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PROOF OF INSURANCE (2022 - 2023) CLOSED (2)DATE (MMIDD/YYYY) ►��"` CERTIFICATE OF LIABILITY INSURANCE 4/1 /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 CONTACT NA1 Stao Paine - �.. _ _ alne 53 FAx 212-607. 15415 Middlebelt Road (Arc Nod -1160 Livonia MI 48154arsh & an Agency LLC ADDREssxtta - marshfrleTsa Dorn 9 Y 73�t 525 24 E-MAnit y.L .. _ ........, -- .. INSURRfS')AFFORDINGCOVERAGE ... ________ NAWC'r� - INSURER A:_ Federal Insurance Company 20281 INSURED IndemnityCo of America velers In INSURER B Travelers � 25666 OCLC, Inc.In OCL , r Place e — __ iMsuRER c : Westchester Surplus. Lines Insurance Co 10172 Dublin OH 43017 INSURERD: Landmark Insurance Comp�� 35637 INSURER E rf11/FRAnPQ rFRTIFIrATF NIIMRFR• 1117AR917 RFVISION NI1MRFR- 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. LTR TYPE OF INSURANCE SIVBR POLICY NUMBER J MVRPn Y'Y CNbg DD/YYXX ....S INSR iADDLPOLICY LIMITS A X COMMERCIAL GENERAL LIABILITY 35756671 3/1/2022 3/1/2023 EACH OCCURRENCE $ 1,000,000 .......... ,..,.. I.... M bAivfA'0ZT i i�LNTii t 000 $ 1 000 CLAIMS -MADE OCCUR PREMISI�S,`LEa ggqyr,r9,n m.m ` ___... --- ................... MED EXP (Any one person) $ 10,000 ...-.......— -- ........................... PERSONAL&ADV INJURY $1,000,000 . GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000.000 PRO- LOC PRODUCTS -COMP/OP AGG X.... X �i JECT $ 2 000,000 $ AUTOMOBILE LIABILITY COMBINEDSINGLE LIMrr I.O n0-------- $ ........ _... f ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED I BODILY INJURY (Peerr accident) $ AUTOS ONLY AUTOS HIRED NON -OWNED ... .. PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY {Per accident]____-- ....„., Is UMBRELLA OCCUR EACH OCCURRENCE $ T11111111— EXCESS LIAB CLAIMS -MADE .._._._ AGGREGATE ....... ................. $ DED L RETENTION $ $ B WORKERS COMPENSATION UB8J443127 12/31/2021 12/31/2022 X PER OTH ER YIN ANYPROOFFICER/MEMBER OEXCLUDEE? ECUTIVE E L EACH ACCIDENT $ 1 000 000 N 1 A _ Mandatory in NH ( ) E L DISEASEE EA EMPLOYEE $1 000,0 00 If yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE- POLICY LIMIT $ 1,000,000 C Cyber Uab)Ftofessional Liab F1564509A 4/2/2022 4/2/2023 Limit $5,000,000 D Excess E40rOyber LHZ788093 4/2/2022 4/2/2023 Limit $2,000,000 (Claims Made) Retention $100,000 I DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of El Segundo, its officials„ and emplo ees are included as additional insured for commercial general liability on a primary and non-contributory basis to the extent provided in the attached form #80-0 2367; and as additional insured for professional/cyber liability coverage to the extent provided in the attached form #PF-48238. The commercial general liability insurance carrier will provide the Certificate Holder with direct notice of cancellation to the extent provided in the attached form 80-02-9779. GERI IFIGA It HULL)tK l.ANk LLLA I IUN 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 350 Main Street El Segundo CA 90245 AurFIOR¢EDREP61Es¢TAr1VE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD CHUBS" Liability Insurance Endorsement Policy Period Effective Date Policy Number Insured Name of Company Date Issued This Endorsement applies to the following forms: GENERAL LIABILrrY LIQUOR LIABILrrY Who Is An Insured Additional Insured - Scheduled Person Or Organization MARCH 1, 2019 TO MARCH 1, 2020 MARCH 1, 2019 3575-66-71 CHI OCLC, INC. FEDERAL INSURANCE COMPANY MARCH 19, 2019 Under Who Is An Insured, the following provision is added. Persons or organizations shown in the Schedule are insureds; but they are insureds only if you are obligated pursuant to a contract or agreement to provide them with such insurance as is afforded by this policy. However, the person or organization is an insured only: • if and then only to the extent the person or organization is described in the Schedule; • to the extent such contract or agreement requires the person or organization to be afforded status as an insured; • for activities that did not occur, in whole or in part, before the execution of the contract or agreement; and • with respect to damages, loss, cost or expense for injury or damage to which this insurance applies. No person or organization is an insured under this provision: • that is more