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PROOF OF INSURANCE (2022) CLOSED.R' CERTIFICATE OF LIABILITY INSURANCE DATE(MMYY) /2021 O6/14/2021 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(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). PRODUCER CONTACT Aon Risk Services Northeast, Inc. (866) 283-7122 FAX (600) 363-0105 CAD KE; I (AtC.No,,); New York NY Office One Liberty Plaza E-MAIL 165 Broadway, Suite 3201 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # New York NY 10006 USA 'INSURED INSURER A: AIU Insurance company 1939 Los Angeles SMSA LP INSURERB: National Union Fire Ins Co of Pittsburgh 19445 dba verizon wireless 1095 Avenue of the Americas INSURERC: INSURER D: New York NY 10036 USA '.. INSURER E: INSURER F: aT3�Ti �73Tit7�` i � J I I I JI_1'�:lliiYlNtNlt"IrMil.'1."flCdi .# �rll.'tw7 s�■ � llf Itirl"=t� THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED T5 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 re uested LTR TYPE OF INSURANCE 4INDA y POLICY NUMBER MNVDDIY'YY'Y MMs"DXOYYyY LIMITS '.. X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 PR�SE$r IEa Occ%aML4 $1,000,000 CLAIMS -MADE �X OCCUR X XCU Coverage is Included MED EXP (Any one person) $10 , 000 PERSONAL & ADV INJURY $1,000,000 AGIMITAPPLIESPER: GENERALGREGATE $1,000,000 NN'LAGGREGATEL POLICY PRO LOD JECT PRODUCTS-COMP/OPAGG $1,000,000... OTHER: B AUTOMOBILE LIABILITY 4594298 06/30/2021 06/30/2022 CEOMBINED SINGLE LIMIT $1,000,000 A05 B X ANYAUTO 4594299 06/30/2021 06/30/2022 BODILY INJURY (Per person) OWNED SCHEDULED MA BODILY INJURY (Per accident) B AUTOS ONLY AUTOS 4594300 06/30/2021 06/30/2022 PROPERTY DAMAGE HIREDAUTOS NON -OWNED VA (Per accident) B ONLY AUTOS ONLY See Next Page 06/30/2021 06/30/2022 UMBRELLA LIAB OCCUR EACH OCCURRENCE AGGREGATE I EXCESS LIAB CLAIMS -MADE Z32 DED RETENTfON A WORKERS COMPENSATION AND 1 0 2 1 X PER STATUTE '.. OTTH- EMPLOYERS' LIABILITY Y R N ANY PROPRIETOR / PARTNER / EXECUTIVE AOS 16393206 06/30/2 221 06/30/2022--. E.L. EACH ACCIDENT $1,000,000 A OFFICER/MEMBER EXCLUDED? a "' II (Mandatory in NH) r.........0 NIA, CA E.L. DISEASE -EA EMPLOYEE �$1,000,000 If es, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space Is required) RE: Cell site: Posa Park, Location Code: 160970, Address: 400 Lomita street, El Segundo, CA 90245. 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. ,ram: Ir City of El Segundo AUTHORIZED REPRESENTATIVE 350 Main street E1 Segundo CA 90245 USA t�4�psa slit ✓spa ©1988-2015 ACORD CORPORATION. All rights reserved„ ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000027366 LOC #: ;w ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMED INSURED ADn Risk Services Northeast, Inc, LOS Angeles SMSA LP POLICY NUMBER See Certificate Number: 570087755130 CARRIER 7—r777E-- see Certificate Number: 570087755130 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liabi ty 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 POLICY POLICY LTR TYPE OF INSURANCE ADDL "SUBR POLICY NUMBER EFFECTIVE EXPIRATION LIMITS INSD WVD DATE DATE (MM/DD/YYYY) (MM/DD/YYYY) AUTOMOBILE LIABILITY B 4594301 06/30/2021 06/30/2022 NH - Primary B 4594302 06/30/2021 06/30/2022 NH - Excess WORKERS COMPENSATION A N/A 16393207 06/30/2021 06/30/2022 NY A N/A 16393208 06/30/2021 06/30/2022 WI A N/A 16393205 06/30/2021 06/30/2022' NJ, TX, VA AUvrtu 1U1 (zuuaiDi) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD