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PROOF OF INSURANCE (2023) CLOSED•^""i' DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 04/05/2023 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME; AOn Risk services Northeast, Inc. PHONE (8F ) 66283 7122 <B00) 363-0105 New York NY office (A/C.No. Ezt: C... Nod• mmITITITmm one Liberty Plaza E-MAIL ADDRESS: 165 Broadway, Suite 3201 INSURER(S) AFFORDING COVERAGE -.-._ NAIC p New York NY 10006 USA pN,$gpdtEg'.. INSURERA: National Fire ins. Co. of Hartford 20478 INSURERB: The Continental insurance Company 35289 KOA Corporation 1100 Corporate Center Drive ." --American Casualty Co. of Reading PA 20427 Suite 201 INSURERC: ..om MontereyPark CA 91754 USA INsuRERo: Beazley insurance Company, Inc, D: 3 37540 INSURER E: ......................... INSURER F: 'P^%1c0APr.Q r:ER711l NUMBER, 570098902072 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, Limits shown are as reque,BtBtii INSR LTETYPE OF INSURANCE ADDL..SUBR rNsn vivoPOLICY NUMBER PDLYCW EFF POLICY EXP LIMITS B X COMMERCIAL GENERAL LIABILITY 1 444WDDfNYYYY EACHOCCURRENCE $1,000,000 DAMAGE TO RENTED m_ .....,.. $1,000,000 . Irk, j CLAIMS -MADE Y X uOCCUR MED EXP (Any one person) $15 , 000 PERSONALB ADV INJURY $1,000,000 ..... GENERAL AGGREGATE $ 2 , 000 , 00 ....... OEC �n 408RE,"G.ATB UM('T APPLIE5 PER PRO,...... POLICY 0 PRODUCTS -COMP/OPAGG $2,000,00 Er OTHER: Deductible $1,000,000 A 7018734438 05/01/2022 05/01/2023 COMBINED SINGLE LIMIT $1,000,000 AUTOMOBILE LIABILITY BODILY INJURY ( Per person) X ANY AUTO ...... OWNED SCHEDULED BODILY INJURY (Per acodent) ...... �.. ALTOS AUTOS ONLY PROPERTY DAMAGE HIRED AUTOS NON -OWNED Per OcxiderH� ONLY AUTOS ONLY I 7018734407 05/01/2022 05/01/2023 EACH OCCURRENCE $15000,00 B X UMBRELLA LAB X OCCUR AGGREGATE _. _. $15 , 000, 00 '', EXCESS LAB CLAIMS -MADE DEir X RF,'(ENIn"K;N Y10,000 C WORKERS COMPENSATION AND 7018734424 05/01/2022 05/01/2023 X.. PER STATUTE EMPLOYERS'LIABILITY ANYPROPRIETOR / PARTNER/ EXECUTIVE Y ON E L EACH ACCIDENT $1,000,000 N OFF ICER/MEMBER EXCLUDED' ..�... (Mandatory In NH) N / A ""'""""' E L DISEASE -EA EMPLOYEE "" $1,000,000 """"' It yes, describe under DESCRIPTION OF OPERATIONS below E LDISEASE-POLICY LIMIT $1,000,000 D Environmenta Contractor v2AEA4220301 05/01/2022 05/61/2023 Prof Limit $10,000,00 Poll/Prof [E&0] SIR $750,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more apace Is required) RE: job Project No: C26044, ENG 22-28: on Call Construction Inspection Services. City of El Segundo is included as Additional Insured in accordance with the policy provisions of the General Liability and Automobile Liability policies. General Liability policy evidenced herein is Primary and Non -Contributory to other insurance available to Additional Insured, but only in accordance with the policy's provisions. A waiver of Subrogation is granted in favor of City of E1 Segundo in accordance with the policy provisions of the General Liability, Automobile Liability and workers' Compensation policies. Should General Liability and Automobile Liability policies be cancelled before the expiration date thereof, the policy provisions of each policy will govern how notice of cancellation may be delivered to certificate holders in accordance with the policy provisions N 0 m 0 I- N CERTIFICATE HOLDER CANCELLATION 31 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 I AUTHORIZED REPRESENTATIVE Attn: Arianne Bola 350 Main St. E1 Segundo CA 90245-3813 USA V J. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks ofACORD AGENCY CUSTOMER ID: 570000088080 LOC #: ADDITIONAL REMARKS SCHEDULE Page _ of _ 4GENCY NAMED INSURED 4on Risk services Northeast, Inc. KOA corporation 'OLICY NUMBER See certificate Number: 570098902072 :ARRIER I'dAIC CODE See certificate Number: 570098902072 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance AddKI—I Description of Operations / Locations / Vehicles: of each policy. ACORD 101 (2006101) V 2111111 AGURD CORPUKA I IUN. All ngnts reserVee. The ACORD name and logo are registered marks of ACORD