
coverage afforded by the policies listed thereon.