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PROOF OF INSURANCE (2021) CLOSEDCERTIFICATE OF LIABILITY INSURANCE DAT 06/ 5/DOD oYYYj......... 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 k0hiTACT NAME. Aon Risk Services Northeast, Inc. PHONE 2 FAX (800) (866) 283 7122„ 363 0105 FN' `y Stamford CT Office IAi Na. Ext) .... 1! 1600 Summer Street E-MAIL p Stamford CT 06907-4907 USA ADDRESS: _ INSURER(S) AFFORDING COVERAGE NAIC p INSURED INSURER A: Mitsui Sumitomo Insurance USA Inc, 22551 ZOLL Medical Corporation INSURERB: Tokio Marine America Insurance Company 10945 and Subsidiaries 269 Mill Road .. ...................... ..................... __ �... INSURER C: Trans Pacific Ins Co 41238 Chelmsford MA 01824-4105 USA INSURERnD: The TravelWers Indemnity Co of America 25666 INSURER E: Federal Insurance Company 20281 INSURER F: COVERAGES CERTIFICATE NUMBER: 570082501912 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 I TA TYPE OF INSURANCE I D VD POLICY NUMBER POLICY EFFyYF MWIDDIYYYY' LIMITS C X COMMERCIAL GENERAL LIABILITY CLL b EACH OCCURRENCE $1, 000, 000 CLAIMS -MADE I X I... OCCUR t. t PREMISES Ea ocr.,urrenca $1 000 000 MED EXP (Any one person) $ 5 , 000 ....... ... ......... _.. PERSONAL B ADV INJURY �.................... ----- $1,000,000 GEN'L AGGR...................................� ELATE LIMIT APPLIES PER: _............................... GENERALAGGREGATE $2, 000, 000 X PRO POLICY JECT LOC PRODUCTS - COMP/OP AGG EXCluded OTHER: 9 AUTOMOBILE LIABILITY CA6409761-03 07/01/2020 07/01/2021 COMBINED SINGLE LIMIT $1,000,000 .. . cci mt ......._ ..... .. X ANYAUTO BODILY INJURY ( Per person) BODILY INJURY (Per accident) OWNED ""SCHEDULED AUTOS - AUTOS ONLY �. NON -OWNED ww HIRED AUTOS ''. _...._______....___.. ............. .........wwww._... PROPERTY DAMAGE .... ....._......._.._ ONLY AUTOS ONLY Per aocidenU A X UMBRELLALIAB X OCCUR EXS5200217 07/01/2020 07/01/2021 EACH OCCURRENCE $25,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $25 , 000 , 000 DED ITET'6 NT90N D WORKERS COMPENSATION AND ''. UB5J319473 077-6-177057507 012021 X I PER STATUTE OTH- A EMPLOYERS' LIABILITY N EL.. EACH ACCIDENT $1, 000 , 000 ANY PROPRIETOR / PARTNER / EXECUTIVE PJ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) N / A E L. DISEASE -EA EMPLOYEE $1, 000 , 000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1, 000 , 000 E Products Liab 36019266 07/15/2020 07/15/2021 Prod/Camp Ops/Agg $5,000,000 '..Retro Date 10/1/2004 Prod/Comp Ops/Occ $5,000„000 Deductible $200,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Products Liability - claims made coverage.. 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. El Segundo Fire Department AUTHORIZED REPRESENTATIVE Attn: Capt. Mark Lees 314 Main St. E1 Segundo CA 90245 USA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD C 4 0 co co 0 r- AGENCY CUSTOMER ID: 570000083508 LOC #: " � ADDITIONAL REMARKS SCHEDULE Page _ of AGENCY NAMED INSURED Aon Risk Services Northeast, Inc. ZOLL Medical Corporation POLICY NUMBER See Certificate Number: 570082501912 CARRIER I NAIL CODE See Certificate Number: 570082501912 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance u INSURER(S) AFFORDING COVERAGE NAIC # INSURER 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 EXCESS LIABILITY ADDLSUBR INSD W VD POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YYYY) POLICY EXPIRATION DATE (MM/DD/YYYY) LIMITS E 79882432 EX Products Liab 07/15/2020 07/15/2021 'Aggregate Each Occurrence $5,000,000 $5,000,000 ACORD 101 (2008/01) (02008 ACORD CORPORATION. All rlgnts reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: CLL6409760-03 COMMERCIAL GENERAL LIABILITY CG 20 26 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED 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): ANY PERSON OR ORGANIZATION WHEN YOU AND SUCH PERSON(S)OR ORGANIZATION(S) HAVE AGREED IN WRITING IN A CONTRACT OR AGREEMENT THAT SUCH PERSON OR ORGANIZATION BE NAMED AS AN ADDITIONAL INSURED ON THIS POLICY PROVIDED THE CONTRACT OR AGREEMENT WAS EXECUTED PRIOR TO THE "BODILY INJURY", "PROPERTY DAMAGE" OR "PERSONAL AND ADVERTISING INJURY". Information reauired to complete this Schedule, if not shown A. Section II — Who Is An Insured is amended to 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 your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. 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 26 0413 will be shown in the Declarations. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. © Insurance Services Office, Inc., 2012 Page 1 of 1 Insured Copy 'TRAVELERS WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 00 03 13 (00) - 001 POLICY NUMBER: UB-5J319473-20-I2-G WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. SCHEDULE DESIGNATED PERSON: DESIGNATED ORGANIZATION: ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. Any person or organization for which the employer has agreed by written contract, executed prior to loss, may execute a waiver of subrogation. However, for purposes of work performed by the employer in Missouri, this waiver of subrogation does not apply to any construction group of classifications as designated by the waiver of right to recover from others (subrogation) rule in our manual. DATE OF ISSUE: 07-18-20 STASSIGN: PAGE 1 OF