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PROOF OF INSURANCE (2023) CLOSED
CERTIFICATE Off' LIABILITY INSURANCE DAI"E(M, �rDDYYY) 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 Aon Risk Services Northeast, Inc. (666) 283-7122 FAX (800) 363-0105 c/o Aon Client services (Arc. No. Exl)` A D. No ' 4 overlook Point E-MAIL ,Lincolnshire IL 60069 USA ADDRESS: INSURER(S) AFFORDING COVERAGE 1I NAIC # INSURED INSURER A: Liberty Mutual Fire Ins co 23035 Pintas corporation INSURER B: LM Insurance Corporation 33600 Attn: Accounts Payable 4320 E. Miraloma Avenue INSURERC: Liberty Insurance Corporation 42404 Anaheim CA 92807 USA INsuRER D: Westchester Fire Insurance Company 10030 INSURER E: INSURER F: s A%Mr7Af.CC. d".f*R"riF:I'ATF NIIIIIARFR• R7nnQ4f)t)&>n7 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. Limits shown are as requested POLICY EXP L7R TYPE OF INSURANCE pNSD WVD.' POLICY NUMBER MM+DDYY... Y MIG4'PCBL'pdYY'YY' LIMITS X COMMERCIAL GENERALLIABILITY TB EACH OCCURRENCE S2,000,000 ' LL CLAIMS -MADE I X V OCCUR PREMISES Ea occurrence $1, 000, 000 Contractual Liability MED EXP (Any one person) S5,000 X PERSONAL& ADV INJURY $1,000,000 GEEVLAGGR'EGATELIMITAPPLIESPER: GENERAL AGGREGATE $27000,000 POLICY JECOT- [E] LOC PRODUCTS - COMP/OPAGG $1,000,000 OTHER: A AUTOMOBILE LIABILITY AS2-651-004227-072 07/01/202207/01/2023' COMBINED I SINGLE LIMIT $5,000,000 0AOS BODILY INJURY ( Per person) X ANYAUTO BODILY INJURY (Per accident) OWNED SCHEDULED AUTOS ONLY AUTOS HI RED AUTOS NON -OWNED PROPERTY DAMAGE Per accident ONLY AUTOS ONLY X ',� t., Dmr0'CW $0 ded, D G22035277 17 07/01/2022 0710112023 EACH OCCURRENCE $5,000,000 X UMBRELLA LIAB X OCCUR EXCESS LIAR CLAIMS -MADE AGGREGATE SS , OOO, 000 DED 1, X RETENT*N $10,000 B WORKERS COMPENSATION AND WA565004227M 077U17=bT7Uf72b 3 X PER STATUTE OTH C EMPLOYERS' LIABILITY YIN WA765DO04227112 07/01/2022 07/01/2023 E.L. EACH ACCIDENT $2 000 000 B ANY PROPRIETOR / PARTNER / EXECUTIVE N / A WC5651004227122 07/01/2022 07/01/2023 , , OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE $2 , 000 , 000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT """""'"'- $2 , 000, 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of El Segundo, its officers, agents and employees are included as Additional Insured on the General Liability, but only with respect to work performed under contract between the certificate holder and the insured. 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. NJ City of El Segundo AUTHORIZED REPRESENTATIVE Public Works Department E1 Segundo City Hall 350 Main street (�J 1710 El Segundo CA 90245 USA tXiafs ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD rn LL LD .. c d 9 d 0 2 r N 0 0 v 0 n LO