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PROOF OF INSURANCE (2022) CLOSEDAka� �'® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) tvzvzort 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 Aon Risk services Northeast, Inc. Aon Risk services Northeast, Inc. CONTACT NAME: PHONE FAX (A/C . No. Ext): 866-283-7122 (A/C.No.): (800) 363-0105 E-MAIL ADDRESS: NY NY Office One Liberty Plaza 165 Broadway, suite 3201 New York NY 10006 USA INSURER(S) AFFORDING COVERAGE NAIC# INSURED INSURERA: Hartford Fire Insurance co. 19682 Bureau Veritas Technical Assessments LLc 10461 Mill Run circle, suite 1100 Owings Mills MD 21117 USA INSURERB: Hartford Underwriters Insurance company 30104 INSURER C: Allianz Global Risks Us Insurance co. 35300 INSURERD: Trumbull Insurance company 27120 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570090365171 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 MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, Limits shown are as re uested INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS C X COMMERCIAL GENERAL LIABILITY USLOO159321 01 01 2021 01 Ol 2022 EACH OCCURRENCE $2,000,000 CLAIMS -MADE OCCUR PREMISES (Ea occurrence) $1,000,000 MED EXP (Any one person) $10 , 000 PERSONAL &ADV INJURY $2,000,000 LIMITAPPLIES PER: GENERAL AGGREGATE $2,000,000 P'LAGGREGATE POLICY TPRO �LOC ECT PRODUCTS - COMP/OPAGG $2,000,000 OTHER: A AUTOMOBILE LIABILITY 10 AB s41202 01/01/2021 01/01/2022 COMBINED SINGLE LIMIT (Ea accident) 2' 000' 000 $2,000,000 AOS BODILY INJURY( Per person) B X ANYAUTO 10 AB s41203 01/01/2021 01/01/2022 BODILY INJURY (Per accident) OWNED SCHEDULED HI AUTOS ONLY AUTOS PROPERTY DAMAGE HIREDAUTOS NON -OWNED (Per accident) ONLY AUTOS ONLY C X UMBRELLALIAB X OCCUR USLOO163321 01/01/2021 01/01/2022 EACH OCCURRENCE $1,000,000 JECLAIMS -MADE AGGREGATE $1,000,000 ENTION $10,000 D WORKERS COMPENSATION AND 10WNs41200 01/01/2021 01/01/2022 X PER STATUTE OTTH- EMPLOYERS' LIABILITY Y/N See state Policy Addendum ER E.L. EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNER/ EXECUTIVE OFFICER/MEMBER EN (Mandatory in NH) N/A E.L. DISEASE -EA EMPLOYEE $1,000,000 IDfyes, describe under ESCRIPTION OF OPERATIONS below I I E.L. DISEASE -POLICY LIMIT $1,000,000 C Archit&Eng Prof USF00248021 01/01/2021 01/01/2022 Each claim $1,000,000 claims Made Aggregate $1,000,000 SIR applies per policy terns & condi ions DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Evidence of insurance. The Architects & Engineers policy includes coverage for Professional Liability and contractors Pollutio Liability. certificate Holder, The city of E1 Segundo, it's Officials and Employees are included as Additional Insured in accordance with the policy provisions of the General Liability coverage, Business Auto coverage & Umbrella Liability policy. CERTIFICATE HOLDER CANCELLATION -:4 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 AUTHORIZED REPRESENTATIVE 350 Main street E1 Segundo CA 90245 USA e�`X�ri r`��e�Gt e�ri,+e� c-ll�vC��` eJ 9asA ©1988-2015 ACORD CORPORATION. All rights reserved ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000048582 LOC #: A ADDITIONAL REMARKS SCHEDULE Page _ of AGENCY Aon Risk services Northeast, Inc. NAMED INSURED Bureau Veritas Technical Assessments LLC POLICY NUMBER See Certificate Numbe 570090365171 CARRIER see Certificate Numbe 570090365171 NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Workers Compensation/Employers Liability 10WN541200 01101121-01101122 Trumbull Insurance AR,DC,IN,LA,RI,UT 10WN541200 01101121-01101122 Twin City Fire Insurance Company FL,ND,OH,WA,WY 10WN541200 01101121-01101122 Hartford Insurance Company of the Midwest AK,ID 10WN541200 01101121-01101122 Hartford Casualty Insurance Company MO JX 10WN541200 01101121-01101122 Nutmeg Insurance Company CT,IL 10WN541200 01101121-01101122 Hartford Fire Insurance Company NH,OR,PA 10WN541200 01101121-01101122 Hartford Accident and Indemnity Company AL,GA,KY,ME,MI,MT,NE,NY,TN,VT 10WN541200 01101121-01101122 Property /Casualty Insurance Company of Hartford CA,CO3DE,MN,M5,5C 10WN541200 01101121-01101122 Hartford Insurance Company of Illinois WV 10WN541200 01101121-01101122 Hartford Insurance Company of the southeast KS,MD 10WN541200 01101121-01101122 Hartford Underwriters Insurance Company AZ,HI,MA,NC,NJ,SD,VA 10WN541200 01101121-01101122 sentinel Insurance Company, Limited IA,NM,NV,OK 10WBR541201 01101121-01101122 Twin City Fire Insurance Company WI 10WBR541201 01101121-01101122 Hartford Fire Insurance Company PR ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD