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PROOF OF INSURANCE (2023) CLOSED THE HARTFORD BUSINESS SERVICE CENTER 3600 WISEMAN BLVD SAN ANTONIO TX 78251April 29, 2022 The City of El Segundo, Its Officers, Officials, Employees, Agents & Volunteers 350 MAIN ST EL SEGUNDO CA 90245 Account Information: Contact Us Dr. Susan Saxe Clifford PhD Policy Holder Details : Need Help? Start a live chat online or call us at (866) 467-8730. We’re here weekdays from 8:00 AM to 8:00 PM ET. EnclosedpleasefindaCertificateOfInsurancefortheabovereferencedPolicyholder.Pleasecontactusifyouhaveany questions or concerns. Sincerely, Your Hartford Service Team WLTR005 DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 04/29/2022 THISCERTIFICATEISISSUEDASAMATTEROFINFORMATIONONLYANDCONFERSNORIGHTSUPONTHECERTIFICATEHOLDER. THISCERTIFICATEDOESNOTAFFIRMATIVELYORNEGATIVELYAMEND,EXTENDORALTERTHECOVERAGEAFFORDEDBYTHE POLICIESBELOW.THISCERTIFICATEOFINSURANCEDOESNOTCONSTITUTEACONTRACTBETWEENTHEISSUINGINSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT:IfthecertificateholderisanADDITIONALINSURED,thepolicy(ies)mustbeendorsed.IfSUBROGATIONISWAIVED, subjecttothetermsandconditionsofthepolicy,certainpoliciesmayrequireanendorsement.Astatementonthiscertificatedoesnot confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME: UNITED VALLEY INSURANCE SRVC/PHS FAX (866) 467-8730(888) 443-6112 PHONE 51131589 (A/C, No): (A/C, No, Ext): The Hartford Business Service Center E-MAIL 3600 Wiseman Blvd ADDRESS: San Antonio, TX 78251 INSURER(S) AFFORDING COVERAGENAIC# INSURED INSURER A : Sentinel Insurance Company Ltd.11000 Dr. Susan Saxe Clifford PhD INSURER B : 16530 VENTURA BLVD STE 603 INSURER C : ENCINOCA91436-5017 INSURER D: INSURER E : INSURER F : COVERAGESCERTIFICATE NUMBER:REVISION NUMBER: THISISTOCERTIFYTHATTHEPOLICIESOFINSURANCELISTEDBELOWHAVEBEENISSUEDTOTHEINSUREDNAMEDABOVEFORTHEPOLICYPERIOD INDICATED.NOTWITHSTANDINGANYREQUIREMENT,TERMORCONDITIONOFANYCONTRACTOROTHERDOCUMENTWITHRESPECTTOWHICHTHIS CERTIFICATEMAYBEISSUEDORMAYPERTAIN,THEINSURANCEAFFORDEDBYTHEPOLICIESDESCRIBEDHEREINISSUBJECTTOALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRADDLSUBRPOLICY EFFPOLICY EXP POLICY NUMBER TYPE OF INSURANCELIMITS LTRINSRWVD(MM/DD/YYYY)(MM/DD/Y YYY) EACH OCCURRENCE COMMERCIAL GENERAL LIABILITY $1,000,000 DAMAGE TO RENTED CLAIMS-MADEOCCUR $1,000,000 X PREMISES (Ea occurrence) General Liability $10,000 MED EXP (Any one person) X PERSONAL & ADV INJURY $1,000,000 AX51 SBA BA940504/29/202204/29/2023 X $2,000,000 GENERAL AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER: PRO- POLICYLOC $2,000,000 PRODUCTS - COMP/OP AGG X JECT OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY $1,000,000 (Ea accident) ANY AUTO BODILY INJURY (Per person) ALL OWNEDSCHEDULED BODILY INJURY (Per accident) A51 SBA BA940504/29/202204/29/2023 AUTOSAUTOS HIREDNON-OWNEDPROPERTY DAMAGE XX AUTOSAUTOS(Per accident) OCCUR EACH OCCURRENCE UMBRELLA LIAB CLAIMS- EXCESS LIAB AGGREGATE MADE DED RETENTION$ WORKERS COMPENSATIONPEROTH- AND EMPLOYERS' LIABILITYSTATUTE ER ANY Y/N E.L. EACH ACCIDENT PROPRIETOR/PARTNER/EXECUTIVE N/ A E.L. DISEASE -EA EMPLOYEE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - POLICY LIMIT 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) Those usual to the Insured's Operations. Certificate holder is an additional insured per the Business Liability Coverage Form SS0008 attached to this policy. Waiver of Subrogation applies in favor of the Certificate Holder per the Business Liability Coverage Form SS0008, attached to this policy. CERTIFICATE HOLDERCANCELLATION SHOULDANYOFTHEABOVEDESCRIBEDPOLICIESBECANCELLED The City of El Segundo, Its Officers, BEFORETHEEXPIRATIONDATETHEREOF,NOTICEWILLBEDELIVERED Officials, Employees, Agents & IN ACCORDANCE WITH THE POLICY PROVISIONS. Volunteers AUTHORIZED REPRESENTATIVE 350 MAIN ST EL SEGUNDO CA 90245 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD