PROOF OF INSURANCE (2023) CLOSEDClient#: 1635640
MATRICON2
ACORDTM CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
1 8/01/2022
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 any rights to the certificate holder in lieu of such endorsement(s).
PRODUCER
CONTACT Christine Torrance
NAME:
USI Insurance Services, LLC
PHONE 602 666-4830 FAX 610 537-2283
A/C, No, Ext : (A/C, No):
2375 E. Camelback Road, Suite 250
E-MAIL ADDRESS: christine.torrance@usi.com
Phoenix, AZ 85016
INSURER(S) AFFORDING COVERAGE
NAIC #
877 468-6516
Sentinel Insurance Company Ltd.
INSURER A: P y
11000
INSURED
INSURER B : Hartford - WC Multiple Issuing COS
00914
Matrix Consulting Group, Ltd
INSURER C : Twin City Fire Insurance Company
29459
1650 S Amphlett Blvd, Ste 213
San Mateo, CA 94402-1234
INSURER D
INSURER E
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 CONTRACTOR 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.
LTR
TYPE OF INSURANCE
ADDLSUBR
NSR
WVD
POLICY NUMBER
POLICY EFF
(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY)
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
59SBAR00849
08/08/2022
08/08/2023
EACH OCCURRENCE
$2,000,000
CLAIMS -MADE [* OCCUR
PREMI6ESOEa oNcurrDence
$1 ,000,000
MED EXP (Any one person)
$10,000
PERSONAL & ADV INJURY
$2,000,000
GEN'L
AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$4,000,000
PRO -
POLICY X JECT LOC
PRODUCTS-COMP/OPAGG
$4,000,000
$
OTHER:
A
AUTOMOBILE
LIABILITY
59SBAR00849
08/08/2022
08/08/202
(CEO, aBc,den SINGLE LIMIT
$2,000,000
BODILY INJURY (Per person)
$
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
X
HIRED NON -OWNED
AUTOS ONLY X AUTOS ONLY
A
X
UMBRELLA LAB
X
OCCUR
59SBAR00849
08/08/2022
08/08/2023
EACH OCCURRENCE
$3 OOO 000
AGGREGATE
s3,000,000
EXCESS LAB
CLAIMS -MADE
DED X RETENTION $10,000
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N
OFFICER/MEMBER EXCLUDED?
N / A
59WECAB6SO4
08/08/2022
08/08/202
O
X STATUTE ERH
E.L. EACH ACCIDENT
$1 ,000,000
E.L. DISEASE - EA EMPLOYEE
$1 ,000,000
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
1 $1 ,000,000
C
Professional Liab
59PGO297372
08/08/2022
08/08/2023
$2,000,000/$3,000,000
$10,000 ded/each claim
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
General Liability, including completed operations, and Auto Liability include an automatic Additional
Insured endorsement that provides Additional Insured status to the Certificate Holder, only when there is a
written contract or written agreement between the named insured and the certificate holder and with regard
to work performed by or on behalf of the named insured. General Liability, Auto Liability and Workers
Compensation provide a blanket Waiver of Subrogation in favor of the same, when required by written
(See Attached Descriptions)
CERTIFICATE HOLDER CANCELLATION
City of El Segundo
350 Main Street
El Segundo, CA 90245
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
n %9$5-2015 ACORD CORPORATION. All riahts reserved
ACORD 25 (2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD
#S36901352/M36888065 DGSZP
DESCRIPTIONS (Continued from Page 1)
contract. General Liability and Auto Liability contain a special endorsement with "Primary and Non-
contributory" wording, when required by written contract. This form is subject to any/all respective policy
provisions.
Additional Insured: City of El Segundo, its officials, and employees
SAGITTA 25.3 (2016/03) 2 of 2
#S36901352/M36888065