Loading...
PROOF OF INSURANCE (2021) CLOSED0 DATE (MMIDDIYYYY) ACC) `L=" CERTIFICATE OF LIABILITY INSURANCE 05/01/2020 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(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, MARSH USA INC NAME: 1050 CONNECTICUT AVENUE, SUITE 700 1.01,4x. EW: __......__ _ _...___ ......... FAXA. km.................m WASHINGTON, DC 20036-5386 EMAIL Attn: CSS, TELEPHONE 202-263-7600 'PPR ' ............ INSURER(S) AFFORDING COVERAGE NAIC p CN 915014019 -NAV -GL+ -20-21 .INSURED DUNCAN SOLUTIONS, INC 633 W. WISCONSIN AVE. MILWAUKEE, WI 53203 INSURER F: COVERAGES CERTIFICATE NUMBER* CLE -006253882-15 REVISION NUMBER: 19 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 SAID CLAIMS N,....�.�..._..:.�......,, ....� ..._. .____._ ._-- --` --------............. LTR TYPE OF INSURANCE INSIRmm ADD/_ SUER.am..-.».......IM POLICY NUMBER POLICY EFF POLICY EXP MI O D1YY YYI IMM/DD/YYYY i LIMITS COMMERCIAL GENERAL LIABILITY 13597-08-27 04/30/2020 04/3012021 EACH OCCURRENCE $ 1000,000 1 _.I ryiAc a Ir�Ilt -- CLAIMS -MADE C X OCCUR PRE C%t^C; (Fsa nrrutronc .$ 000,000 INSURER A : Feder I Insurance Company 20281 INSURER B : Vigilant Insurance Company 20397 INSURER C: INSURER D: INSURER E: DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) THE CITY, ITS OFFICERS, OFFICIALS, EMPLOYEES, AGENTS, AND VOLUNTEERS IS/ARE INCLUDED AS ADDITIONAL INSURED WHERE REQUIRED BY WRITTEN CONTRACT WITH RESPECTS TO GENERAL AND AUTO LIABILITY, WAIVER OF SUBROGATION IS APPLICABLE WHERE REQUIRED BY WRITTEN CONTRACT AND SUBJECT TO POLICY TERMS AND CONDITIONS WITH RESPECT TO WORKER'S COMPENSATION. I CERTIFICATE HOLDER CITY CLERK'S OFFICE CITY OF EL SEGUNDO 350 MAIN ST ELSEGUNDO,CA 90245 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 of Marsh USA Inc. Manashi Mukherjee ©1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 10,000 MED EXP (Any one person) $ PERSONAL & ADV INJURY $............ ,00..0,..0.......0.......0 .. 1.......1 GENT AGGREGATE LIMIT APPLIES GENERAL AGGREGATE $ 2,000,000 c �I LOC ....... PRO, ..(...� PRODUCTS-COMP/OP AGG $ 2,000,000I .. OTHER A AUTOMOBILE LIABILITY 7358-87-40 0413012021 COMBINED SINGLEI.IMI1 $ 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED ( era ie AUTOS ONLY AUTOS HIRED NON -OWNED . PROPER'fYDAMAGE AUTOS ONLY AUTOS ONLY /Por orcnrleniw —.. ............... $ A X UMBRELLA LIAB X 93647773EACH 04/30/2020 04130/2021 OCCURRENCE 5,000,000 mm EXCESS LIAB COLAIMS,MADE .... –1 AGGREGATE $ 5,00 0,000 DEDI RETENTION I$ B WORKERS COMPENSATION 7174-06-33 0413011020 0413012021 PER I 1OTH- FR AND YIN STATIITE _ ............. 1,000,000 ANYP OPRI TOR'PARTBILITY NEREXECUTIVE L ACCIDENT $ E. EACH AC OFFICER/MEMBEREXCLUDED� N/A 1,000,000 (Mandatory in NH) E L DISEASE - EA EMPLOYEE,/ $ If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) THE CITY, ITS OFFICERS, OFFICIALS, EMPLOYEES, AGENTS, AND VOLUNTEERS IS/ARE INCLUDED AS ADDITIONAL INSURED WHERE REQUIRED BY WRITTEN CONTRACT WITH RESPECTS TO GENERAL AND AUTO LIABILITY, WAIVER OF SUBROGATION IS APPLICABLE WHERE REQUIRED BY WRITTEN CONTRACT AND SUBJECT TO POLICY TERMS AND CONDITIONS WITH RESPECT TO WORKER'S COMPENSATION. I CERTIFICATE HOLDER CITY CLERK'S OFFICE CITY OF EL SEGUNDO 350 MAIN ST ELSEGUNDO,CA 90245 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 of Marsh USA Inc. Manashi Mukherjee ©1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD