PROOF OF INSURANCE (2020 - 2021) CLOSEDA� CERTIFICATE OF LIABILITY INSURANCE DATEtMMIDDIYYYY)
5/4/2020
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.
dr is an ADDITIONAL INSURED, the pollcy(tes) must have ADDITIONAL INS11 provision
.VMI�+DR"fANT: If the certificate hold s 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 Nicole ZGaffney
Marsh 81 McLennan Agency LLC PHONE FAX
15415 Middlebelt Road d Is 734-525-2403 WS, Nna:212-607-1179
Livonia MI 48154 ° n' affne I mma�mi.com
INSURER(S) AFFORDING COVERAGE NAICA
INSURER A: Federal Insurance Company p�I 20281
INSURED N INSURER 0: Travelers IndemnitV CO of America 11 25666
OCLC, Inc.INSURER C: Westchester Surplus Lines Insurance CO N 10172
6565 Kilg'our Place
Dublin 011 43017 N INSURER 0:
I INSURER IE:
INSURER F:
COVERAGE$ CERTIFICATE NUMBER 600326228 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.
1,SR ADOL S'UBR FbLICY EOP I POLICY EXP LIMITS
19 p TYPE OF INSURANCE IN D POLICY NUMBER IMMIDDIYYVYw ImwootYyyyl
A ,X U COMMERCIAL GENERAL LIABILITY 35756671 31WD20 3/1/2021 1 EACH OCCURRENCE s1,000,000
�CAMAGE 1O RENS$1,000,00CLAIMS-MADE OCCUR occnamneo1 0
EDEXPtAny
one person) $10,000
PERSONAL 8 ADV INJURY 1 $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: N GENERAL AGGREGATE $2.000,000
POLICY FX7 PRO- 7 LOC
JECT$
PRODUCTS - COMP/OP AGG s 2.000,000
V__7
OTHER;
AUTOMOBILE LIABILITYCO'1.#'81N'EtTSINGLELIMIT
$
n9
ANY AUTO
BODILY INJURY (Per person) n $
OWNED SCHEDULED
I BODILY INJURY (Per acdden0 s
AUTOS ONLY AUTOS
HIRED NON -OWNED
PROPERTY DAMAGE g
AUTOS ONLY ALTOS ONLY
Wain ocddoml
S
[EACH
UMBRELLA UAB.1 OCCUR
$
OCCURRENCE Is
EXCESS
EXCESS LIAR I�IAGGREGATE
CLAIMS -MADE
I $
Rte$
$
ESATION
g WORKERS COMPENSATION
X
UBBJ443127 12131/2019 12/31/2020 STA
STATUTE I I W
AND MER oO M IABILI rY
ANYPROPRIETOR/PARTNER/FXECUTIVE Ya
E.L. EACH ACCIDENT $1,000.000
OFFI CERIMEMBER EXCLUD ED7
(Mandatory In NH)
NIA
E.L DISEASE- EA EMPLOYEE $1,000.000
ION OF Done OPERATIONSbelow
pvh
.$1,0110,000
POLICY LIMIT i,,.
C h a teaalCRIPT
$7,000,000
F1564509A 412/2020 41212021 Limit $7.000,000
( aims Made)
DESCRIPTION OF OPERATIONS I LOCATIONS Y VEHICLES (ACORD 101, Addldlonal R'ramorks'Schedule, may be a"Ac''hed It morn space Is required)
The City of EI Segundo, its officials, and emplo�ye'Bs are i'nclUded as additional Insured for commercial eneral liability on a primary and noncontributory basis to
the extent provided In the attached form '#80.02-2367, and as additional insured for professional/cyber liability coverage to the extent provided in the attached
form #PF -48238.
The commercial general liability insurance carrier will provide the Certificate Holder with direct notice of cancellation to the extent provided in the attached form
8"2-9779.
G',u;,y,,ellr dyy°vrd 1,p ecavglan l,ma
KnA"nnnab,l+I,DIA,IVI',eY,l{VNYuw"�pFYTMAr! G+ajlG+i OAS
Joseph
No J6.10015 AWN 11,0W
CERTIFICATE HOLDER
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.
City of El Segundo
350 darn Street
AUTHORIZED REPRESENTATIVE
EI Segundo CA 90245
I
1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103)
The ACORD name and logo are registered marks of ACORD
C H U B B• Liability Insurance
Endorsement
Policy Period
Effective Date
Policy Number
Insured
Name of Company
Date Issued
This Endorsement applies to the following forms:
GENERAL LIABl1-M
LIQUOR LIABILITY
Who Is An Insured
Additional Insured -
Soheduled Person
Or Organization
MARCH 1, 2019 TO MARCH 1, 2020
MARCH 1, 2019
3575-66-71 CHI
OCLC, INC.
