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PROOF OF INSURANCE (2023) CLOSEDPage 1 of 2 � b CERTIFICATE OF LIABILITY INSURANCE °09/30/2022 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 ri hts to the certificate holder in lieu of such endorsement(s). Certificate Center W11118 PRODUCER TowersWatson Northeast, Inc.. CONTACTN,.. Willis Towers Watson — ---"1 888 4 PHONE _877 945 7378 ( 67-2, c/o 26 CenturyBlvd No P.O. Box 305191 E11AtL eeEwllis.com Nashville, TN 372305191 USA ER(S�AFFORDING COVERAGE "__ NAIC S mu ...--......, ... INSUR an INSURER A ACE an insurance Company 22667 Vn First Corporation and its Subsidiaries INSURED INSURERS ""Indemnitycinsurance Company of North Ameril 43575v. 68 Jonspin Road I RCp underwriters Insurance Company 20702 INSURE ACE Fire ..--- ......... ............... Wilmington, GIH 018871086 INSURER D : COVERAGE a CERTIFICATE NUMBER: W26180271 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. 7q a TYPE OF INSURANCE ADDL SUER POLICY NUMBER xp My00a YY YY LIMITS BP�VM�0 Y YY 4M O Y ,, X ', COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE 2,000, 000 �( i CLAIMS -MADE OCCUR 6" �I���P��-I 1,000,000 RES 4Ea occ„rran4�) w.. .. A X Contractual 5 00 MED EXP (Any one person) $ , Y Y HDOG47358966 10/01/2022I10/Ol/2023'PERSONAL&ADVINJURY $ - 0 1 aoo 000 CENL A( GaNtEzATC LIMIT API LIC S PER: GENERAL AGGREGATE $ 4,000,000 POLICY PRO % LOC PRODUCTS - COMP/OP AGO I$ 4,000,000 - - '.. r OTHER.: } AUTOMOBILELIABWTY C MMINED SIINaE 111,111 $ 4,000,000 GE.LcI5ig�xnlJ _..,._ X ANY AUTO BODILY INJURY (Per person) Is A j` SCHEDULED Y Y iSAR10769723 '..10/01/2022 `10/01/2023 BODILY INJURY (Per accident) Imo$ AUTOS ONLY I AUTOS _ .�— ..... .... . yOWNED HIRED NON -OWNED PIiDFER3YDA 1Fk4aE $ AUTOS ONLY AUTOS ONLY (Rsr.dw lwlc UMBRELLA UAB OCCUR EACH OCCURRENCE � � -. �.'s EXCESS LIAR CLA&'tit r•MADE AGGREGATE $ _. - DEfp RETENT6 71Q $ IYdORKERSCOMPENSATION X PE S1aTpJtk 0 AND EMPLOYERS' LIABILITY YIN - ..... , . 1, 000, 000 B-ANYPROPRIETORIPARTNERIEXECUTIVE N N / A Y OFFICERlMEMBEREXCLUDED? WLAC50740067 (A08) E L EACH ACCIDENT $ 10/OS/2022 10/01/2023I 1,000,000 (Mandatory In NH) E L DISEASE EA EMPLOYEEI $ II as, describe under E.L. DISEASE - POLICY LIMIT � $ 11000,000 0 SCRIPTION OF OPERATIONS, below A �Worksrs Compensation and Y WCUC50740250 (OH) 10/01/2022.10/01/202319L Each Accident i$1,000,000 ,Employers Liability EL Disease -Pol Limit,$1,000,000 Per Statute fEL Disease - Each Emir $1, 000, 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Division/Location: 324 Certificate Holder is an Additional Insured under the General Liability policy for bodily injury and/or property damage resulting from the work or product of the Named Insured where required by a written contract with the Named Insured. SEE ATTACHED 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: City Clerk City Clerk's Office, 350 main Street Room 5 El Segundo, CA 90245-3813 01988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SR ID; 23124884 nATCa: 2687345 2 of 3 32921 AGENCY CUSTOMER ID: LOC #: ACC ADDITIONAL REMARKS SCHEDULE Page z of 2 AGENCY NAMED INSURED Willis Towers Watson Northeast, Inca DniFiret Corporation and its Subsidiaries _.. - 68 Jonspin Road POLICY NUMBER Wilmington, M& 018871096 See Page 1 CARRIER NAIC CODE See Page 1 g EFFECTIVE DATE g See Page 1 See Page 1 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE. „- .., bib y Insurance Certificate of Liability Incur Certificate Holder is an Additional Insured for Auto Liability as their interest may appear if required by written contract. It is understood and agreed that UniFirst Corporation waives its right of subrogation against the Additional Insured which may arise by reason of a payment of claim under General Liability, Auto Liability and Workers Compensation policies, if required by written contract and as permitted by law. Additional Insureds: City of E1 Segundo, its officials, and employees. General Liability policy shall be Primary and Non-contributory with any other insurance in force for or which may be purchased by Additional Insureds. INSURER AFFORDING COVERAGE: ACE Fire Underwriters Insurance Company NAIC#: 20702 POLICY NUMBER: SCFC50740195 (WI) EFF DATE: 10/01/2022 EXP DATE: 10/01/2023 SUBROGATION WAIVED: Y TYPE OF INSURANCE: Workers Compensation and Employers Liability Per Statute LIMIT DESCRIPTION: EL Each Accident EL Disease -Pol Limit EL Disease - Each Emp LIMIT AMOUNT: $1,000,000 $1,000,000 $1,000,000 ACORD 101 (2008/01) ® 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 23124884 BATCH: 2687345 CERT: W26180171 POLICY NUMBER: HDOG47358966 Endorsement Number: COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Any person or organization whom you have agreed to include as an additional insured under a written contract, provided such contract was executed prior to the date of loss. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. © Insurance Services Office, Inc., 2018 Page 1 of 1 3 of 3 32921