C H U B Bm Liability Insurance Endorsement Policy Period Effective Date Policy Number Insured Name of Company Date Issued This Endorsement applies to the following forms: GENERAL LIABILITY Who Is An Insured Additional Insured - Scheduled Person Or Organization APRIL 30, 2020 TO APRIL 30, 2021 APRIL 30, 2020 3597-08-27 DTO NAVIENT CORPORATION FEDERAL INSURANCE COMPANY MAY 15, 2020 Under Who Is An Insured, the following provision is added Persons or organizations shown in the Schedule are insureds; but they are insureds only if you are obligated pursuant to a contract or agreement to provide them 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 damage to which this insurance applies. No person or organization is an insured 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 injury or damage, to which this insurance applies, that the person or organization would have in the absence of such contract or agreement. Liability Insurance Additional Insured - Scheduled Person Or Organization continued Form 80-02-2367 (Rev_ 5-07) Endorsement Page 1 CHUBB" Liability Endorsement (continued) Under Conditions, the following provision is added to the condition titled Other Insurance. Conditions Other Insurance — If you are oblig t _ e p _ u t to a contract ora agreement, to provide the person or organization .__. . _ ..__.__..._ _ _.._... ._ .___. Primary, Noncontributory ..... ........................... ... Insurance — Scheduled Person Or Organization 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 Representative��'i Liability Insurance Additional Insured - Scheduled Person Or organization last page Form 8042-2367 (Rev. 5-07) ndorsement Page 2 H U B B® Liability Insurance Endorsement Policy Period APRIL 30,2020 TO APRIL 30,2021 Effeclive, Date APRIL 30, 2020 Policy Number 3597-08-27 DTO Insured NAVIENT CORPORATION Name of Company FEDERAL INSURANCE COMPANY Date Issued MAY 15, 2020 I , I , I I ;,I lill I "I I o 111, "', I vv I 1111:10h, 1 14 hlx1 "OW Ill �', ��, , , ll, I dA I I I I 111111I " , I '1 :1 ilill"I nasi I I " I I " "..I I I h''11111 ", " I " , I ,rt I , , I ho,.. '', 1 '01" ,•, , M I *1, I , , I "! e' 'I ', "1,: 11:111 , �I : I '1 11111111 1: 11; 1 ,;11 . I , I 1�1 " I ", , , 111111111111111,11111 Nn p., .. ...... I . ... . .. I , ,; , 11, 111 11,v MI I , , , " This Endorsement applies to the following forms: GENERAL LIABILITY EMPLOYEE BENEFITS ERRORS OR OMISSIONS I MINIM Y.411M'�E",My+11WM1I&lIV MAWAII W IN. II111111l, W", ,,, — "'6'1 '"A Oil I I, f N110 IIIM—1 11 R4111111 N"j 1: W, III IN 1W 111141 611111M WIM IN 111111151,11111 WMIR ffl- Ili I 1I Under Conditions, the following provision is added to the condition titled Other Insurance. Conditions Other Insurance - If you are obligated, pursuant to a written contract or agreement, to provide the person or organization' ......... ......... this Primary, Noncontributory 8 Insurance - Scheduled and Person Or Organization contribution from insurance available to such person or organization. . . .. . ...... I. lllglIi liI !Eq Ri"090", V10 I M Ill 7 111 4 ji vv, "f"111 MI11111111 11111111'"uv 0 1,104'", Schedule Persons or organizations ........... conditions remain unchanged. Auftdzed Raprosonfadve �a, Liability Irmurance CDndlfions- Ofierinsuranco - Pilmary, Aloncontr7butafy Insurance -SchaduladPerswOrOrganization IMP299 Form 8042-2653 (Rev. 7-09) EndDmmant Page I