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PROOF OF INSURANCE (2024) CLOSEDM_ DMM/DD/YYYY) CE TI ICAT OF LIABILITY INSURANCE ATE( 06/27/2D23 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIF'I!CATE 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(tes) musthave ADDITIONAL INSURED provisions or he endorsed, If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this 2 certificate does not confer rights to the certificate holder in lieu of such a dorse"nl(s), � .PRODUCER CONTACT' -gyp Aon Risk Services Northeast, Inc. NAME. Stamford R office (AC, N , E, xI: (866) 283-7122 C Nsr . (B00) 363-01o5 a 1600 summer street 5-MAIL Eas Stamford CT 06907-4907 USA INSURER(S) AFFORDING COVERAGE NAIC # 'INSURED INSURER A: TOkio Marine America insurance Company '10945 ZOLL Medical Corporation INSURERB: Trans Pacific Ins co 41.238 and subsidiaries 269 Mill Road INSURERC: Sompo America Fire & Marine insurance Co 38997 Chelmsford MA 01824-4105 USA INSURERD: Mitsui Sumitomo insurance USA Inc. 22551 INSURERE: SOmpO America insurance Company 11.1.26 INSURER F: COVERAGES CERTIFICATE NUMBER: 570100287754 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 muesletl INSH L R, TYPE OF INSURANCE AUDLISUBII D Vy'lIM7.. POLICY NUMBER IDDPYYY MM D pYrpyyr', LIMITS X COMMERCIALGENER�A�L-PLIABILITY LL ry EACH OCCURRENCE $1,000,000. CLAIMS -MADE RX VOCCUR .� PR@7MIhU"S Eud�cocrrrtyr9Ce. $100,000..... MED EXP (Any one person) S5,000 PERSONAL & ADV INJURY $110001000 � N-LIMITAPPLIESPER: GENERAL AGGREGATE '., $2,000,600 f X iPOLaCY ED JE � ElLOC PRODUCTS - COMP/OP AGG $ 2 , 000 , 000 0 OTHER: r I r` A AUTOMOBILE LIABILITY CA6409761-06 07/Cul/2023 07/Ol./'202+i CLOMBINED SINGLE'.. LIMIT $1, 000, 000 LID X ANY AUTO BODILY I NJURY ( Per person) C Z OWNED SCHEDULED BODILYINJURY (Per a.Id.nl) '.. 0 AUTOS ONLY AUTOS HIRED AUTOS NON -OWNED PROPERTYDAMAGE ONLY AUTOS ONLY Pear acc Jaara' t: D UMBRELLALIAB X OCCUR EX552.00217 '7 O1/2 0 /'2 2'4 EACH OCCURRENCE 3170010,000 (v L) X EXCESS I. CLAIMS -MADE AGGREGATE $15 , 000, O'00 D'EO I RETENTION C7 WORKERS COMPENSATIONAN'D JCD401' ww 7 1 0: 1 2 4 ' X PERSTATUTE OTH• YIN EMPLOYERS' LIABILITY AOS E. R C ANY PROPRIETOR/ PARTNER/ EXECUTIVE OFFICERIMOEXCLUDED? N N/A ]CR40013NO 07/01/2023 07/01/2024 E.LII:RfliaiEACH ACCIDENT $1, 000, 000 (Mandawry in NIA Wd E.L. DISEASE -EA EMPLOYEE S1,000,000 II'yy�tl5 IJrAS�ir�4 dtndal DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT - $1, 000, 000 -� DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 1 Additional Schedule, may attached If more space required) o l ude d n c RE: Premises/operations. City of El Segundo is included as Additional Insured in accordance with the policy provisions of the , p ogation is granted in favor of City of E1 Segundo in accordance with the policy General Liability policy. Cy . A waiver r Of Subrogation provisions of the workers' compensation policy. nq CERTIFICATE HOLDER CANCELLATION - g SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE m POLICY PROVISIONS. o City Of El Segundo AUTHORIZED REPRESENTATIVE Attn: Carol Lynn Anderson o 350 Main Street E1 Segundo CA 92045-3813 USA ,«' �i1'oazwo "IIIL o g ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000083508 LOC #: ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMED INSURED Aon Risk services Northeast, Inc, ZOLL Medical Corporation POLICY NUMBER see certificate Number: 570100287754 CARRIER NAIC CCDE See certificate Number: 570100287754 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liabilliv Insurance I' INSURER(S) AFFORDING COVERAGE I NAIC # I INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. INSR.L.. LTR TYPE OF INSURANCE EXCESS LIABILITY '.ADDL INSD SUBR '.WVD POLICYNUMBER POLICY EFFECTIVE DATE (MM/DD/YYYY) POLIC:Y... EXPIRATION DATE (MM/DD/YYYY) LIMITS E UUX40172UO 07/01/2023!07/01/2024 'Aggregate $10,000,000 Each $10,000,000 Occurrence ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) POLICY NUMBER: JCD40122WO WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule PARTIES WITH WHOM THE INSURED HAS ENTERED INTO A WRITTEN WAIVER AGREEMENT PRIOR TO THE DATE OF LOSS. ***THIS ENDORSEMENT DOES NOT APPLY TO KENTUCKY, NEW HAMPSHIRE, AND NEW JERSEY. For policies or exposure in Missouri: Any person or organization for which the employer has agreed by written contract, executed prior to loss, may execute a waiver of subrogation. However, for purposes of work performed by the employer in Missouri, this waiver of subrogation does not apply to any construction group of classifications as designated by the waiver of right to recover from others (subrogation) rule in our manual. DATE OF ISSUE: 07-14-21 WC 00 03 13 (Ed. 4-84) © 1983 National Council on Compensation Insurance.