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PROOF OF INSURANCE (2024) CLOSED
�.., DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 06/26/2023 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 NAMEz AOn Risk Services Central, Inc,PHONE Omaha NE office (402) 697-1400 FAX (402) 697-0017 OVC. No. Ext): AC. No,„ 17807 Burke Street E-MAIL suite 401 ADDRESS: Omaha NE 68118 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: Travelers Property Cas CO of America 25674 Musco Sports Lighting, LLC INSURER B: Sentry Casualty Company 28460 c/o Musco Corporation 100 15t Ave w INSURERC: Sentry Insurance Company 24988 Oskaloosa IA 52577 USA INSURERD: Indian Harbor insurance Company 36940 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER 57010045214 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 requested INSH LTR TYPE OF INSURANCE 9NS..D VMVCi POLICY NUMBER M iy5/yyy pgM,�DDtYYYy '... LIMITS X COMMERCIAL GENER�A—L—LyIABILITY EACH OCCURRENCE $1, 000, 000 CLAIMS -MADE Y X II OCCUR L..... x PREMISES Ea occcTurrencet $1, 000, OOO MED EXP (Any one person) $10 , 000 PERSONAL& ADV INJURY $1,0001000'.... GEN'LAGGREGATE LIMITAP'PUE,S PER: GENERAL AGGREGATE $2 , 000, 000 POLICY 17t II PE � FILOC t...�� PRODUCTS - COMP/OP AGO $ 2 , 000 , 000 o OTHER: c AUTOMOBILE LIABILITY Y 90 16877 003 07/01/2023 07/01/2024 COMBINED SINGLE LIMIT 4Ea acridenfil_ $1,000,000 X ANYAUTO BODILY INJURY (Per person) .. O Z BODILY INJURY (Per accident) OWNED SCHEDULED AUTOS ONLY AUTOS HIREDAUTOS NON -OWNED PROPERTY DAMAGE US U ONLY AUTOS ONLY (Per accident) LL G! A X UMBRELLA LIAR X OCCUR CUP35ri3 3 023NF 07 1 O'7/0'1/ 0 4 EACH OCCURRENCE $10,000,000 U AGGREGATE $10,000,000 EXCESS LIAB CLAIMS -MADE ED.... RETE0JtON . B WORKERS COMPENSATION AND 9016877001 0 4 X PER STATUTE OTH- Y A05 � B N NIA A 9016877002 07/01/2023 07/01/2024 E L. EACH ACCIDENT $1, 000, 000 ' LU ED?EXECUTIVE OPRCERIMEMBERRR EXCLUDED? (Mandatory in NH) AZ, WI E L DISEASE -EA EMPLOYEE $1, 000, 000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. EASE POLICY LIMIT $1, 000, 000 o Architects &Engineers CEO'742"11 903 07/01/2023 07/01/20'24 Aggregate $5',000,000 Professional Claims -Made SIR $250,000 SIR applies per policy terns & conditions Each Claim $5,000,000 21 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) RE: Musco Project SVC-468450 - Campus El Segundo Athletic Fields. City of El Segundo along with its officials and employees are included as Additional insured in accordance Liability Automobile with the policy provisions of the General Liability and Automobile Liability Liability herein Non policies. General and insurance available to Additional Insured, policies evidenced are Primary and -Contributory to other but only in accordance with the policy's provisions. CERTIFICATE HOLDER CANCELLATION 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 AUTHORIZED REPRESENTATIVE 350 Main St. E1 Segundo CA 90245 USA - ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 214191910111IMMIU "JUM111-MM-063MMIll IMMUZURM CG 20 10 12 19 END] A Mfftw,�� Wall This endorsement modifies insurance provided under the follovAng: Name Of Additional Insured Person(sli Or Organizatis) Location1s) Of Covered Operations Information required to complete this Schedtille, if not, shovm a bove, will too shown in the Ded arations. X Section 11 - Who Is An Insured is amended to include as an additional 1111SUr ed the personW or organization(s) shown in the SchedUle, but only with respect to liabdity, for "bodily injury", .'property damage" or "personW and advertising injur/' caused, in whole or in part, by, 1�„ Your acts or omissions; or 2. The, �acts or omissions of those acting on your blehalf, in the perform anine of your ongoing operations for the additional in at the locaton(s) designated above. Hawever 1 . The insurance afforded to such additional insured only applies to the extent permiitted 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 ,sill not be broader than that whichi YOU are required by the contract or agreement to provide for such additional insured. CG 20- 10 12 19 go I 6BT-1 Sentry lnsuram* Company CM I MO=DM 23 i7A 0 N, & With respect to the [nsurance —afforded to these: a I drditional insureds, the fb4lowing addifional exclusions apply. This insurancedoes not apply to "bodily injury" or "property damage" occurring after.- 1 . Ail work, including matedais, parts, or equipmerd furnished in connection With such worll(, on the project (other than service, maintenance or repairs) to l�3e: performed by or on behalf of the additional insured(s) at the location of the covered i operations has been completed: or 2That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor iengaged in performing operations for a principal as a part of the same project- Q Insurance Services Office, Inc., 2018 bB&%dU-bt4,+472D-b399-4d7d8MSW I 1y Nam C Wdh respect to the insurance afforded to these additional insurds, the following is added to Section III - Limits Of InSUrance: If coverage provided to the additiona! insured is required by a contract or agreement, the mostwe will pay on behalf of the additional insured is the arnount of insurance, 1. Required by the contract or agreement, or 2. Aiiable Linder the appficaNe fimitof ingurance; R MMMMMM This endorsement shalt not increase the appkable finifts of insurance. Page 2 of 2 Insurance SeMces Office, Inc., 20,18 CG 20 10 12 19 9016677 OW21102023 an II ranee Company POLICY NUMBER: 9016877004 COMMERCIAL GENERAL LIABILITY CG20371219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Any person or organization you are required to add as All Locations an additional insured by written contract or agreement See Continuation Page 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" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". 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. