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PROOF OF INSURANCE (2023) CLOSEDDDfY m CERTIFICATEOF LIABILITY INSU ANCE DATE(MM,12/29/0212021 Y) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT'S 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: U the certificate holder ik an ADDITIONAL INSURED, the policy(les) 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 endorsernent(s). CONTACT PRODUCER NAME: AOn Risk Services Northeast, Inc. StE-2$3-7122 PAX (800) 363-0105 Aran Risk services Northeast, Inc. (Ac.No, Ex')° (vc"N'q")' NY NY Office E-MA)L One Liberty Plaza ADDRESS° 165 Broadway, suite 3201 INSURER(S) AFFORDING COVERAGE NAIC# New York NY 10006 USA '.INSURED INSURER A: Hartford Fire Insurance Co. 19 882 Bureau Veritas Technical Assessments LLC INSURER8: Trumbull Insurance company 2712.0 Owing MillRUM circle,1117suite 1100 MSURERC: AllianZ Global Risks US Insurance CO.. 35300 Owings MillsM11MD 21117 USA INSURER D: INSURER E: INSURER F: ,........ .. _. -.. _ _ ST LIED BELOW HAVE BEEN ISSUED TO THE INEf3ED NAMED A63VE FOR THE POLICY PERIOD IS TO CERTIFY THAT THE 'POLICIES OF INSURANCE US _ THIS NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS INDICATED. 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. Limits shown are as requested FINSURANCEPOLICY NUMBER fUM' DDlYYY DCMYYYY LTR TYPE NSU ANCELITY INSO, WVD -LIMITS $2,000n000 X COMMERCIAL USL 32-2 EACH OCCURRENCE $1,000,000 CLAIMS -MADE E OCCUR PREMISES Ea oocurrenca MED EXP (Any one person) $10 , 000 PERSONAL & ADV INJURY $2 ,000, 000 AGGREGATEGENERAL GE N'LAGGREGATE LIMIT APPLIES PER: PRO � LOC COMP/OPAGG $2,000,000 POLICY �X PRODUCTS JECT OTHER: A 10 AS S41202 01/01/2022 01/01/2023 COMBINED SINGLE LIMIT $2 000, 000 AUTOMOBILE LIABILITY Ea nt , AOS '.. 10 AB S41203 01/01/2022 01/01/2023 BODILY INJURY ( Per person) A X ANYAUTO SCHEDULED HI BODILY .INJURY (Per accident) OWNED AUTOS ONLY AUTOS PROPERTY DAMAGE HIREDAUTOS NON -OWNED (Per accident) ONLY AUTOS ONLY C 'OCCUR USLOO16 322 Ol Ol 022 01761/2021 EACH OCCURRENCE $1,000,000 X UMBRELLALIAB X AGGREGATE $1,000,000 EXCESS LIAB CLAIMS -MADE DED I X RETENTION$10,000 B WORKERS COMPENSATION AND loms41200 6 1 01 1 2023 X PER STATUTE OTRH, EMPLOYERS' LIABILITY YIN See State Policy Addendum E1, EACH ACCIDENT $1, 000, O00 ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED? S N / A ''.. E.L. DISEASE -EA EMPLOYEE $1,000,000 (Mandatoryin NH) If yes, describe under E.L. DISEASE•POUCY LIMIT $1,000,000 C DESCRIPTION OF OPERATIONS below Ar°Chi't&Eng Prof USFOO248022 01/01/2022 01./01/2023 Each Claim $1,000,000 Claims Made Aggregate $1,000,000 SIR applies per policy ter s & condiions DESCRIPTION OF OPERATIONS t LOCATIONS / VEHICLES (ACORD 101, Addhlonal Remarks Schedule, may Im altached if more space is required) Evidence of insurance. The Architects & Engineers policy includes coverage for Professional Liability and Contractors Pollution 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 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 A 1L v CO So m 0 0 r LO O Z r A V u", ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ADDITIONAL AGENCY Aon Risk services Northeast, Inc.. POLICY NUMBER see Certificate Number: 570090934951 CARRIER see Certificate Number: 570090934951 ADDITIONAL REMARKS AGENCY CUSTOMER ID: 570000048582 LOC #: REMARKS SCHEDULE Page _ of _ NAMED INSURED Bureau Veritas Technical Assessments LLC CODE EFFECTIVE DATE: p THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, II —FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance workers compensation/Employers Liability 1OWNS41200 01/01/22-01/01/23 Trumbull insurance AR,DC„IN,LA„NE,RI,UT 1OWNS41200 01./01/22-01/01/23 Twin City Eire ]insurance Company F-L,ND,OH,WA,WY 1OWNS41200 01/01/22-01/01/23 Hartford Insurance company of the Midwest AK,ID 1OWNS41200 01/01/22-01/01/23 Hartford casualty insurance Company MO,WV 1OWNS41200 01/01/22-01/01/23 Nutmeat insurance company CT,IL 10WNS41200 01/01/22-01/01/23 Hartford Eire insurance Company NH,OR,PA 1OWNS41200 01/01/22-01/01/23 Hartford Accident and indemnity Company AL,GA,KY,MI,MT,NY,TN,VT 1OWNS41200 01/01/22-01/01/23 Property & Casualty ins Co of Hartford C.A,CO,DE,ME, MN,MS,SC 10WNs41200 01/01/22-01/01/23 Hartford insurance company of T11incris T 10WNs41200 01/01/22-01/01/23 Hartford Insurance company of the Southeast KS,MD 1OWNS41200 01/01/22-01/01/23 Hartford Underwriters Insurance Company A7,HI,NC,N3,SD,VA 1OWNS41200 01/01/22-01/01/2'3 Sentinel insurance company, Limited IA,NM,NV,OK 10WBRS41201 01/01/22-01/01/23 Twin city Fire Insurance Company WI' 1OWBRS41201 01.101122°01/01/23 Hartford Underwriters insurance company MA 1OWBRS41201 01/01/22-01/01,/23 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