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PROOF OF INSURANCE (2023) CLOSEDCERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYY1/) 04/05/2022 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 NAME: Hiscox Inc. d/b/a/ Hiscox Insurance Agency In CA PHONE (�"""" ����" 520 Madison Avenue E-MAIL 9 Y FAX contact@hiscox.com 3 01. 32nd Floor .Apn{ § sl ...�..........tact@hiscox.:.CO.m................................................... ......__________ New York, New York 10022 ............ INSURERLSIMFORDING COVERAGE NAIC # INSURERA: Hiscox Insurance Company Inc 10200 INSURED INSURER B Firestats LLC INSURERc.�...................................................................................................._._ 578 Sutton Way, #353 _.�. Grass Valley, CA 95945 INSURER O INSURER F COVERAGES CERTIFICATE NUMBER: 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. IIW§. _...uu--_..................... .---... POLICY EFF POLICY TYPE OF INSURANCE LTR POLICY NUMBER M D YY MMPDD Yt LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2 OOO OOO LK 100,000 CLAIMS -MADE OCCUR PREMISES Ea occurrence $ MED EXP_(Any one person) $ 5000 A ...... ..GEh9 ._......................................................... ....�..-....-.,� Y P100.278.491.12 05/20/2022 05/20/2023 PERSONAL&ADVINJURY _.. .... $ 2,000,000 m-....... ....................................... L A,G..SREC,A'1 E..._.. LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X.] PRO- POLICY „_] JECT LOC PRODUCTS -COMP/OPAGGw $www2,m000IT00Owwwwwwwwwwwwwwwwwww OTHER: $ AUTOMOBILE LIABILITY _.., COMBINEDSINGLE LIMIT Ear mccidenill $ .......................................... ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULEDBODILY INJURY (Per accident) ...................................._..,_ $ AUTOS AUTOS ............... 'P .$....µ..IT.......-.-...---�. .. NON -OWNED OPEkff5'AwpAGE ,_......... HIRED AUTOS .� AUTOS It.#.?Am-'........._.........__..............,.,�.........m., .......... .___..: UMBRELLA LIAB LCLAI,R EACH OCCURRENCE $ EXCESS LIAB -MADE AGGREGATE DED RETENTION $ $ WORKERS COMPENSATION PER OTH- �TAT-UTE ER AND EMPLOYERS' LIABILITY YIN E L EACH ACCIDENT Is ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A --"'---"'""— (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E"L. DISEASE - POLICY LIMIT 1 $ A Professional Liability Y P100.276.932.12 05/20/2022 05/20/2023 Each Claim: $ 1,000,000 Aggregate: $ 1.000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of El Segundo, its employees and officials are named as additional insured. The Hiscox General Liability Policy is Primary, subject to policy terms and c onditions. The City of El Segundo 350 Main Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE El Segundo, CA 90245 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE l ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD