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I NI5 BINDER IS A TEMPORARY INSURANCE CONTRACT, SUBJECT TO THE CONDITIONS SHOWN ON THE REVERSE SIDE OF THIS FORM. <br />PRODU PHONE CER (AJC. No, ExQ 310- 322 -1301 COMPANY BINDER # <br />E.L.M. INSURANCE BROKERS, INC. Lloyds of London 19832 <br />P.O. BOX 2668 DATE EFFECTIVE TIME DATE EXPIRATION TIME <br />1990 E. GRAND AVE STE 210 CA LIC OD28706 - ----- - <br />EL SEGUNDO CA 90245 -1768 X AM � X 12:01 AM <br />PHONE: 310- 322 -1301 JUN 28 07 12 :01 PM AUG 28 07 LNOON <br />FAX: 310- 322 -1302 -- -- - - — - - - - THIS BINDER IS ISSUED TO EXTEND COVERAGE IN THE ABOVE NAMED COMPANY <br />CODE, SUB CODE. PER EXPIRING POLICY #: <br />AGENCY 29878 DESCRIPTION OF OPERATIONSNEHICLESlPROPERTY (Including Location) <br />C11STONIFIFt In- <br />INSURED ALTERNATIVE DISPUTE RESOLUTION SERVICES <br />BETSY BENTON <br />422 W. SANTA CLARA AVENUE POLICY #0608- 00067145D <br />SANTA ANA CA 92706 <br />1 1 M ITC <br />vv v crvw�.� <br />COVERAGE/FORMS DEDUCTIBLE i <br />TYPE COINS % <br />OF INSURANCE <br />AMOUNT <br />t <br />PROPERTY OF LOSS NOT INCLUDED <br />BASIC ;BROAD (SPEC <br />GENERAL LIABILITY PROFESSIONAL LIABILITY SUBJECT TO A $5,000 ; <br />EACH OCCURRENCE � <br />- -- - - <br />$ 250,000 <br />- <br />COMMERCIAL GENERAL LIABILITY PER CLAIM (LOSS /EXPENSE) DEDUCTIBLE 4DAMAGE <br />TO RENTED PREMISES - <br />$NOT INCLUDED <br />Xi CLAIMS MADE ! OCCUR. <br />MEDICAL EXPENSE (Any one person) <br />$NOT INCLUDED <br />X PROFESSIONAL LIABILITY <br />PERSONAL & ADV INJURY <br />9VOT INCLUDED <br />GENERAL AGGREGATE <br />$ rjQ(j QO0! <br />RETRO DATE FOR CLAIMS MADE. JUN 28 04 <br />PRODUCTS - COMP /OP AGG <br />$ NOT INCLUDED <br />AUTOMOBILE LIABILITY NOT INCLUDED <br />COMBINED SINGLE LIMIT ; <br />$ <br />ANY AUTO <br />BODILY INJURY(Per person) <br />$ <br />ALL OWNED AUTOS �. <br />BODILY INJURY (Per accident) <br />$ <br />_$ -- __ - - -- <br />SCHEDULED AUTOS <br />PROPERTY DAMAGE <br />i$ <br />HIRED AUTOS <br />MEDICALPAYMENTS <br />$ <br />NON -OWNED AUTOS <br />PERSONAL INJURY PROT <br />$ <br />I <br />UNINSURED MOTORIST <br />$ <br />� <br />AUTO PHYSICAL DAMAGE DEDUCTIBLE ALL VEHICLES I SCHEDULED VEHICLES <br />+ <br />ACTUAL CASH VALUE _ <br />1 <br />COLLISION NOT INCLUDED <br />STATED AMOUNT $ <br />- <br />- <br />OTHER THAN COLL <br />I <br />OTHER <br />GARAGE LIABILITY <br />AUTO ONLY - EA ACCIDENT <br />$ <br />NOT INCLUDED <br />ANY AUTO <br />I OTHER THAN AUTO ONLY <br />- <br />EACH ACCIDENT <br />- <br />$ <br />AGGREGATE.!$ <br />EXCESS LIABILITY 1 NOT INCLUDED <br />EACH OCCURENCE <br />$ <br />UMBRELLA FORM <br />'AGGREGATE$ <br />-- ---- - - - - -- <br />OTHER THAN UMBRELLA FORM RETRO DATE FOR CLAIMS MADE: <br />SELF - INSURED RETENTION <br />$ <br />NOT INCLUDED <br />WC STATUTORY LIMITS <br />'r -_ -- - -- - - -.. -- -- - -- -- -- <br />WORKER'S COMPENSATION <br />E.L. EACH ACCIDENT $ <br />AND <br />EMPLOYER'S LIABILITY ! <br />-- - - -- - -- <br />! E.L. DISEASE - EACH EMPLOYEE $ <br />-- - -- - - - --- --- -- - - - -- - -t -- - - -- - - <br />i E.L. DISEASE -POLICY LIMIT $ <br />SPECIAL <br />I FEES $ <br />CONDITIONS/ <br />TAXES $ <br />�r- <br />OTHER <br />_- ____ i - - <br />COVERAGES <br />! ESTIMATED TOTAL PREMIUM $ <br />NAMt & AUUKtbb <br />1 MORTGAGEE I ADDITIONAL INSURED <br />I LOSS PAYEE <br />AUTHORIZE ESENTATIVE <br />ATTENTION: <br />OC72477 <br />ACORD 75 -S (2001101) NOTE: IMPORTANT STATE INFOR ON REVEK5E SIUt v AcvKU t um-ur A 1 wry , vyo <br />Ipvl, <br />