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PROOF OF INSURANCE (2021) CLOSEDDATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 1/13/2020 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). CONTA PRODUCER N4MAPHONE ��703-790-5770 -�fAl EWo�; .. Arthur J. Gallagher Risk Management Services, Inc. PHONECT FAX 46179 Westlake Dr #300 g _ ALC, ext) :........................... 703-433-1959 Sterling VA 20165 ...AgPRESS-,_. DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of EI Segundo, it officials and employees are additional insured under the general liability on a primary basis as their interest may appear.; CER'T'IFICATE HOLDER City of EI Segundo 314 Main Street EI Segundo CA 90245 USA ACORD 25 (2016/03) 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. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD INSURER(S) AFFORDING COVERAGE _. I NAIC # ........ INSURER A: Alliance Assurance Companymof„America 20273 INSUREDPUBSAFE-01 y - Indemnity.......................,11230 for Public Safety Excellence Inc Underwriters atLloyd'saLondonmpan INSURER C : Un23 4501 Singer Court .'.... ..................... .................. Suite 180 INSURER D,: ChantillyVA 20151 INSURERE......i,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,.................................. ........ INSURER F : COVERAGES CERTIFICATE NUMBER: 252887613 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, ...... .............~ iNSRA,CIDLSRIL"R�, FF .. .. POLICY E POLICY EXP LIMITS POLICVNU.. TYPE OF INSURANCE..... IMMI WD MB ER IMMIDD/YVYVI � IMMIpD/YVYY1 MME.ARIMIALGENERXLLIABILITY Y Y CLUVAD521824633N COMMERCIAL 1/1/2020 1/1/2021 EACH$1,000,000 EACH OCCURRENCE _ OCCUR PSEMISE:Sr w�cfilalDrlGe)....., .,,$.1..000,000 MED EXP (Any oneperson) $ 10,000 PERSONAL&ADV INJURY $1,000,000 GE'N'L AGGREGATE LIMIT APPLIES.. P ....................... PER: GENERAL AGGREGATE $2.000,000 GEN E POLICY �I PRO- LOC X JECT PRODUCTS - COMP/OP AGG $ 2 000,000 A AUTOMOBILELIABILITY Y Y CLUVAD521824633N co aBc NEDl)SINGLE LIMIT 1/1/2020 1/1/2021 $1000000 ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ X„ AUTOS ONLY AUTOS X SA PERTY r) $ �I�ee� AUTOS ONLY AUTOS ONLNON-OWNEY 1 ucoualein)' „ ..................................... A X UMBRELLA LIAB X Y Y UMBVAD521825053N OLAIMS-MADE( 1/1/2020 1/112021 EACH OCCURRENCE000 OCCUR 1,000, RENCE $ OCCUR EXCESS LIAB B 1 1 „000 EA,C$ ,000 ( C RETENTIO DED B WORKERS COMPENSATION Y 71765862 1/1/2020 1/1/2021 X PER OTH- $ TAH TPIE T AND EMPLOYERS' LIABILITY Y / N ^TER„ ECUTIVE TOEXC E , L ACCI DEN $ 1.000,000 OFFICER/MEMBER EXCLUDED? N / A Mandatory In NH ( ) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1=D,000 C Professional Liability ( MPL4355074.20 1/1/2020 1/1/2021 Errors & Omissions limit $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of EI Segundo, it officials and employees are additional insured under the general liability on a primary basis as their interest may appear.; CER'T'IFICATE HOLDER City of EI Segundo 314 Main Street EI Segundo CA 90245 USA ACORD 25 (2016/03) 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. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NOTICE OF CANCELLATION TO SCHEDULED PERSONS OR ORGANIZATIONS (EXCEPT NON-PAYMENT OF PREMIUM) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Person(s) Or Organization(s)- City of Segundo Address: 314 Main Street El Segundo, CA 90245 Number Of Days Notice Of Cancellation: 30 - Information to complete this Schedule, if not shown above, will be shown in the Declarations. The following condition is added to Section III — Common Policy Conditions: NOTICE OF CANCELLATION TO SCHEDULED PERSONS OR ORGANIZATIONS (EXCEPT NON- PAYMENT OF PREMIUM) When Nve cancel this policy for any reason, other than non-payment of premium, we will notify the person(s) or organization(s) shown in the Schedule at least the number of'days shown in the Schedule in advance of the effective date of cancellation. Any failure by us to notify such person(s) or organization(s) will not: i. Impose any liability or obligation of any kind upon us; or 2. Invalidate such cancellation. All other terms and conditions of this policy remain unchanged. MS -554o6 (oi/17) Includes copyrighted material of Insurance Services Office, Inc., Page 1 of i with its permission, 2017 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 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 anyone not named in the Schedule. Schedule AS REQUIRED PER WRITTEN CONTRACT This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 01-01-20 Policy No. (21) 7176-58-62 Insured CPSE , INC Insurance Company Chubb Indemnity Insurance Company WC 00 0313 (Ed. 4-84) ® 1983 National Council on Compensation Insurance. Countersigned By Insured Copy Endorsement No. Premium $ Incl. VAG