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PROOF OF INSURANCE (2021 - 2021) CLOSED�0 DATE (MMIDDIYYYY) ACC?RE'I CERTIFICATE OF LIABILITY INSURANCE ,,.. ....., 01(12(2021 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 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). CONTACT ., PRODUCER NAME: Dean Dunlap ISU - Dunlap Agency PHONE Exrl: (714) 838-3158 (A/C, N'd1 (714) 922-6157 A'C700 West 1st St ,Suite 8 E MAIL' service@dunlapins cam ADDRESS. INSURER(S) AFFORDING COVERAGE NAIC # .......... .................. ..._ Tustin CA 92780 INSURERA: Hartford/Sentinel Insurance Co ._. _._.. ......... .._.................. INSURED INSURER B: Preferred Employers Ins Co ............... __WW......_. Matrix Imaging Products, Inc INSURER C : United States Liability Co ........ ....... ....... ................ 18445 Amistad INSURER D INSURER E Fountain Valley CA 92708 INSURER F: COVERAGES CERTIFICATE NUMBER: 2020-2021 REVISION NUMBER: THIS IS TO CERTIFY THATTHE 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 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 ',ADDL S R"'""""........... .�."�..��1')Y_YCY EFF' POLICY EXP INSR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER LM MIDDIYYYY) (MMIDD/YYYY) LIMITS ._.�.._.._...... X COMMERCIAL GENERAL LIABILITY ..._....... ,...,..__ .... .�.,.•. .................. EACH OCCURRENCE ._ S 1,000,000 b""C/ iVWCt"°' P'i 'REN I'Et...._0 1 ,000,000 I, CLAIMS'-MADE19 OCCUR EREMISES (E2 occurrence) S MED EYP IAny one Gerson) S 10'000 A 72SBABD3913 10/17/2020 10(17/2021 PERSONAL&ADV INJURY s 1,000,000 L�1MIT APPLIES PER: GEIJERALAGGREGATE S 2,000,000 `GI�',�N�'G.F,^0.GREGA-"E: POLICY _ PRO F1 LOC JECT PRODUCTS-COMPtOPAGG Employee Benefits S 2,000,000 . s 2,000,000 OT,HFR, AUTOMOBILE LIABILITYC'OIti'7SInNED $ING1,F LN 057 r a,ttidnaecY ._ S 1,000,000 ANYAUTO BODILY INJURY (Per person) S A OWNED 172SBABD3913 10/17/2020 BODILY INJURY (Per accident) ................ S AUTOS ONLY HIRED ��,,,,rr AUTOS NON -OWNED II PROPERTY __ �'t'W' Dr,,4u4AGE ............. $ AUTOS ONLY �✓'"w AUTOS ONLY N r"+e,a ttit,c ...._....... .... 'di'^x1Y .... -..... S .............RELLA.. � UMBRELLA LAB X _........._._. OCCUR .. EACH OCCURRENCE S A EXCESS LIAB CLAIMS MADE 72SBABD3913 10(17/2020 10/17/2021 AGGREGATE __.................. s __.•.._.•.•.__. .....•. DED X) RETENTIONS 10,000 S WORKERS COMPENSATION X� ,. ...... PER � OTH- STATUTE FR AND EMPLOYERS' LIABILITY YIN ANY PROPP.IETORtPARTNERtEXECUTIVE •„ I E I_ EACH ACCIDENT $ 1,000,000 B OFFICERIMEMBEREXCLUDED9 � NIA N157011-7 12/01/2020 12/01/2021 •-•• (Mandatory in NH) PF . DISEASE - EA EMPLOYEE S1,®00'000 It yes, describe under DESCRIPTION OF OPERATIONS below . DISEASE -POLICY LIMIT S 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 I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD MATRIX IMAGING PRODUCTS, INC POLICY NUMBER: 72ABABD3913DX 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: CITY OF EL SEGUNDO, ITS OFFICIALS AND EMPLOYEES Primary Wording/Non-Contributory It is further agreed that such insurance as is afforded by the policy for the benefit of the above Additional Insured(s) shall be primary insurance but only as respects any claims, loss or liability arising out of the Named Insured(s) shall be excess and non-contributing. (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