specifically identified under any other provision of the Who Is An Insured section (regardless of any limitation applicable thereto). • with respect to any assumption of liability (of another person or organization) by them in a contract or agreement. This 'limitation does not apply to the liability for damages, loss, cost or expense for injury or damage, to which this insurance applies, that the person or organization would have in the absence of such contract or agreement. Liability Insurance Additional Insured - Scheduled Person Or Organization continued Form 80-02-2367 (Rev. 5-07) Endorsement Page 1 Liability Endorsement (continued) Under Conditions, the following provision is added to the condition titled Other Insurance. Conditions Other Insurance — If you are obligated, pursuant to a contract or agreement, to provide the person or organization Primary, Noncontributory shown in the Schedule with primary insurance such as is afforded by this policy, then in such case Insurance — Scheduled this insurance is primary and we will not seek contribution from insurance available to such person Person Or Organization or organization. Schedule Persons or organizations that you are obligated, pursuant to a contract or agreement, to provide with such insurance as is afforded by this policy. All other terms and conditions remain unchanged. Authorized Representative. " Liability Insurance Additional Insured - Scheduled Person Or Organisation last page Form 80-02-2367 (Rev. 5-07) Endorsement Page 2 Policy Conditions Endorsement Policy Period Effective Date Policy Number Insured Name of Company Date Issued This Endorsement applies to the following forms; COMMON POLICY CONDITIONS www A 0 Under Conditions, the following condition is added. Conditions Notice Of Cancellation When we cancel this policy for any reason, other than non-payment of premium, we will notify To Scheduled Persons person(s) or organization(s) shown in the Schedule at least 30 days in advance of the cancellation Or Organizations When date. We Cancel Any failure by us to notify such person(s) or organization(s) will not: • impose any liability or obligation of any kind upon us; or • invalidate such cancellation. Schedule Person(s) or Organization (s) : Address: Notice Of Cancekggbjf 4U'JRWWbdQ&Pys Or Organizations Policy Conditions (Except Non -Payment Of Premium) continued Form 80-02-9779 (Ed. 3-11) Endorsement Page 1 Conditions (continued) All other terms and conditions remain unchanged. Authorized Representative Notice Of Cancellationft fA rsGVpt_Wrganizations Policy Conditions (Except Non -Payment Of Premium) last page Form 80-02-9779 (Ed. 3-11) Endorsement Page 2 Additional Insured - Blanket Pursuant to a Contract - DigiTech® THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: Chubb DigiTech® Enterprise Risk Management Policy It is agreed that Section II, Definitions, Insured, subparagraph 6 is deleted and replaced with the following: 6. any natural person or entity for whom an Organization is required by written contract or agreement to provide insurance coverage under this Policy (hereinafter "Additional Insured"), but only with respect to Claims: a. arising out of any Incident committed after the Organization and the Additional Insured entered into such written contract or agreement; b. for any Incident committed by, on behalf of, or at the direction of the Organization; and c. subject to the lesser of the limits of insurance required by such written contract or agreement between the Organization and the Additional Insured, or the applicable Limits of Insurance of this Policy. However, no natural person or entity shall be an Additional Insured with respect to any Claim arising solely out of such natural person's or entity's independent act, error, or omission. In the event of a disagreement between the Named Insured and the natural person or entity as to whether the Claim arises solely out of such natural person's or entity's independent act, error, or omission, it is agreed that the Insurer shall abide by the determination of the Named Insured on this issue, and such determination shall be made by the Named Insured within 20 days of the notification of the applicable Claim. All other terms and conditions of this Policy remain unchanged. PF-48238 (og/16) Page i of 1