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PROOF OF INSURANCE (2019 - 2020) CLOSED (2)AC 1 00/17/2/171201199 CERTIFICATE OF LIABILITY INSURANCE DAT DI 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 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). III,.4-ONYTAbIrMa r P PRODUCER V NAME: ojar ISU - Dunlap Agency PHONE E,t,, (714') 838-3158 PAX No)s (714) 922-6157 700 West 1 st St., Suite 8 E-fu1A@C mary p @dunla ins.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # Tustin CA 92780 INSURERA: Sentinel Insurance Co INSURED INSURER B: Preferred Employers Ins. Co. Matrix Imaging Products, Inc. INSURER C: Lloyds of London 20512 Crescent Bay, I INSURER D: Suite 100 I INSURER E,: Lake Forest CA 92630 INSURER F: COVERAGES CERTIFICATE NUMBER: 2019-2020 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. INSR AUIJL SUeK1 POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INgM WVD I POLICY NUMBER (MM/DD/YYYY) (MMIDD(YYYYIn X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 r;z;i DAMAGE'IURENibu 1,000,000 CLAIMS -MADE OCCUR VII PREMISES (Ea occurrence) $ V MED EXP (Any one person) $ 10,000 A 72SBABD3913 DX 10/17/2019 10/17/2020 PERSONAL&ADV INJURY $ 1,000,000 Professional Liability C Network Security MPL-0000265-02 GENERAL AGGREGATE I $ 2,000,000 PRODUCTS-COMP/OPAGG 7G�EC'^yd'L AGGREGATE LIMIT APPLIES PER: Employee Benefits $ 1,000,000 POLICY PRO LOC JECT $ 1,000,000 (Ea arcbdonli OTHER, BODILY INJURY (Per person) $ AUTOMOBILE LIABILITY ANY AUTO A OWNED SCHEDULED 72SBABD3913 DX AUTOS ONLY AUTOS +X' HIRED NON -OWNED AUTOS ONLY ONI AUTOS ONLY X UMBRELLA LIABHCLAIMS-MADE OCCUR A EXCESS LIAB I 72 SBABD3913 10,000 Xt DED 1 RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N B ANY PROPRIETOR/PARTNER/EXECUTIVE WKN157011-5 OFFICERIMEMBER EXCLUDED? NIA (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Professional Liability C Network Security MPL-0000265-02 GENERAL AGGREGATE I $ 2,000,000 PRODUCTS-COMP/OPAGG II $ 2,000,000 Employee Benefits $ 1,000,000 fCOMBINED SINGLE LIMIT $ 1,000,000 (Ea arcbdonli BODILY INJURY (Per person) $ 10/17/2019 10/17/2020 BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Por a:ccldeW EACH GREGATE OCCURRENCE $ 4,000,000 10/17/2019 10/17/2020 I AGGREGATE $ 4,000,000 Ip $ Xd PER STATUTE I I EERH 12/01/2018 12/01/2019 I EL.EACH ACCIDENT $ 1,000,000 EL DISEASE - EA EMPLOYEE $ 1,000,000 IEL,DISEASE- POLICY LIMIT $ 1,000,000 Deductible: $1,000 $1,000,000 06/17/2019 06/17/2020 Deductible: $1,000 $250,000 _ I I 1 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) I The City of EI Segundo, its officials. and employees are named as additonal insured. Insurance on the Certificate is Primary. Thirty (30) days notice of Cancellation required. - CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of EI Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main St. AUTHORIZED REPRESENTATIVE EI Segundo CA 90245 D*. 1 I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD MATRIX IMAGING PRODUCTS, INC POLICY NUMBER: 72SBABD3913 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS (Form B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: The City of Ell Segundo, its officials and employees (If no entry appears above, information required to complete this endorsement will be shown in the Declaration as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the schedule, but only with respects to liability arising out of your work preformed for that insured. CG 20 10 07 04 Copyright, Insurance Services Office, Inc. 2004 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 0313 (Ed, 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover oar payments from anyone liab* for an injury covered by this policy. We Will not enforce our right against the person or organization named in the Schedule, (This agreement applies cnly to the extent that you perform work under a written contract that req uass you to obtain this agreement Prom us.) This agreement shall not operate directly or Indirectly to benefit anyone not named in the Schedule, Schedule The City El Segundo, Its officials and employees This endorsement changes the polity to which It is attached and is effective on the date issued unless otherwise stated. (The Information below Is required only when this endorsement 4 issued: subsequent to preparation of the pollrayj Endorsement Effective:, Insuwd: MATRIX WAGING PRODUCTS, INC. Insurance Company. Employers WC 00 0313 (Ed. 4-84) Policy No. WKN157O1I Countersigned by _,P§A_n ALnlitp Copyright 1963 National Council on Compensation Insurance, Endorsement No. I Premium $0