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PROOF OF INSURANCE (2021) CLOSED"- ffia DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE I 06/09/2020 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 Aon Risk Services Northeast, Inc. New York NY Office One Liberty Plaza 165 Broadway, Suite 3201 New York NY 10006 USA INSURED Los Angeles SMSA LP dba Verizon wireless 1095 Avenue of the Americas New York NY 10036 USA CONTACT NAME: PRUNE(866) 283-7122 oo FAX (800) 363-0105 No. Ext : u BArC'. No.V E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: National Union Fire Ins Co Of Pittsburgh 19445 INSURER B: AIU Insurance Company 19399 INSURER C: American Home Assurance Co. 19380 .. ................................................. INSURER D: New Hampshire Insurance Company 23841 .................................................. INSURER E: OWNED ._......... EMPLOYERS' LIABILITY INSURER F: COVERAGES CERTIFICATE NUMBER', 570062000423 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. Limits shown are as requested) .INSR LTR TYPE OF INSURANCE ADOL15UB'R POLBCY LFP POLJCY EXP' I'NSO wVO POLICY NUMBER MW=YYYY) (MMaTSOV4ypyt 915/36/'20201Jb/30/'2021 LIMITS A X COMMERCIAL GENERAL LIABILITY GL1/2889U EACH OCCURRENCE $1,000,000 CLAIMS -MADE OCCUR DAMAGE IO HENtED PREMISE S(Fa occurrence) $1,000,000 X XCU Coverage is Included I MED EXP (Any one person) $10 , 000 DEDL IRFTENTION (PERSONAL &ADV INJURY $1,000,000 GEN'LAGGREGA"TE LIMIT APPLIESPER: GENERAL AGGREGATE $1,000,000 wc045886576 0PRO- PO'a,Ut'}Y LOC ..,.�.�.............. I PRODUCTS -COMP/OP AGG $1, 000 , 000 JECT OTHER: • AUTOMOBILE LIABILITY CA 4594298 06/30/2020 06/30/2021 COMBINED SINGLE LIMIT $1,000,000 AOS (Ea scridnnA 06/30/2020 06/30/20211 BODILY INJURY ( Per A X ANYAUTO CA 4594299 person) OWNED ._......... EMPLOYERS' LIABILITY SCHEDULED MA — AUTOS ONLY AUTOS CA 4594300 HIREDAUTOS NON -OWNED VA .�. ONLY _.........w AUTOS ONLY ,V,,,sY� See Next Page UMBRELLA LIAB EXCESS LIAB HOCCUR CLAIMS -MADE DEDL IRFTENTION WORKERS COMPENSATION AND wc045886576 BODILY INJURY (Per accident) 06/30/2020 06/30/2021 PROPERTY DAMAGE (Per accident) 06/30/2020 06/30/2021 EACH OCCURRENCE AGGREGATE FR - 06/30/2020 06/30/2021 X I PER STATUTE I OTH- ER ANY PROPRIETOR/ PARTNER, YII�N AOS I E.L EACH ACCIDENT OFFICER/MEMBER EXCLUDED? N/AI wc045886575 06/30/202006/30/2021._............................................................................... (Mandatory In NH) CA E DISEASE -EA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Cell Site: Posa Park, Location Code: 160970, Address: 400 Lomita Street, E1 Segundo, CA 90245, CERTIFICATE HOLDER City Of E1 Segundo 350 Main Street E1 Segundo CA 90245 USA CANCELLATION L a� CO M 0 N co 0 CD Lo $1,000,000 $1,000,000 $1,000,000 —� 0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE V_r EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ,V,,,sY� F ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD u ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000027366 LOC #: -- ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY "NAMEDINSURED Aon Risk Services Northeast, Inc. Los Angeles SMSA LP POLICY NUMBER See Certificate Number: 570082090423 CARRIER NAIC CODE See Certificate Number: 570082090423 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER I INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY INSD WVD EFFECTIVE POLICY EXPIRATION LIMITS DATE DATE (MM/DD/YYYY) (MM/DD/YYYY) AUTOMOBILE LIABILITY I A ® r CA 4594301 06/30/2020 06/30/2021 NH - Primary A °cA 4594302 06/30/2020 06/30/2021 NH - Excess �pWORKERS COMPENSATION II B N/A WC045886579 06/30/2020 06/30/2021 NY B N/A wc045886577 06/30/2020 06/30/2021 FL D C N/A WC045896578 06/30/2020 06/30/2021 MA,ND,OH,WI,WY B N/A WC045886574 06/30/2020 06/30/2021 NJ,TX,VA u ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD