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PROOF OF INSURANCE (2022 - 2022) CLOSED0DATE (MM/DDfYYYY) CERTIFICATE OF LIABILITY INSURANCE 1/9/2022 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 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: Jennifer Leroy W,W El Dorado Insurance Agency, Inc. =�Exa (713) 521-9251 PAID No (713)521-e125 El Dorado Sec Srvs Ins Agy E-MAILileroy@eldoradoinsurance.com ADDR..... _................ ...._.......................... ........................... ............ 3673 Westcenter Drive INSURER(S) AFFORDING COVERAGE NAIC # Houston TX 77042 INSURER A: Allied World Surplus Lines Insurance Cc 24319 INSURED INSURER B: Harford Accident & Indemnity Co. 360 Group International, Inc. INSURERC: 8903 Devonshire Drive INSURERD: INSURER E Dallas TX 75209 INSURERF: COVERAGES CERTIFICATE NUMBER:Special Endorsement 3/21 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 CONTRACTOR 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR at75E ........ POLICY EFF POLICY EXP.... . LTR TYPE OF INSURANCE POLICY NUMBEST,' M ✓D YYy MM/DD/YYYY. LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 ] E.'�,' c . ) 100,000 A CLAIMS -MADE .. OCCUR L. PRp Ea ree..n $ X Errors & Omissions X 5200-3389-00 2/1/2021 2/1/2022 MED EXP (Any one person) $ 10,000 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GEN'LAGGREGATE LIMITAPPLIES PER X POLICY D JEG1PRO,.. LOC PRODUCTS - COMP/OPAGG $ 3,000,000 CUNER. $ AUTOMOBILE LIABILITY OOMMNEID SGNM LIMIT Ea a LicenD $ 1,000,000 ANYAUTO BODILY INJURY (Per person) $ AIx ALL OWNED SCHEDULED 5200-3389-00 2/1/2021 2/1/2022 BODILY INJURY (Per accident) $ AUTOS AUTOS PRtiDPER"F�'YCDASUSGE Peracedd-ronl $ NON -OWNED X HIREDAUTOS AUTOS $ X UMBRELLA LIAB X .00CUR EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 A EXCESS LIAB CLAIMS -MADE DED I J RETENTION $ 5201-1394-00 2/1/2021 2/1/2022 $ WORKERS COMPENSATION X PER 07H- STAT T ER AND EMPLOYERS' LIABILITY Y / N ... ANY PROPRIETOR/PARTNERIEXECUTIVE E L EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? II II N/A B ,(Mandatory in NH) 'MM. ,.VI 16WEQY5BNM 3/27/2021 3/27/2022 EL DISEASE - EA EMPLOYEE $ 1,000,000 ',.If yes, describe under .................. DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S 1,000,000 if o sac is required) ' DES O OF OPERATIONS / LOCATIONS I VEHICLES ACORD 101 Additional Remarks Schedule may be attached rf mom e i DESCRIPTION ( _ y p The General Liability policy includes a blanket automatic additional insured endorsement that provides additional insured status to the certificate holder only when there is a written contract between the named insured and the certificate holder that requires such status. The General Liability policy contains a special endorsement with "Primary and Noncontributory" wording. Certificate holder to include the City of E1 Segundo, its officials and employees. CERTIFICATE HOLDER CANCELLATION City of El Segundo Attn: Randal Collins 314 Main Street El Segundo, CA 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 R.L. Ring, Jr,/JL03 1988-2014 ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401) POLICY NUMBER: 5200-3389-00 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR. ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or anization(s) Locations Of Covered Operations Blanket Basis — Any entity that the named insured Any through written contract or agreement agrees to include as an additional insured. Item 4.b. of Section IV — commercial liability conditions is amended by the addition of the following: (3) this insur- ance is primary and /or noncontributory to any coverage afforded to the "additional insured" if a written contract or agreement states the named insured agrees to name a person or entity as an additional insured. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who 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. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 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. 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. Ali 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 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. 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 0413