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PROOF OF INSURANCE (2020) CLOSED
A�R� DATE (MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 9/27/2019 ------ - 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 have ADDITIONAL INSURED provisions or 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). ci PNRODUC OPalmay, LLC Ne FAX Barnard Street Io ExOr ikc , E-M'AM Suite 200 imp'i 8 s::pssoluttons(ftalmerand'cay,com Savannah GA 31401 mm.INSURER(S) AFFORDING COVERAGE o a ........... L, NAIC p INSURER A: National Casualty Company 11991 INSURED Girl . :i5s 0 Girl Scouts o th Olive Greater Los ales n„demnitarmm p y — 1558 _m INSURER C . Scottsdale I ' 600 Los Angeles CA 90015 INSURER o: - - - - -- --- -- INSURER E: INSURER F ; COVERAGES CERTIFICATE NUMBER: 1459955268 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. IIJSR ADDCSUSRjPOLIdY'iEFF POLicv ExP LTR TYPEOFINSURANCE INSD WVDV POLICY NUMBER (RtWDD[YYYY) I'M%66yyY'Y) LIMITS ' ��y�y�yH OCCURRENCE 1,000,000 � $1 000,000 a a . B X COMMERCIAL LGEEEI GENERAL LIABILITY Y Y KK123598900 10M12019 10/1/2020 V MAV5NH CCURRONCE 000,000 X i nDMI,, d OCC I —, _... MEb EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1 .000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 65 000 000 Xt l?CT LOC , POLICY JLCT I OTHER: B AUTOMOBILE LIABILITY KK123599200 X ANY AUTO OWNED AUTOS ONLY j SCHEDULED AUTOS X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EXCESS L`IAB CLAIMS -MADE DED RETENTION $ A WORKERSCOMPENSATION WCC330962A AND EMPLOYERS' LIABILITY Y I N ANYPROPRIETOR/PARTNER/EXECUIIV= ❑ OFFICER/MEMS EREXCLUDED? NIAI (Mandatory In NH) 11 yes, describe under DESCRIPTION OF OPERATIONS below PRODUCTS - COMP/OP AGG $5,000,000 6 10/1/2019 10/1/2020 COi7B"hNnr,o:EDSINGLELIMA $1,000.000 4E:y der,R) BODILY INJURY (Per person) $ DILY INJURY (Per POi PrErlFreIr AMAG Sacci en 675,000 6 EACH OCCURRENCE $ AGGREGATE i,6, I$ 1011/2019 10/l/2020 E L E TATUTE ERH EACH ACCIIDE,I$1,,,,, 0000, .0 000 E L- DISEASE - EMPLOYEE' $12000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space Is required) The City of EI Segundo„ its officers, officials, employees, agents and volunteers are named additional insured on the general Iiabilllity olicy with respect to fhe' use of its premises fair Girl Scout activities of'tfle insured Girl Scout Council. Should any of the above described policies be ctanoelled before the expiration Slate thereof, the issuing company will mail 30 days written notice to the certificate holder named below. • t, The City of EI Segundo, its officers, employees, agents and volunteers 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. 339 Sheldon Street AUTHORIZED REPRESENTATIVE EI Segundo CA 90245 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 4 of 5 6005 POLICY NUMBER: KK123598900 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) The City of EI Segundo, its officers, employees, agents and volunteers 339 Sheldon Street EI Segundo CA 90245 i Information required to complete this Schedule, if not shown above„ will be shown in the Declarations. Section II — Who Is An Insured is amended to in- clude as an additional insured the person(s) or organi- zations) shown in the Schedule, but only with respect to liability for "bodily injury', "property damage" or "personal and advertising injury' caused, in whole or in part, by your acts or omissions or the acts or omis- sions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 5 or 5 6005