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PROOF OF INSURANCE (2021) CLOSEDA� 0 DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 12/09/2020
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 CONTACT La Thomas uercia
Marsh USA, Inc NAME: q
AX
1166 Avenue of the Americas PHONE,n t). (212) 345-8538 (Arc, No):
New York. NY 10036 E-MAIL q
ADDRESS Thomas La uercia marsh.com
INSURER(S) AFFORDING COVERAGE NAIC 4
CN102238245-DNG, GAU-20-21 INSURER A: Tokio Marine America Insurance Company 10945
INSURED Digital Networks Group, Inc INSURER B: Travelers Indemnity Company 25658
20382 Hermana Circle INSURER C :
Lake Forest, CA 92630 INSURER D:
INSURER E :
INSURER F:
COVERAGES CERTIFICATE NUMBER: NYC -010999870-01 REVISION NUMBER: 2
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.
INTA
R TYPE OF INSURANCE NSDSV
n wvn POLICY NUMBER (1101W
RYYYI . (MMIDD/YYYY) LIMITS
A X COMMERCIAL GENERAL LIABILITY
CLL6403455-10
06/30/2020 06/30/2021
EACH OCCURRENCE
S 1,000,000
X
DAMAGE 10 kENIED
1,000,000
CLAIMS -MADE OCCUR
PREMISES (Fa nrcurrence),
S
MED EXP (Any one oerson)
S 5,000
PERSONAL & ADV INJURY
S 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
X POLICY PRO-
.. JECT LOC
PRODUCTS-COMP/OPAGG
S 1,000,000
OTHER',
$
B AUTOMOBILE LIABILITY
810-31\1540855-43-20-G
06/30/2020 06/30/2021
Cb rARINEDSINGl,lFLIMIT
$ 1,000,000
X ANY AUTO
BODILY INJURY (Per person)
S
OWNED SCHEDULED
BODILY INJURY (Per accident)
S
AUTOS ONLY AUTOS
X HIREDX NON -OWNED
IPur0PEIkTY CVWAGIm
$
. AUTOS ONLY AUTOS ONLY
(fber acc�w+;, itiYl
„
$
A X UMBRELLA LIAB X OCCUR
CU6406757-07
06/30/2020 06/30/2021
EACH OCCURRENCE
S 5,000,000
EXCESS LIAB CLAIMS -MADE
AGGREGATE
S 5,000,000
DED RETENTION $
$
WORKERS COMPENSATION
PER OTH-
AND EMPLOYERS' LIABILITY Y X N
STATUTE „ER
ANYPROPRIErTNIR/PARTNERIEXECUTIVE
EL EACH ACCIDENT
$
OFFICER/MEMBER EXCLUDED? 14 N / A
[ p
..
(Mandatory ' )
EL DISEASE - EAEMPLOYEE,
S
If yes, describe under
DESCRIPTION OF OPERATIONS below
EL DISEASE POLICY LIMIT
$
DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
City of EI Segundo, its officials, and employees are included as additional insured where required by written contract, This insurance is primary and non-contributory over any existing insurance and limited to
liability arising out of the operations of the named insured subject to policy terms and conditions
CERTIFICATE HOLDER CANCELLATION
City of EI Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
350 Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
EI Segundo, CA 90245 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
Mina Cho
©1988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
POLICY NUMBER: CLL6403455-10
COMMERCIAL GENERAL LIABILITY
CG 20 10 0413
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE,; ,
Name Of Additional Insured Person(s)
Or Organization(s) Location(s) Of Covered Operations
ANY PERSON OR ANY LOCATION IN CONNECTION
ORGANIZATION WHEN YOU AND WITH A WRITTEN CONTRACT OR
SUCH PERSON(S) OR ORGANIZATION AGREEMENT EXECUTED WITH THE
(S) HAVE AGREED IN WRITING IN ADDITIONAL INSURED SHOWN IN
A CONTRACT OR AGREEMENT,WHICH THE SCHEDULE.
