PROOF OF INSURANCE (2022 - 2022) CLOSEDACCORD® CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DD/YYYY)
11 /1 /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
Lamb, Little & Co
1101 Perimeter Drive
500
CONTACT
NAME: Sandy Crespin
PHONE FAX
A/C No Ext : 847-719-7877 A/c, No): 847-398-7077
E-MSuite
ADDRESS: screspin@lamblittle.com
INSURER(S) AFFORDING COVERAGE
NAIC#
Schaumburg IL 60173
INSURERA: Hartford Casualty Company
29424
INSURED AMERI-B
INSURERB: Hartford Ins Co of Illinois
38288
American Technology Solutions
1212 S. Naper Blvd.
INSURERC: Travelers Cas & Surety Company of America
31194
INSURERD:
Naperville IL 60540
INSURER E
INSURER F :
COVERAGES CERTIFICATE NUMBER:2050676774 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
Y
83SBAIJ1747
1/3/2021
1/3/2022
EACH OCCURRENCE
$1,000,000
CLAIMS -MADE OCCUR
DAMAGE TO RENTED
PREMISES Ea occurrence
$ 300,000
MED EXP (Any one person)
$ 10,000
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
83SBAIJ1747
1/3/2021
1/3/2022
COMBINED SINGLE LIMIT
Ea accident
$1,000,000
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
A
X
UMBRELLALIAB
X
OCCUR
83SBAIJ1747
1/3/2021
1/3/2022
EACH OCCURRENCE
$1,000,000
AGGREGATE
$ 1,000,000
EXCESS LAB
CLAIMS -MADE
DED X RETENTION $ 1 n nnn
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
83WECZP0480
2/3/2021
2/3/2022
X PER OTH-
STATUTE ER
ANYPROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT
$ 500,000
OFFICE R/M EMBER EXCLUDED? FY]
N/A
E.L. DISEASE - EA EMPLOYEE
$ 500,000
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 500,000
C
Professional Liability
105571602
8/17/2021
8/17/2022
Each Claim
1,000,000
Retro Date 1/13/10
Aggregate
1,000,000
Retention
2,500
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
City of El Segundo, its Council, officers, boards, commissions, employees, and agents are named as additional insured for operations conducted by the named
insured. Subject to policy terms and conditions.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of El Segundo
ACCORDANCE WITH THE POLICY PROVISIONS.
Attn: Erica Miramontes
AUTHORIZED REPRESENTATIVE
350 Main Street
El Segundo CA 90245
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