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PROOF OF INSURANCE (2021) CLOSED
A� 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