WAS EXECUTED PRIOR TO THE TIME
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II — Who Is An Insured is amended to B.
include as an additional insured the person(s) or
organization(s) 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:
1. Your acts or omissions; or
2. The acts or omissions of those acting on your
behalf;
in the performance of your ongoing operations for
the additional insured(s) at the location(s)
designated above.
However:
1. The insurance afforded to such additional
insured only applies to the extent permitted by
law; and
2. If coverage provided to the additional insured
is required by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.
CG 20 10 04 13
With respect to the insurance afforded to these
additional insureds, the following additional
exclusions apply:
This insurance does not apply to "bodily injury" or
"property damage" occurring after:
1. All work, including materials, parts or
equipment furnished in connection with such
work, on the project (other than service,
maintenance or repairs) to be performed by or
on behalf of the additional insured(s) at the
location of the covered operations has been
completed; or
2. That portion of 'your work" out of which the
injury or damage arises has been put to its
intended use by any person or organization
other than another contractor or subcontractor
engaged in performing operations for a
principal as a part of the same project.
© Insurance Services Office, Inc., 2012
Insured Copy
Page 1 of 2
This endorsement changes policy CLL6403455-10 to which it is attached and is effective
06/30/2020 at 12:01 a.m. standard time at the Insured's mailing address.
Issued to: ITOCHU INTERNATIONAL INC.
Issued by: Trans Pacific Insurance Company
Producer: MARSH JCS, INC.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY,
AMENDMENT -OTHER INSURANCE PRIMARY AND NON
CONTRIBUTORY
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
This endorsement applies to the following states:
AL,
AK,
AZ,
AR,
CA,
CO,
CT,
DE,
DC,
FL,
GA,
HI,
ID,
IL,
IN,
IA,
KS,
KY,
LA,
ME,
MD,
MA,
MI,
MN,
MS,
MO,
MT,
NE,
NV,
NH,
NJ,
NM,
NY,
NC,
ND,
OH,
OK,
OR,
PA,
PR,
RI,
SC,
SD,
TN,
TX,
UT,
VT,
VI,
VA,
WA,
WV,
WI,
WY
PARAGRAPH A. OF CONDITION 4.,OTHER INSURANCE, OF CONDITIONS SECTION
IS REPLACED BY THE FOLLOWING:
4. OTHER INSURANCE
A. PRIMARY INSURANCE
THIS INSURANCE, INCLUDING INSURANCE AFFORDED TO AN ADDITIONAL
INSURED, IS PRIMARY EXCEPT WHEN PARAGRAPH B. BELOW APPLIES.
THE INSURANCE AFFORDED TO AN ADDITIONAL INSURED IS NON-
CONTRIBUTORY WITH OTHER INSURANCE WHEN YOU HAVE AGREED TO DO
THAT IN A WRITTEN CONTRACT OR AGREEMENT THAT WAS EXECUTED
PRIOR TO THE "BODILY INJURY","PROPERTY DAMAGE" OR "PERSONAL
AND ADVERTISING INJURY". IF THIS INSURANCE IS PRIMARY, OUR
OBLIGATIONS ARE NOT AFFECTED UNLESS ANY OF THE OTHER
INSURANCE, EXCEPT THE ADDITIONAL INSURED INSURANCE DESCRIBED
GL9 99 001 09 11
Tokio Marine Management, Inc. 2011
Insured Copy
Page 1
P011 ICY NUMBER:: CLL6403455-10
AMENDMENT -OTHER INSURANCE PRIMARY AND NON
(CONTINUED)
AWME, 10 ALSO PRIMARY. THNN, V01 WTV, SHARE WITH Wn T11AT
OTHER TNSURANCE RY THN METHOP DNSCRFHXD TN PARAGRAPH C.BELOW.
GL9 99 001 09 11
Tokio Marine Management, Inc. 2011
mmmd Cwy
Page 2
Ay y, y I DATE (MMIDD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 12/2/2020
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 z .. ... ... .. ....
