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PROOF OF INSURANCE (2022) CLOSEDDATE (MMIDDIYYYY) ACCMV � CERTIFICATE OF LIABILITY INSURANCE 10/28/2021 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). NAME PRODUCER 1166 Avenue of the Americas JAI N�. M) . Marsh USA, Inc. PHONE FAX New York, NY 10036 EMAIL ADDRE;S&, Attn: NewYork.Certs@marsh.com Fax: 212-948-0500 INSURER(S) AFFORDING COVERAGE ........ ,... . �...... .,....... _.— GE NAIC # po surance Company 11126 _ wsuRERA Som Amenca In....... ...........� Marine America 110945 Canon utions merica INSURED425 N. MalringaleARoad, Suite 100 INSUREItc Sor koAmenca Fire &IMarinecInsurran enCompan,y 38997 Schaumburg, IL 60173 INSURERD: r`r yeccrAn_rc f`CDTICIPATC KIIIIIIIRCI2• NYC-0f19357A70.37 REVISION NIIMRFR' 3 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. INS .... ....... ....._.. - —'. FF V,4V➢�R1 ---- POLICY EFF YE4"XYY „_... ........_ LIMITS .... .........,,. MOLICY N MMd TR TYPE OF INSURANCE I R POLIGYNUMBER mro B X COMMERCIAL GENERAL LIABILITY X X GLD6404741-11 '..11/01/2021 11101/2022 EACH OCCURRENCE $ 1,000,000 -AA"L 1,000,000 CLAIMS -MADE X OCCUR P $ _.. M ED EEIXP(Any— one $ _. ` >__ RY $ 000 GE; L AGGREGATE LIMIT APPLIES PER: _ GENERALA GGREGAT . � 2,000,000 " WeO. POLICY' C ... PRO X LOG �_PRODUCTS-COMP/OPAGG .... $1,000,000 OTHER' $ A AUTOMOBILE LIABILITY X X FTA40003DO (AOS) 11/01/2021 11101/2022 INGLELIMIT 1 � III EDSSINGLE $ _ 1,000,000 A X ANY AUTO ACV40995RO (MA) 11/01/2021 11/01/2022 BODILY INJURY (Per person) $ SCHEDULED BODILY INJURY (Per accident) $ ALIT .-- _ _.. NON-O ROPERT�t' DAMA+`aL.. $ AHIRED UTOS ONLY AUTOS ONLD COMP/COLL DED $ 1,000 UMBRELLA LIAB ( .00CUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE.. E AGGREGATE „I $ _ _ — DED RETEN. G WORKERSCOMPENSAT10N X J 'D40017R0 11101/2021 11/511 022 PER H YNN I 1,000,000 AN TOR/PA TNER/E ECUTIVE L. E E.L.ACH ACCIDENTLUD $ ICER ME (Mandatory in NH) N / A E.L.. DISEASE - EA EMPLOYEE $ 1,000,000, If yes, describe under DESCRIPTION OF OPERATIONS be i E.L DISEASE -POLICY LIMIT 1,000,000 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City, its officials, and employees are additional insured (except workers' compensation) where required by written contract. This insurance is primary and non-contributory over any existing insurance and limited to liability arising out of the operations of the named insured and where required by written contract. Waiver of subrogation is applicable where required by written contract. CFRTIFICATE HOLDER CANCELLATION City of El Segundo 350 Main Street El Segundo, CA 90245 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 7w1a&414 2L.191-0 1711w. (V I VtSt$-LUI t) At U KLI GUKF'UKA I IUN. An rignm reserveo. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: FTA40003DO COMMERCIAL AUTO CA20481013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED: AUTOS LIABILITY COVERAGE, This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Canon U.S.A., Inc. Endorsement Effective Date: 11/1/2020 SCHEDULE Name Of Person(s) Or Organization(s): As required by written contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.I. of Section If — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 POLICY NUMBER: CLL6404741-10 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED � OWNERS, LESSEES OR CONTRACTORS SCHEDULED ARSON O ORGANIZATION This endorsement modifies insurance provided under the following:. COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered Operations Any erson or organization if you are required to do so under the, ""bodily As required by written contract with a Named hsured a wrten contract„ agreement or permit provided injury". or "propperty damage" occurs subsequent to the execution of the contract, agreement or permit.. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — VVho 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: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. 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. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these additional insureds, the following is added to Section 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. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13 POLICY NUMBER: CLL6404741-10 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES O CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Any person or organization if you are required to do As required by written contract with a Named Insured so under a written contract, agreement or permit provided the "bodily injury" or "property damage" occurs subsequent to the execution of the contract, agreement or permit. Information required to com fete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III — Limits Of Insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured is "property damage" caused, in whole or in part, by required by a contract or agreement, the most we your work" at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement amount of insurance: performed for that additional insured and included in the "products -completed operations 1. Required by the contract or agreement; or hazard". 2. Available under the applicable Limits of However: Insurance shown in the Declarations; 1. The insurance afforded to such additional whichever is less. insured only applies to the extent permitted This endorsement shall not increase the applicable by law; and Limits of Insurance shown in the Declarations. 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. CG 20 37 04 13 Oc Insurance Services Office, Inc., 2012 Page 1 of 1 Policy #CLL6404741-10 COMMERCIAL GENERAL LIABILITY CG 20 01 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL- GENERAL. LIABILITY COVERAGE PART PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Flamed Insured under such other insurance; and CG 20 01 0413 (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. ® Insurance Services Office, Inc., 2012 Cor-pany Copy page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) 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 As required by written contract ***THIS ENDORSEMENT DOES NOT APPLYTO KENTUCKY, NEW HAMPSHIRE, AND NEW JERSEY. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. IThe information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective: 1110112020 Policy No.JCD40017RO Endorsement No. Insured: CANON U.S.A., INC. Premium: INCL. Insurance Company: Sompo America Fire & Marine Insurance Company Countersigned by WC 00 03 13 (Ed. 4-84) 0 19133 National Council on Compensation Insurance.