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PROOF OF INSURANCE (2021) CLOSED
A� ® CERTIFICATE OF LIABILITY INSURANCE I DAT1/(,3/2o20YY> 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). PRODUCER CONTACT NAME: Julee Hager Diversified Insurance Industries, Inc. PHONE FAX, No): 410 307 International Circle I (A/C. No. ExtC 410-433-3000 Suite 610 I E-MAIL ADDREss: julee.hager@dii-ins.com Hunt Valley MD 21030 I INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Great Northern Insurance Co* 20303 INSURED ENVIS-2 INSURER B: Federal Insurance Co.* 20281 Envisionware Inc 2855 Premiere Parkway, Suite A I INSURERC: Chubb Indemnity Ins Co.* 12777 Duluth GA 30097 I INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1445810128 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYYI IMM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY Y 35943516EUC 1/8/2020 1/8/2021 EACH OCCURRENCE $ 1 000 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Regarding Bodily Injury & Property Damage under the General Liability, City of EI Segundo is included as Additional Insured with respects to ongoing operations of Named Insured, if required by written contract as per attached Form# 80022367 5/07. Waiver of Subrogation in favor of City of EI Segundo as per attached Form# WC000313 4/84. 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. Attn: City Clerk 350 Main 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 DAMAGE TO RENTED CLAIMS -MADE � OCCUR PREMISES (Ea occurrence) $ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X PRO - POLICY ❑JECTPRO ❑LOC PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY 73565308 1/8/2020 1/8/2021 COMBINED SINGLE LIMIT $ 1,000,000 fEa accident) X ANY AUTO BODILY INJURY (Per person) $ OWNEDSCHEDULED BODILY INJURY $ AUTOS ONLY AUTOS (Per accident) X HIRED I X I NON -OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY fPer accident) B X UMBRELLALIAB OCCUR 79876897 1/8/2020 1/8/2021 EACH OCCURRENCE $2,000,000 EXCESS LIAB CLAIMS -MADE H AGGREGATE $ 2,000,000 DED I X I RETENTION $ n $ C WORKERS COMPENSATION Y 71741378 1/8/2020 1/8/2021 X I AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y / N SPER TATUTE EORH E.L. EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 A Errors & Omission 35943516EUC 1/8/2020 1/8/2021 Per Claim $1,000,000 A Cyber Liability 35943516EUC 1/8/2020 1/8/2021 Aggregate $1,000,000 Deductible $25,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Regarding Bodily Injury & Property Damage under the General Liability, City of EI Segundo is included as Additional Insured with respects to ongoing operations of Named Insured, if required by written contract as per attached Form# 80022367 5/07. Waiver of Subrogation in favor of City of EI Segundo as per attached Form# WC000313 4/84. 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. Attn: City Clerk 350 Main 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 FIFIf 001 F =1 11 � I 51141T74'ro, MIA AddNonal Insured - Persons or organizations shown in the Schedule are hmre&, but they are hmre& only if you are Scheduled Person obhgated pursuant to a contract or agreement to provide them with such insurance as is afforded by Or Organkaffon this policy. However, the person or organization is an hmred only: • if and then only to the extent the person or organization is described in the Schedule-, • to the extent such contract or agreement requires the person or organization to be afforded status as an ,lin ured-, • for activities that did not occur, in whole or in part, before the execution of the contract or agreement; and • with respect to darnagm loss, cost or expense for injury or damage to which this insurance applies. No person or organization is an kwm�d under this provision. • that is more specifically identified under any other provision of the Who Is An hisured section (regardless of any limitation applicable thereto). • with Wspect to any assumption of liability (of another person or organization) by them in a contract or agreement. This limitation does not apply to the liability for damages, loss, cost or expense for injury or damage, to which this insurance applim that the person or organizadon would have in the absence of such contract or agreement. Liability Insurance Addxmw Ineurad - Scheduled Psman Or Organkadon conMued Fbrm a04 Ry. 5-M Endorseamt Pago I ,rfffffff F (condnued) Arors-7tW-MraM I T=1 -7 N M, W,74n, 7= -.416117.71777M MM 7M Other Insurance — If you are obligated, pursuant to a contract or agreement, to provide the person or organization 3rnMaly, Nonccnb7bUtory shown in the Schedule with primary insurance such as is afforded by tins policy, then in such case Insurance — Scheduled this insurance is primary and we will not seek contribution from insurance available to such persoT FO'erson Or Organizatfon or organization. ,FT KI 1i 11IN 11914 1 Kill 1jr4l lkwIlkIRAW11 F11AIN F411WITIMI, f =$,M, ni i"AI :I, kil'all"llej �Mll �- QAuthodkod Representative Liability InsuranGe Addidond Insured - Sdodulsd ftrwn Or OManoabon kwPage Fbnn 8042-2367 (Rev. 5-07) Endbimment Paga 2 UX "1 14,11:4 L,-1 [47 Irmtk"Rill"Xil,► WC 124 (4-84) WC 00 03 13 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (rhe following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy.) This endorsement, effective on 01108/18 (DATA Policy No. 7174-13-78 issued to ENVISIONWARE, INC. Endorsement No. at 12:01 A. M. standard time, forms a part of Authorized Representative We have the right to recover our payments from anyone liable 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 only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.* This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. Schedule City of El Segundo 350 Main Street El Segundo, CA 90245 WC 124 (4-84) WC 00 0313 Copyright 1983 National Council on Compensation Insurance. Page 1 of 1