NAME Lori Staples
Arthur J. Gallagher Risk Management Services, Inc. PHONE FAX
4700 Homewood Court, Suite 260 F,M 336 217-5767 No, Ext) (Adc, No): 336-275-1776
Raleigh NC 27609-5732 a'DOREss L.orri_Staples atg.col'n
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER As Twin City Fire Insurance Company 29459
INSURED TELELEA-01 INSURER B: Hartford Fire Insurance Company 19682
Digital Networks Group, Inc.
20382 Hermana Cir INSURER C:
Lake Forest, CA 92630 INSURER D:
INSURER E,
INSURER F:
COVERAGES CERTIFICATE NUMBER: 1078506354 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,
YNSR TYPE OF INSURANCE AL70L SUBR POLICY EFF POLICY EXP
LTR. INqQ_Vap POLICY NUMBER fMMIDD/YYYY1 IMMIOD/YXYYI LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
S
DAMAGL TOREN I` r b
CLAIMS -MADE OCCUR
PREMISES,(Ea oc;cUrrence)
$
MED EXP (Any one person)
S
PERSONAL & ADV INJURY
$
GErA AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$
PROJECI.
POLICY EL,l1" n LOG
PRODUCTS - COMP/OPAGG
$
O"a pH iE N
$
AUTOMOBILE LIABILITY
CONIBINfl 0 SINGLE LIMIT
„(Ea ar;r; d alal)
$
ANY AUTO
BODILY INJURY (Per person)
$
OWNED SCHEDULED
BODILY INJURY (Per accident)
$
AUTOS ONLY AUTOS
HIRED NON -OWNED
PROPERTYDAkiAGE
S
AUTOS ONLY AUTOS ONLY
(Pire mx;19etil)
S
UMBRELLA LIAB OCCUR
EACH OCCURRENCE
S
EXCESS LAB CLAIMS -MADE
AGGREGATE
DIED RETENTION S
A WORKERS COMPENSATION r 22WBAA3GT9
6/30/2020 6/30/2021 X r'4�f
Lh`
AND EMPYERS' LIABILITY
EL EACHIACCIIENT
51,000,000
OFFICER/IOMBER/PARTND EXECUTIVE IY.4,N N/A
(Mandatory in NH)
E L DISEASE - EA EMPLOYEE
$ 1,000,000
Ili yes, describe under
DESCRIPTION OF OPERATIONS below
E L DISEASE - POLICY LIMIT
$ 1,000,000
B Professional Liability 22TE029939420
6/30/2020 6/30/2021 Technology E&O
$10,000,000
Aggregale
$10,000,000
Relentlon
$100,000 ea claim
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Waiver of subrogation under the workers compensation is applicable in favor of the City of EI Segundo and its officers, officials, employees, agents,
representatives, and certified volunteers per WC form 04 03 06.
The producer will endeavor to mail 30 days written notice to the certificate holder named on the certificate if any policy listed on the certificate is cancelled prior
to the expiration date. Failure to do so shall impose no obligation or liability of any kind upon the Producer or otherwise after the policy term.
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 EI Segundo
350 Main Street
EI Segundo Street
90245 ;AUTHORIED REPRESENTATIVE
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF OUR RIGHT TO RECOVER FROM
OTHERS ENDORSEMENT - CALIFORNIA
Policy Number: 22 WB AA3GT9 Endorsement Number:
Effective Date: 06/30/20 Effective hour is the same as stated on the Information Page of the policy.
Named Insured and Address: TELERENT LEASING CORPORATION, Avidex Industries LLC and
4191 FAYETTEVILLE RD Digital Network Group Inc
RALEIGH NC 27603
We have the right to recover our payments from anyone liable 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 only to the extent that you
perform work under a written contract that requires you to obtain this agreement from us.)
You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work
described in the Schedule.
The additional premium for this endorsement shall be 2 % of the California workers' compensation premium otherwise due
on such remuneration.
SCHEDULE
Person or Organization
Job Description
Any person or organization from whom you are required by written contract or agreement to obtain this waiver of rights
from us
Countersigned by
Form WC 04 03 06 (1) Printed in U.S.A.
Process Date: 06/25/20
Authorized Representative
Policy Expiration Date: 06/30/21