PROOF OF INSURANCE (2023) CLOSEDPage 1 of 1
1 w'Id9 DATE (MWDD/YYYY)
- CERTIFICATE OF LIABILITY INSURANCE 07/27/2022
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 Willis Towers Watson Certificate Center
NAMC_
1-877 945-737 - --
Willis of New Jersey, Inc.PHONE ..._.
..
c/o 26 Century Blvd A 8 1-888-467-2378
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E NSfkIL certi£icatesPwillia.com
P .O. Sax 305191 '.JiID(1..... ......,......,.._..._,...,,,.,._..._�..._.,.-._
Nashville, TN 372305191 USA
_INSURERS) AFFORDING COVERAGE NAIC q
INSURERA: 22551
Mitsui Sumitomo Insurance USA Inc -�� _
INSURED INSURERB: Mitsui Sumitomo Insurance Company of Ames.! 20362
Serlitz Corporation ... ..--, ..,.__, �- _ __.— ........,.n
INSURER C : _
7 Roszel Road ._�...... ............. .............. ....�. r..,
Princeton, NJ 08540 INSURER D :
INSURER E s
vv.�.,....a..v..s,....�,. ......__... ---- - -- --- -
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.
tNSA TYPEOFINSURANCE AD'kiL�SUBFfI"""" .e., . ,m. OLICYNU ER , ,,.�9A01,CpIDVyY'M' � PO.frw.YE)y
LTR : - - Y MMfCYDd"YYYY 1 LIMITS
X 1 COMMERCIAL GENERAL LIABILITY FACHOCCURRENCE $ 1,000, 000
ry Iti �I~TT 1,000,000
A .. 1 OCCUR i (rF f9(P rr,( sro �aprrtJ':Iaua�Y ,..,$
CLAIMS -MADE
MEb EXP (Any one oerson)
10,000
= PKG3000272 08/01/2022 08/01/2023 PERSONAL&ADVINJURY $ 1,000,000
G"EN L �AGG11EGATq� LIMIT APPLIES -
.........
{ S 2,000,000
PLXiES PER: PRODUCTSGCOMP/OP
POLICY , PRO- 1 000, 000
...�: JECT ._ .....I LOC �...�.�....._. AGO I S ...
OTHER f I � $ ..�..
AUTOMOBILE LIABILITY COIhd31 D SINOLE OMI
SA Hru rk rrI 1,000,000 ,(m.. person)
,� $.......
ANY AUTO BODILY INJURY Per on $
HIRED NON OWNED PROPERTY INJURY (Per accident) $
X t AUTOS ONLY X AUTOS ONLY
I.r roc-elrtny�
_ AUTOS ONLY AUTOS 4 BODILY }AMAC"�'
B -OWNED' SCHEDULED BVR8302170 OB/O1/2022 08/O1/2023 B
s
X UMBRELLA LIAR X � 10,000,000
A _J t LAllt +MADE ? AGGREGATEOCCURRENCE $ _
E%CESSLJAB OCCUR Ut4B5500107 OB/O1/2022 08/O1/2023I 5 10,000,000
DED X I 11ETCN71C,NS 10,000
O H
AND EMPLOYERS' LIABILITY x TA7I�7Ew FR
WORKERS COMPENSATION 5 R
B ANYPROFFICER/MEMBER
FFICE /MEMB REXC EXCLUDED
ECUTIVE L �� EI i AA GMI: LIJ D �YII II S 1, 000 000
OFFICER MEMBEREXCLUDED. N
NIA � WCP9001200 OB/O1/2022 D8/Ol/2023 �_� 1,000,000
(Mandatory In H) c 1,000, 000',
If yes, dew> vibe under
DESCRIPTION OF OPERATIONS below E.L, DISEASE • POLICY LIMIT 4
s i
I
I
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space Is required)
It is agreed that City of EL Segundo, the officers, officials, employees and volunteers are included as Additional
Insureds as respects to General Liability policy. It is further agreed that such insurance as is afforded shall be
primary and non-contributory with any other insurance in force for or which may be purchased by Additional Insureds.
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.
AUTHORIZED REPRESENTATIVE
City of EL Segundo
350 Main Street
El Segundo, CA 90245 /
01988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
SR ID, 22878633 saace: 2610664
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