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PROOF OF INSURANCE (2023) CLOSEDDATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 06/28,2022 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 NAME. Aon Risk Services Northeast, Inc. (866) 283-7122 (800) 363-0105 Stamford CT Office (RAJ No. Ex1).. 1600 Summer Street E-MAIL Stamford CT 06907-4907 USA ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: Tokio Marine America Insurance Company 10945 ZOLL Medical Corporation p INSURERS: Trans Pacific ins Co 41238 and subsidiaries 269 Mill Road INSURER C: Sompo America Fire & Marine Insurance Co 38997 Chelmsford MA 01824-4105 USA ...................... INSURER D: Federal Insurance Commpanpan_•y " "��� 20251 INSURER E: Mitsui Sumitomo insurance USA Inc. '..22551 INSURER F: COVERAGES CERTIFICATE NUMBER: 570094144090 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 INSR LTR TYPE OF INSURANCE IINSO', WVD POLICY NUMBER AiMM D1`YYN MMdg M Y Y LIMITS X COMMERCIAL GENERAL LIABILITY CLL '.. EACH OCCURRENCE $1, 000, 000 CLAIMS -MADE XX OCCUR rzT i PREMISES Ea occurrence) $100,000 www ''. MED EXP (Any one person) 15,000 PERSONAL & ADV INJURY $1, 000, 000 R rn GEN'L:AGGRFG:ATIC�LIMITAPPLIESPER: GENERAL AGGREGATE S2,000,000 X POLICY CAPE° F—]LOC PRODUCTS - COMP/OPAGG ...". ._..M....._.. EXcluded OTHER: o CD n A AUTOMOBILE LIABILITY CA640976105 07/01/2022 07/01/2023 COMBINED SINGLE LIMIT $1.000, 0001 Eaac�ciden[. .................. .. X ANYAUTO BODILY INJURY ( Per person) Z BODILY INJURY (Per accident) OWNED SCHEDULED Gr AUTOS AUTOS ONLY """""", NON -OWNED HIRED AUTOS PROPERTY DAMAGE ........ i0 p ..-,._ ONLY AUTOS ONLY Per accldenA. ......... _ fD E X UMBRELLALIAB X '.. OCCUR EX55200217 07/01/ 022 07/01/2023 EACH OCCURRENCE $25 , 000, 000 L) AGGREGATE I $25,000,005 _ EXCESS LAB '. CLAIMS -MADE I' DED I RETENTION C WORKERS COMPENSATION AND 3C040122wO 07/01/2022 07/01/ 0 X .PER STATUTE OTH• R TY YJ PPROPRIETOIRB A05 E L EACH ACCIDENT $1, OOO, OOO C AN AIR NER/EXECUTIVE """' � N.� NIA JCR40013N0 07/Ol/2022 07/Ol/2023 OFFICER/MEMBER EXCLUDED (Mandatory in NF♦) wi E.L. DISEASE -EA EMPLOYEE $1, 000, 000 II yes, describe under DESCRIPTION OF OPERATIONS below IMIT E.L. DISEASE -POLICY L $1, 000, 000.— D Products Liab 66 07/15/2022 07/15/2023 Rettro2Date 10/1/2004 $5$000,000 Deductoble0ps/Occ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) in Products Liability - claims made coverage. RE: Premises/Operations. City of El Segundo is included as Additional insured accordance with the policy provisions of the General Liability policy. A waiver of Subrogation is granted in favor of City of E1 Segundo in accordance with the policy provisions of the workers. Compensation 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 Attn: Carol Lynn Anderson 350 Main Street E1 Segundo CA 92045-3813 USA (�/% �, p JL ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD M AGENCY CUSTOMER ID: 570000083508 LOC #: ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY Aon Risk Services Northeast, Inc. NAMEDINSURED ZOLL Medical corporation POLICY NUMBER See certificate Number: 570094144090 CARRIER See Certificate Number: 570094144090 NAIL CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. INSR LTR TYPE OFINSURANCE ADDL INSD SUBR WVD POLICY NUMBER I POLICY EFFECTIVE DATE .. (MM/DD/YYYY) POLICY EXPIRATION DATE (MM/DD/YYYY) LIMITS '.. EXCESS LIABILITY p 79882432 EX Products Liab 07/15/2022 07/15/2023 Aggregate 15,000,000 Each Occurrence $5,000,000 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) POLICY NUMBER: JCD40122WO WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule PARTIES WITH WHOM THE INSURED HAS ENTERED INTO A WRITTEN WAIVER AGREEMENT PRIOR TO THE DATE OF LOSS. ***THIS ENDORSEMENT DOES NOT APPLY TO KENTUCKY, NEW HAMPSHIRE, AND NEW JERSEY. For policies or exposure in Missouri: Any person or organization for which the employer has agreed by written contract, executed prior to loss, may execute a waiver of subrogation. However, for purposes of work performed by the employer in Missouri, this waiver of subrogation does not apply to any construction group of classifications as designated by the waiver of right to recover from others (subrogation) rule in our manual. DATE OF ISSUE: 07-14-21 WC 00 03 13 (Ed. 4-84) © 1983 National Council on Compensation Insurance.