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PROOF OF INSURANCE (2022 - 2022) CLOSED° DATE(MM/DDIYYYY) , C4'-:)RV CERTIFICATE OF LIABILITY INSURANCE .° 01 /03/2022 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 NAME: T Christy Dunlap ISU - Dunlap Agency PHONEAO� F f (714) 838 3158 IC Na , (714) 922 6157 700 West 1st St, Suite 8 I ° chris dunla Ins.com ❑�aCW10 tY@ P INSURER(S) AFFORDING COVERAGE NAIC # Tustin CA 92780 INSURERA: Sentinet Ins. Co./Hartford Insurance 11000 ............................... INSURED INSURER B : Insurance Company of the West 27847 Matrix Imaging Products, Inc. INSURER C : United States Liability 25895 18445 Amistad INSURER D INSURER E Fountain Valley CA 92708 INSURERF: COVERAGES CERTIFICATE NUMBER: CL2110405996 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, __ ................ SU5KP LI YFI=......_�7LIY FJµT TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) IMMIDDIYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE OCCUR FA UAMRIS�S'RENTED Loorrwrree�I;ts;. $ 1,000,000 MED EXP (Any one person) $ 10,000 I 72SBABD3913 10/17/2021 10/17/2022 PERSONAL & ADV INJURY $ 1,000,000 GrN'LAGGREiGAT[: LIMITAPPLIESPER: GENERALAGGREGATE $ 2,000,000 w.... " PRO, .+^+w POLICY JEC,T' LOC PRODUCTS - COMP/OP AGG 2,000,000 $ OTHE'.R:. $ AUTOMOBILE LIABILITY COMBINED SiNCLE LIMT Ea acr�menl'i s 1,000,000 ANYAUTO BODILY INJURY (Per person) $ A OWNED SCHEDULED 72SBABD3913 10/17/2021 10/17/2022 BODILY INJURY (Per accident) S AUTOS ONLY AUTOS • X NON -OWNED X HIRED I PR4OP ^P Y DAMAGE .... $ AUTOS ONLY AUTOS ONLY Pe�'rtr:GdanE' S X UMBRELLA LIAB X; OCCUR EACH OCCURRENCE $ 4,000,000 A EXCESS LIAB CLAIMS -MADE '.. 72SBABD3913 10(17/2021 10/17/2022 AGGREGATE $ 4,000,000 DED RETENTION $ $ WORKERS COMPENSATION _ PE R OiH ATUTE ER AND EMPLOYERS' LIABILITY YIN °' ............................................ 1000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE B Y NIA WPL5063824-00 12/30/2021 12/30/2022 OFFICER/MEMBER EXCLUDED? EA ••••-•--• GHACCIDENT° $ (Mandatory in NH) E. L. DISEASE - EA EMPLOYEE $ 11000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY $ 1,000,000 Professional Liability/Network Security C Liability TK1553465 06(17(2021 06/17/2022 Deductible: $2,500 $1,000,000 _... .............................................. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of El Segundo, its officials and employees are named as additonal insured. Insurance on the Certificate is Primary, Thirty (30) days notice of Cancellation required 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. 350 Main St. AUTHORIZED REPRESENTATIVE ElSegundo CA 90245 ©1988-2015 ACORD-"CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD MATRIX IMAGING PRODUCTS, INC POLICY NUMBER: 7 'I A i Ci1'I MERCMAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS (Form B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: The City of El Segundo, its officials and employees (If no entry appears above, information required to complete this endorsement will be shown in the Declaration as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or orgenlzation shown in the ,schedule, but only with respects to liability arising out of your work preformed for that insured. CG 20 10 07 04 Copyright, Insurance Services Office, Inc. 2004 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 City of E1 Segundo, its officials and employees This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated, (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective: 12/30/2021 Policy No.: WPL5063824-00 Endorsement No. 1 Insured:Matrix Imaging Products, Inc. Premium$ Insurance Company: Insurance Company of the West Countersigned by: Cean Dunlap WC000313 (Ed. 4-84) Copyright 1983 National Council on Compensation Insurance.