PROOF OF INSURANCE (2022) CLOSEDACCORD® CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DD/YYYY)
7/14/2021
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(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
Arthur J. Gallagher Risk Management Services, Inc.
2850 Golf Road
Meadows IL 60008
CONTACT
NAME:
PHONE FAX
A/C No Ext : 630-595-5300 A/c, No): 630-694-4401
E-MRolling
ADDRESS: certrequests@ajg.com
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURERA: Valley Forge Insurance Company
20508
INSURED CLEOCOM-01
Cleo Communications Holding, LLC
Cleo Communications, Inc.
INSURERB: Continental Insurance Company
35289
INSURERC: National Fire Insurance Co of Hartford
20478
INSURERD: Scottsdale Insurance Company
41297
Cleo Communications US, LLC
4949 Harrison Avenue, Ste 200
Rockford IL 61108-7947
INSURERE:
INSURER F
COVERAGES CERTIFICATE NUMBER:2027503844 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.
INSR
LTR
TYPE OF INSURANCE
ADDL
INSD
SUBR
WVD
POLICY NUMBER
POLICY EFF
MM/DD
POLICY EXP
MM/DD
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
6057103335
6/1/2021
6/1/2022
EACH OCCURRENCE
$1,000,000
CLAIMS -MADE OCCUR
DAMAGE TO RENTED
PREMISES Ea occurrence
$ 100,000
MED EXP (Any one person)
$ 5,000
PERSONAL &ADV INJURY
$ 1,000,000
GEN'L
AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
POLICY ❑PRO ❑
JECT LOC
X
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
OTHER:
A
AUTOMOBILE
LIABILITY
6057103366
6/1/2021
6/1/2022
COMBINED SINGLE LIMIT
Ea accident
$1,000,000
X
BODILY INJURY (Per person)
$
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident)
$
X
PROPERTY DAMAGE
Per accident
$
HIRED X NON -OWNED
AUTOS ONLY AUTOS ONLY
B
X
UMBRELLALIAB
X
OCCUR
6057103383
6/1/2021
6/1/2022
EACH OCCURRENCE
$ 10,000,000
AGGREGATE
$ 10,000,000
EXCESS LAB
CLAIMS -MADE
DED X RETENTION $ 1 n nnn
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
6057103349
6/1/2021
6/1/2022
X PER OTH-
STATUTE ER
ANYPROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT
$ 1,000,000
OFFICE R/M EMBER EXCLUDED? ❑
N/A
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
D
Tech Errors & Omissions/Cyber
EKI3381694
6/1/2021
6/1/2022
Limit
$5,000,000
Aggregate
$10,000,000
Retention
$25,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
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 El Segundo
350 Main Street
El Segundo CA 90245
AUTHORIZED REPRESENTATIVE
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