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PROOF OF INSURANCE (2022 - 2022) CLOSEDaa. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 0B/29/2D2, 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. It 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 CONrACiT Aon Risk Services Northeast, Inc. ""I�'N N. "7 FAX (800) 363-0105 (866) 263 7122 Stamford CT Office I", No.EX't)-. C Nr�.: 1600 Summer Street E-MAIL ADDRESS: Stamford CT 06907-4907 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: Federal Insurance Company ,_.,_--- 20281 ZOLL Medical Corporation p KERB: Mitsui Sumitomo Insurance USA Inc. INSURER 22551 and Subsidiaries 269 Mill Road INSURERC: Trans Pacific Ins CO 41238 Chelmsford MA 01824-4105 USA INSURERD: Tokio Marine America Insurance Company 10945 ........ _...... INSURERE: Sompo America Fire & Marine Insurance Co 38997 INSURER F: COVERAGES CERTIFICATE ATE NUMBER: 570088158417 REVISION NUMBER.. THIS 19 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE (INSURED NAMED ABOVE FOR. TIME 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 INSR LTATYPE OF INSURANCE Ili D411", wV05UBRI POLICY NUMBER I�pD,ryyyy D. yv LIMITS X COMMERCIALGENERALLIABILITY CLL 40976664 0710112021 EACH OCCURRENCE $1,000,000' AMA $100, 000 CLAIMS -MADE OCCUR-' PREMISES. Ea occurrence),,, __ MEd EX'(Any one person) $5 , 000 PERSONAL&ADV INJURY $1,000,000 GEN'L ................-.... AGGREGATE LIMIT APPLIES PER,.. _.-..._... GENERAL AGGREGATE ......... _............m. $2 000,000 POLICY ❑ LOC JEST PRODUCTS -COMP/OPAGG Xcluded ....... OTHER: OMOBILE LIABILITY CA640976104 07/Ol/2021 07/01/2022 COMBINED SINGLE LIMIT $1,000,000 I ANYAUTOOWNED BODILY INJURY ( Per person) SCHEDULED BODILY INJURY (Per accident) AUTOS ONLY AUTOS PROPERTY DAMAGEHIREDAUTOS NON-OWNEDPeracoidonYONLY - AUTOS ONLYUMBRELLA EXS5200217 07 01 1 07/01 22 EACH OCCURRENCE $25,000,000 LIAB X ,.....00CUR EXCESS LIAB CLAIMS -MADE 1. .....AGGREGATE $25,000,000 DED IRETENTION E WORKERS COMPENSATION AND 3CD40122WO 07/011202107/ 1/2 2 X PER STATUTE OTH• EMPLOYERS' LIABILITY V,YN ANYPROPRS'LIA PARTNER/EXECUTIVE N ! ADS JCR40013N0 JCR 07/O1/2021 07/O1/2022 E.L.EL EACH ACCIDENT 1,000, ' ....._ E OFFICER/MEMBER EXCLUDED? �; (Mandatory in NH) N/A WI E.L. DISEASE -EA EMPLOYE $1,000, 000 E.L. DISEASE -POLICY LIMIT $1, 000, OOO II yes, descrOF OPERATIONS below ibe under DESCRIPTION A Products Liab 36019266 07/15/2021 07/15/2022 Prod/Comp 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. A �� "r. El Segundo CA 90245 USA e�GIN'a/ss ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD d 00 L0 m 0 0 Lo O Z N V d) U AGENCY CUSTOMER ID: 570000083508 LOC #: 111%1*4�1 ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMED INSURED Aon Risk Services Northeast, Inc. ZOLL Medical Corporation POLICY NUMBER See Certificate Number: 570088158417 CARRIER NAIC CODE see Certificate Number: 570088158417 11 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance 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 ADDL tNSD SUBR W VD POLICYNUMBER POLICY EFFECTIVE DATE (MM/DD/YYYY) POLICY EXPIRATION DATE (MM/DD/YYYY) LIMITS EXCESS LIABILITY A 79882432 Ex Products Liab 07/15/2021 07/15/2022 Aggregate $5,000,000 Each occurrence $5,000,000 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: CLL6409760-04 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 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 required to complete this Schedule, if not shown above,"wiil b shown in the Declarations. ...._... 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'tose'�atn on your behalf: 1. In the performance of your ongoing opertiions; 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. !,"respect to the insurance afforded to these itional insureds, the following is added to tion 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. CG 20 26 04 13 ©insurance Services Office, Inc., 2012 Page 1 of 6 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) POLICY NUMBER: JCD40122WO 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 anyone not named in the Schedule. Schedule PARTIES WITH WHOM THE INSURED HAS ENTERED INTO A WRITTEN WAIVER AGREEMENT PRIOR TO THE DATE OF LOSS. ***THIS ENDORSEMENT DOES NOT APPLY TO KENTUCKY, NEW HAMPSHIRE, AND NEW JERSEY. For policies or exposure in Missouri: 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: 07-14-21 WC 00 03 13 (Ed. 4-84) © 1983 National Council on Compensation Insurance.