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PROOF OF INSURANCE (2020 - 2021) CLOSEDAC<> 1 00/17117/22019019 CERTIFICATE OF LIABILITY INSURANCE DATE / 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). CONTACTPRODUCER NAME. Mary Po'1 ar ISU - Dunlap Agency PHONE (714) 838-3158 g FAX (714) 922-6157 (AIC Na. Ext): II LAIC, Npl� 700 West 1st St., Suite 8 E•M4IL marydunlapins.com ADDRiES$: 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 t �_ ©1988-2015 ACORD'CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD INSURER(S) AFFORDING COVERAGE NAIC # Tustin CA 92780 INSURERA: Sentinel Insurance Cc INSURED INSURER B: Preferred Employers Ins. CO. Matrix Imaging Products, Inc. INSURER C: United States Liability Company 20512 Crescent Bay, INSURER D: Suite 100 INSURER E: Lake Forest CA 92630 p� N 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 AVUL SUMM LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER POLICY EFF' POLICY EXP (MM/DDIYYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE 7 OCCUR PREIWSESQ aoccurrence) $ 1,000,000 MED EXP (Any one person) $ 10,000 A 72SBABD3913 10/17/2019 10/17/2020 I PERSONAL &ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: I GENERALAGGREGATE $ 2,000,000 POLICY PRO. JEC"I 7 LOC I PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER I Employee Benefits $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT I $ 1,000,000 I1 IEa accident) ANY AUTO I BODILY INJURY (Per person) I $ A OWNED AUTOONLY S SCHEDULED 72SBABD3913 10/17/2019 10/17/2020 I BODILY INJURY (Per accident) $ w ,r HIREDNON-OWNED � AUTOS PROPERTY DAMAGE $ +^' AUTOS ONLY AUTOS ONLY WeraWdenll I$ X UMBRELLA LIAB /� HCLAIMS-MADE OCCUR EACH OCCURRENCE 4,000,000 $A EXCESS LIAB 72 SBABD3913 10/17/2019 10/17/2020 I AGGREGATE $ 4,000,000 , DED I X] RETENTION $ 10,000 +�+ I $ WORKERS COMPENSATION f f OTH AND EMPLOYERS' LIABILITYER YIN STATUTE I I B ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? F] NIA WKN157011-6 12/01/2019 12/01/2020 E.LEACHACCIDENT $ 1,000,000 (Mandatory In NH) I E L DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT $ 1,000,000 Deductible: $2,500 $1,000,000 Professional Liability C Network Security TK1553465 06/17/2020 06/17/2021 Deductible: $2,500 $250,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) 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 t �_ ©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