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PROOF OF INSURANCE (2022) CLOSED1111 AC y,R DATE (MMIDD/YYYY) lr� CERTIFICATE OF LIABILITY INSURANCE 12/31/2022 10/14/20 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 INSURERS), 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 p CONTACT Lockton Companies NAME ,,... "" ....,. ....... 444 W. 47th Street, Suite 900 PHONE FAX (A/G, No, .Fx* , ( 9, Not Kansas City MO 64112-1906 MAIL.. (816) 960-9000AxaS wsuRER kctsu@lockton.com INSURER A : S3fCiV National S) AFFORDING COVERAGE NAIC # nal Casualtv Comoration 15105 INSURED UNITED SITE SERVICES OF CALIFORNIA, INC. INSURER B 1508610 118 FLANDERS ROAD, SUITE 1000 INSURER C WESTBOROUGH MA 01581 INSURER D INSURER E INSURER F [ RnVFRAC.FA CFRTIFIRATF NIIMRFR° It.Md"4"A«,.+x'".XA RFVISH)N NIIMRFR- ')r.""l""x""'X°yC"IM y 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,. YNSR AbDL sUBR POLICY w. ...., r. EFF POLICY EXP LTR TYPE OF INSURANCE I POLICY NUMBER MM/DD/YYYY1- LMM/DD/YYYY. _ _ LIMITS A X COMMERCIAL GENERAL LIABILITY Y N GL4057787 12/31/2021 12/31/2022 r EACH OCCURRENCE s2,000,000 ..C�At'i1A01 TO'k814iE1 ' $ 1,000,00 CLAIMS -MADE OCCUR ePfjEl,!(SES,I�a accurren,2e) 0 MED EXP (Any one person) S 1 O.000 PERSONAL & ADV INJURY $ 1.000.000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4 000 000 " PRO. . POLICY JrC'T LOC PRODUCTS - COMP/OP AGG $ 4,000,000 A AUTOMOBILE LIABILITY COhABINY O SINGLE L1191 y N CA6675838 i 12(:.§1/202.1 : 12(3'I.(2022 (.. J $ _ �� �Tb) � �ooron�� OWNED SCHEDULED INJURY (Per person) $XXXXXXX BODILY INJURY (Per accident) $ XXXXXXX r ANY AUTO F AUTOSONLY AUTOS HIRED NON -OWNED GJ9i4:JPC=I"�tY CWAMAGE -� AUTOS ONLY AUTOS ONLY Pdrr,.a n,nr9eriY, S XXXXXXX $XXXXXXX OCCUR _. 5...-yXXXXXXe,,,,,,.... UMBRELLA LIAB NOT APPLICABLE EACH OCCURRENCE x EXCESS LIAB CLAIMS -MADE '... AGGREGATE '.. $ XXXXXXX a,,,,,, ..... � . .. —. DED... RETENTION $ I $ XXXXXXX WORKERS COMPENSATION N ANY PROP R EMPLOYERS' LIABILITY _ ALDS4047370 12/31/2027 12/91/2022x PER AND Ro O BorvPER XICI..LI.DEDXECUTIVE Y� N A E LL EACH ACCIDENT ROFFICERNAEMFi $ 1. 000 000 Mandator In NH) i E L. DISEASE EA EMPLOYEE $ 1 000 000 „....,,_. a ,.�,. if OF OPERATIONS below E L, DISEASE POLICY LIMIT . S 1 000 000 1 f DESCRIPTION OF OPERATIONS t LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: HALLOWEEN FROLIC 2022. THE CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS, EMPLOYEES, AGENTS, AND VOLUNTEERS ARE NAMED AS ADDITIONAL INSUREDS AS RESPECTS TO GENERAL LIABILITY AND AUTOMOBILE LIABILITY COVERAGES ARISING OUT OF THE AC'I IVITIES PERFORMED BY OR ON BEHALF OF THE NAMED INSURED AS PER WRITTEN AGREEMENT, SUBJECT TO POLICY TERMS, CONDITIONS AND EXCLUSIONS. CERTIFICATE HOLDER CANCELLATION See Altachnienls 19035884 THE CITY OF EL SEGUNDO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 3SO MAIN STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN EL SEGUNDO, CA 90245-3813 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED ©198W015 ACORD CORPORATION. All rights reserved, ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: GL4057787 COMMERCIAL GENERAL LIABILITY CG 20 10 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Orcianization(s) As required by written contract or agreement when such written contract or agreement is executed prior to an occurrence, offense or loss to which this endorsement applies, but only for the limits agreed to in such contract or the Limits of Liability provided by this policy, whichever is less. Any individually scheduled additional insureds shall not be construed to override nor negate this blanket additional insured. Locations Of Covered Operation Location(s) of operations as per written contract or agreement between you and the Additional Insured. 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: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. 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. CG 20 10 12 19 CA6675838 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL AUTOMOBILE COVERAGE PART SCHEDULE Name of Additional Insured Persons or Organizations : Person(s) or orrg anizvat i.on (s) as rc.qu.I..r-ed by wi i..t:tctra c.craat rr.iCt . Any i..n d i t .i..ciura l.::l. y scheduied D , :.i.cln at:ced A.dd r.t ..I c. n a:l. Insured . laaa:.l.:.l.. not. h: e c orl ,t;irazc:xc'd. to over. i 'i.de nc:]r~ raeq at,ca t h.a -s tr l aarral,:a t Dex,c i gri ated k"ac:d.cii t ona a I Insured. CHANGE The person(s) or organization(s) shown in the Schedule above with whom you have agreed in a written contract to provide insurance such as is afforded under this Coverage Form, is included as an Additional Insured subject to the below: (1) Insurance for such Additional Insured(s) scheduled above shall be afforded only to the extent that such Additional Insured is liable for "bodily injury" or "property damage" arising out of your operations and resulting from the ownership, maintenance or use of covered "autos" by you while the covered "autos" are on premises owned or leased by the above scheduled Additional Insured(s). (2) The insurance afforded under this Coverage Form to such Additional Insured(s) applies only: (a) If the "accident" takes place subsequent to the execution and effective date of such written contract: and, (b) While such written contract is in force, or until the end of the policy period, which ever occurs first. (3) How Limits Apply to Additional Insured(s) The most we will pay on behalf of the Additional Insured(s) scheduled above is the lesser of: (a) The limits of insurance specified in the written contract or written agreement; or, (b) The Limits of Insurance provided by the Coverage Form. SNCA 026 10 13 Safety National Casualty Corporation