PROOF OF INSURANCE (2023) CLOSEDpage 2 of 3
Client#: 1165526 70BAKERTAY
CERTIFICATE
........., I LIABILITY DATE (MM/DD/VYYY)
11/04/2022
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 CO TACT NC Certificate Team
NAME,
McGriff Insurance Services PHorve j A
4777 Sharon Rd., 4th Floor MAIL I rC rda
AOP� ri"ff com ..®
NCCertrflcateTearrl rDc
Charlotte, NC 28210 �® INSURER(S)AFFORDING _ „�� COVERAGE NAIC #
INSURER A : Phoenix Insurance Company 25623
_................... INSURER B . Travelers Property.Cas .......... ..... ........ ... 2 4 _.
INsuAeD ... � � . „� ���. - — Casualty Co of Amer 25674
Baker & Taylor, LLC m �... . _ ......... ...._ ......
y INSURER C : Great American Alliance Insurance Co. 26832
2810 Coliseum Center Drive, Suite 300 �._ .._.. .__._._ ......... _m..
INSURER D ;
Charlotte, NC 28217
INSURER E :
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.
IN$A AORLSUBR
`A TYPE OF INSURANCE p gypX
POI ICY EFF" POt oCY ExP LIMITS _ L
POLICY NUMBER I1
X COMMERCIAL GENERAL LIABILITY X
6304T145579 2/2022 11/02/2023� EACH OCCURRENCE
�$.1,000,000
CLAIMS -MADE � X1 OCCUR
DAMAGE TO RENTED
S
IXLE,a occurrence)
J $1 OOO OOO
ne rs
MED EP(Any opeon}
$10,000
PERSONAL&ADVINJURY""",,,$1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: -
GENERAL. AGGREGATE
S 2,01[10,000
PRO'
POLICY JECT �.!�... LOC
PRODUCT5 COMP/OP AGG
$ 2 O00 OOO
�. a
... ...�
s1HeR.
� �
BAOMOBILE LIABILITY
�CI111EDSINeLL'i P/wT
BA9T408637 1/02022 .
$1 000,000
AUTO
BODILY INJURY Per person)
,
$XANY
OWNED SCHEDULED
AUTOS O AUTOS
AUTOS
BODILY IN. JURY (Per accident)
$
.....
HIRED ON -OWNED
AUTOS ONLY AUTOS ONLY
TY UAMAGE
( ? „m
$
B X UMBRELLA X CCLaMs-MADE
CUP9T481644 1/02/2022 11/02/2023 EAGGA"O C RENCE_
.....
$25 000,000
Excess ABAB
e
$ x 000
„
DED X,RETENTION$10,000
_-
$
,..
C
�.�. ,,..�.. �,,,,,,,,,,,,,,, , ...., ,,,,, -..,___
WC.. „
E78380200 1/02/2022 11/02/2023,X STATUTE �,." ..
MPLOYERS' LIABILITY Y A
d4h&'MPW3CNPRIETCiR/rARTNERAE�S4C.'GUi4V(n N
OFF CeRPFiliEUEIREkCLUDED? N/A,
DENT
(Mandatory In NH)1,000�000
f E.L.E.L.DSEASECIEAEMPLOYEE $,1,000,000
If yes, describe under
. , DESCRIPTION OF OPERATIONS below
E L DISEASE POLICY LIMIT
,.......... ,........ ...... .
$1 000 000
r �t
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more space Is required)
** Workers Comp Information **
Workers Compensation coverage applies for
this certificate as the policy states for section 3A and 3C but
regardless does not apply for any of the following
monopolistic states: ND, WY, OH, WA
The City of El Segundo, its officials, and employees are named as Additional Insured and coverage is Primary
(See Attached Descriptions)
t'r-RTIFW.ATP wnt nFR
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
®1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) 1 of 2 The ACORD name and logo are registered marks of ACORD
1825 #S31018806/M31006563 KTA
SAQITTA 25.3 (2016/03) 2 Of 2
#S31018806/M31006563
Im
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