FEDERAL INSURANCE COMPANY
MARCH 19, 2019
Under Who Is An Insured, the following provision is added
Persons or organizations shown in the Schedule are ; but they are meds only if you are
obligated pursuant to a contract or agreement to provide therm with such insurance as is afforded by
this policy.
However, the person or organization is an insured 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 insured;
• for activities that did not occur, in whole or in part, before the execution of the contract or
agreement; and
• with respect to damages, loss, cost or expense for injury or daniage to which this insurance
applies.
No person or organization is an leisured under this provision:
• that is more specifically identified under any other provision of the Who Is An Insured
section (regardless of any limitation applicable thereto).
• with respect 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 inj,wy or damage, to which this insurance applies, that the person or organization
would have in the absence of such contractor agreement.
u71 -
Liability Insurance Addflonel Insured - Scheduled Person Or O►ganlzatfon continued
Form 80.02.2367IRev. 5-07J Endamoment Page i
CHUaae
Liability Endorsement
(continued)
Under Conditions, the following provision is added to the condition titled Other Insurance.
Conditions
Other Insurance — If you are obligated, pursuant to a contract or agreement, to provide the person or organization
Primary, Noncontributory shown in the Schedule with primary insurance such as is afforded by this policy, then in such case
Insurance — Scheduled this insurance is primary and we will not seek contribution from insurance available to such person
Person Or Organization or organization.
Schedule
Persons or organizations that you are obligated, pursuant to a contract or agreement, to provide with
such insurance as is afforded by this policy.
All other terms and conditions remain unchanged.
Authorized Repre veniadve Q�V--Iea-
Lfablifty
Insurance Additfcrrsl Insured - scheduled Person OrOrgantratlon last page
Form 00.02-23671Rev. 547) Endorsement Pegs 2
Policy Conditions
Endorsement
Policy Period
Effective Date
Policy Number
Insured
Name of Company
Date Issued
This Endorsement applies to the following forms:
COMMON POLICY CONDITIONS
Under Conditions, the following condition is added.
Conditions
Notice Of Cancellation When we cancel this policy for any reason, other than non-payment of premium, we will notify
To Scheduled Persons person(s) or organization(s) shown in the Schedule at least 30 days in advance of the cancellation
Or Organizations When date.
We Cancel Any failure by us to notify such person(s) or organization(s) will not:
• impose any liability or obligation of any kind upon us; or
• invalidate such cancellation.
Schedule
Person(s) or Organization(s):
Address:
t7L
Notice Of CanceLVIbif 0XftWk9bdQQAyS Or Organizations
Policy Conditions (Except Non -Payment Of Premium) continued
Form 80.02-9779 (Ed. 3-11) Endorsement Page I
Conditions
(continued)
Polley Condidons
Form 80-02-9779 (Ed. 3-11)
All other terms and conditions remain unchanged.
Authorized Reprosentative �c^ �ja
Notica Cu CaraceJla onl M ss u6i�) q Yrgsnizetions
(Except Non -Payment Of PwWum)
Endorsement
last page
Page 2
Additional Insured - Blanket Pursuant to a Contract - DigiTech@
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the following:
Chubb DigiTech® Enterprise Risk Management Policy
It is agreed that Section II, Definitions, Insured, subparagraph 6 is deleted and replaced with the following:
6. any natural person or entity for whom an Organization is required by written contract or agreement to
provide insurance coverage under this Policy (hereinafter "Additional Insured"), but only with respect
to Claims:
a. arising out of any Incident committed after the Organization and the Additional Insured
entered into such written contract or agreement;
b. for any Incident committed by, on behalf of, or at the direction of the Organization; and
c. subject to the lesser of the limits of insurance required by such written contract or agreement between
the Organization and the Additional Insured, or the applicable Limits of Insurance of this
Policy.
However, no natural person or entity shall be an Additional Insured with respect to any Claim arising
solely out of such natural person's or entity's independent act, error, or omission. In the event of a
disagreement between the Named, Insured and the natural person, or entity as to whether the Claim
arises solely out of such natural person's or entity's independent act, error, or omission, it is agreed that
the Insurer shall abide by the determination of the Named Insured on this issue, and such
determination shall be made by the Named Insured within 20 days of the notification of the applicable
Claim.
All other terms and conditions of this Policy remain unchanged.
PF -48238 (og/16) Page i of i