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PROOF OF INSURANCE (2021) CLOSED
ACCW?" DATE (MMIDDNYYY) CERTIFICATE OF LIABILITY INSURANCE � 10/9/2020 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 subject to the terms and holder l/policy, certain policies may require a n endorsement. A statement on this certificate doesnot WAIVED,oonfer rig the certificate inleu of suchdorsennt(s). PRODUCER CONTACT Palmer & Cay, LLC PHONd VAX AIL 22 Barnard Street fit, Suite 200 .. ...... 0...:':I�BIdon,paBmerandcay.cmrru...... ...................... NAIL Savannah GA 31401 INSURE .R�S 9, AFFORDING CCiVERAGE INSURER A: National Casualty Company 11991 INSURED 153INSURER B: Indemnity 00171 any 15580 Scottsdale Ind p Girl Scouts of Greater Los Angeles 1150 South Olive 'Street, Suite 600 INSURER --- Los Angeles CA 90015 ........................ ........... INSURER D: INSURER„E.. i.................... INSURER F: COVERAGES CERTIFICATE NUMBER: 1950707975 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. INSI TYPEOFINSURANCE A,DDL Sttt1R^ LTRINSD WVD POLICYNUMBER POLICY EFF POLICY EXP .i (MMrDDIYYYY) tMM;DDd'YYYYI LIMITS B X COMMERCIAL GENERAL LIABILITY Y Y KK124870800 10M1202010/1/2021 !EACH OCCURRENCE $1.000.000 CLAIMS -MADE X OCCUR Li,i"4MP1�w� `dt`I Ilr;t�'tEt� ... ...,,....._.... PIEW aES fE v ol.r:a a ncx, $ 1,000,000 .,. .... MED EXP IMy one person) $10.000 .... PERSONAL & ADV INJURY i�$1,00000 GEN'L AGGREGATE; LIMIT APPLIES PER: ,0 GENERAL $5,000'000 X POLICY PRO- JECT LOC PRODUCTS - COMP/OPAGG $5,000,000 CIHER $ LIABILITY KK124871000 B AUTOMOBILEANY 10/1/2020 10/l/2021 FE X AUTO BODILY NJIURY (Per person) 1 $1'000,000 I I OWNED SCHEDULED AUTOS ONLY AUTOS INJURY (Per a don91 i $ X I, Xv, HIRED NON -OWNED j AUTOS ONLY � AUTOS ONLY P. OP i� Y D.AMA EBODILY $75,000 $ UMBRELLA LIAB O J CCUR -- — EACH OCCURRENCE $ EXCESS UAB CLAIMS -MADE GREGATE $ DED 7 RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS'LIABILITY WCC330982A 1011/2020 10/1/2021 X 1 STAER :STATUTE E„ OFFICER/MEMBER YIN EXC UDED?ECUTIVE ) N / A E.L. EACH ACCIDENT $ 1,000,000 (Mandatory In NH rY ) el. DISEASE - EA E 1.000.000 If es, describe under y r, DESCRIPTION OF OPERATIONS below , E.L. DISEASE - POLICY LIMIT 1.000.000 DESCRIPTION OF OPERATIONS + LOCATIONS d VEHICLE'S (ACORD 101, Addi'Idonal Remarks Schedule, may be en6ched, it mora space Is required) The City of EI Segundo, i'ts officers, officials, employees, agents and volunteers are named additional Insured on the general liability policy with respect to the use of its prernises for girl Scout activities of the 'insured Girl Scoa.It Council Should any of the above described policies be cancelled before the expiration date thereof, the issuing company will maul 30 days written notice to the, certificate holder named below CERTIFICATE 'HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of EI Segundo, Its officers, employees, agents ACCORDANCE WITH THE POLICY PROVISIONS. and volunteers 339 Sheldon Street AUTHORIZED REPRESENTATIVE EI Segundo CA 90245 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 4 of 5 2604 POLICY NUMBER: KK124870800 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) The City of EI Segundo, its officers, employees, agents and volunteers 339 Sheldon Street EI Segundo CA 90245 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to in- clude as an additional insured the person(s) or organi- zations) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury' caused, in whole or in part, by your acts or omissions or the acts or omis- sions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 3 of 5 2604