PROOF OF INSURANCE (2022) CLOSEDCERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
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).
NTACT
PRODUCER Newfront Insurance Services NAME: Cert Request
777 Mariners Island Blvd Suite 250 PHONE 650-488-8565c N
San Mateo, CA 94404 E-MAIL
INSURER(S) AFFORDING COVERAGE
NAIC #
www.newfront.com
INSURER A; Berkley National Insurance Company
_www_38911
INSURED
INSURERS: Berkley II1SU.ranGe Company
29580„m
PowerDMS Parent Inc
PowerDMS Holdings Inc
INSURERc ____ ...........................................
PowerDMS Inc.
INSURERD:
101 S. Garland Ave, Ste 300
INSURERE:
Orlando, FL 32801
COVFRAnFS CFRTIFICOTF NIIMRFR• 7nn11AAA REVISION NLIMRFR-
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.
.............................. ........ ...,......�... ........
iNSf2 „„.„.„��-„„„„„„„„„„ SUBR,..,,,. POLICY MM/DD/YYYY MMIDDIYYYV ''... LIMITS
TYPE OF INSURANCE .... POLICY
LTR POLICY Y EFF POLICY EXP
A
COMMERCIAL GENERAL LIABILITY
TCP 7011473
8/25/2021
9/25/2022
EACH OCCURRENCE
$ 1 000 000A
CLAIMS -MADE OCCUR
Ala' � I�i�1"�„�.. WWWWWWWW
'.. PREMISES Ea occurrence
$ 1 000.000
MED EXP (Any one person)
$ 15 000
PERSONAL & ADV INJURY
$ 1 000 000
GENERAL
...........
$3,000,000
GEN•www
LAGGREGATELIMITAPPLIESPER:
POLICY PRCm. LOC
1ECT
PRODUCTS -COMP/OP AGG
j ._
$ 3,000 OOO ........
OTHER:
$
B
AUTOMOBILE
LIABILITY
TCA 7011474
8/25/2021
9/25/2022
COMBINED INGLITE LIMIT
$1,000,000
ANY AUTO
BODILY INJURY (Per person)
$
.......,..
OWNED SCHEDULED
AUTOS ONLY AUTOS
...... _ .......�............
BODILY INJURY (Per accident)
m_._ _ ......_..
"PROPERTY
.....
$
..
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
DAMAGEE
Pur as uAdrt„],,,
$.
11,
»'�..
A
✓
UMBRELLA LIAB / OCCUR
TCP 7011473
8/25/2021
9/25/2022
$1 000000
EXCESS LIAB CLAIMS -MADE
[�EcHAoccURRENCE
TE
DED ✓ RETENTION $10,000
$
AND EMPLOYERS' LIABILITYA WORKERS COMPENSATION
Y
TWC 7011475
8/25/2022
9/25/2022
�/ STER
EORH
E.L. EACH ACCIDENT
$ 1,000.000
OF ICERIMEMB REXCLUDED?ECUTIVE
N /A
(Mandatory in NH)
E.L.. DISEASE - EA EMPLOYEE
$ 1 Q
E-L. DISEASE -POLICY LIMIT
$ 1 000 000
If yes, describe under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
RE: All Operations of the Named Insured.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Clty of El Segundo Police Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
348 Main Street ACCORDANCE WITH THE POLICY PROVISIONS.
El Segundo, CA 90245
AUTHORIZED REPRESENTATIVE
� I
Rod Sockolov
01988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
70011433 1 21-22 All/E&O $1M I Patra (1) 18/30/2022 10:49:07 AM (PDT) I Page 1 of 1