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. CG 20 3712 19 9016877 Sentry Insurance Company 1 00001 0000000000 23174 0 N © Insurance Services Office, Inc., 2018 24937384-bf3e-4e60-9a45-647961dcfd3b Page 1 of 2 06/23/2023 Continuation Page in effect prior to any loss or damage. Page 2 of 2 © Insurance Services Office, Inc., 2018 CG 20 37 12 19 9016877 06/23/2023 Sentry Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL, INSURED - AUTOMATIC STATUS WHEN 1 REQUIRED BY CONTRACTOR AGREEMENT WITH YOU I This endorsement m4odifies insurance pro,0ded under the folloWng� AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form appiy unlesi modified by this endorsement CA 80 07 06 18 9016877 Sentry Insurame Company 0WfJ h OMMMM 1-3174 0 K POLICY NUMBER: 9016877003 COMMERCIAL AUTO CA 76 01 06 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. _- _MOP,# This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM AUTO DEALERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated. Named Insured: Musco Corporation Endorsement Effective Date: 07/01 /2023 SCHEDULE Name Of Person(s) Or Organization(s): Any person or organization you are required to add as an additional insured by written contract or agreement See Continuation Page Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in: (1) Paragraph A.I. of Section II - Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms; or (2) Paragraph D.2. of Section I - Covered Autos Coverages of the Auto Dealers Coverage Form. CA 76 01 06 15 9016877 Sentry Insurance Company 1 00001 0000000000 23174 0 N B. Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other auto insurance issued to the person or organization in the schedule under your policy provided that: (1) The person or organization is a Named Insured under such other insurance; and (2) Prior to the "accident" you have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the person or organization. Includes copyrighted material of Insurance Services Office, Inc., with its permission. fae987a2-6397.4h9f-a97e-3f89ffd 2f736 Page 1 of 2 06/23/2023 Continuation Page in effect prior to any loss or damage. Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc., CA 76 01 0615 9016877 with its permission. 06/23/2023 Sentry Insurance Company This endorsement modifies msurance provided under the foIlowinn: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to th�e contrary - Primary And Noncontributory Insurance This insurance is prinianj to and Wit not seek contribution from any other insurance available to an additional insured! under youi policy provided that: (1� The additional' Insured is a Named Insured under such oftr insurance; and CG 20 0112 19 9016877 Sen" Insurance Company H MUCH R=WEVW 2317-A 0 N WO)JIdAraAw- jw#1-*A%1W4fflwWd!1-A11AM CG 11 19 (2) You have agreed in wrIting in a Contract or agreement that this insurance would be primary and would not seek contribubon from, any other insurance available to the additional Insured. Page I of I W12112701M IL 70 58 02 14 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM COMMERCIAL AUTOMOBILE COVERAGE PARTS COMMERCIAL PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PARTS COMMERCIAL EXCESS/UMBRELLA LIABILI I Y COVERAGE FORM EMPLOYMENT RELATED PRACTICES LIABILITY POLLUTION LIABILITY COVERAGE ERRORS AND OMISSIONS COVERAGE FORM In the event we cancel this policy, we shall endeavor to also mail to the person(s) or organization(s) listed in the Schedule for this endorsement advance written notice of cancellation. This notification of cancellation of the policy is intended as a courtesy only. Our failure to provide such notification to the person(s) or organization(s) shown in the Schedule will not extend any policy cancellation date nor impact or negate any cancellation of the policy. This endorsement does not entitle the person(s) or organization(s) listed or described in the Schedule below to any benefit, rights or protection under this policy. Failure by us to provide this notice of cancellation to the person(s) or organization(s) listed or described in the Schedule below will not impose liability of any kind upon us. Any of these provisions that conflict with a law that controls the notice of cancellation of the insurance in this endorsement is changed by this statement to comply with the law. Schedule Person(s) or Organization(s) including mailing address: Per the listing of certificate holders provided by the Broker upon our request. All other terms and conditions of this policy remain unchanged. IL 70 58 02 14 Page 1 of 1 9016877004 Sentry Insurance Company 1 00001 0000000000 21179 0 N ecc6dblb-e566-4a90-a486-d55ef474254f THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. The person(s) or organization(s) listed or described in the Schedule below have requested that they receive written notice of cancellation when this policy is cancelled by us. We will mail or deliver to the Person(s) or Organization(s) listed or described in the Schedule a copy of the written notice of cancellation that we sent to you. Such copies of the notice will be mailed as soon as practicable to the address or addresses provided by your broker or agent. This notification of cancellation of the policy is intended as a courtesy only. Our failure to provide such notification to the person(s) or organization(s) shown in the Schedule will not extend any policy cancellation date nor impact or negate any cancellation of the policy. This endorsement does not entitle the person(s) or organization(s) listed or described in the Schedule below to any benefit, rights or protection under this policy. Failure by us to provide this notice of cancellation to the person(s) or organization(s) listed or described in the Schedule below will not impose liability of any kind upon us. Any of these provisions that conflict with a law that controls the notice of cancellation of the insurance in this endorsement is changed by this statement to comply with the law. SCHEDULE Person(s) or Organization(s) including mailing address: Per the listing of certificate holders provided by the Broker upon our request. All other terms and conditions of this policy remain unchanged. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. Endorsement No. Insured Premium: Insurance Company Countersigned by WC 99 06 72 (Ed. 0911) Page 1 of 1 9016877 Sentry Casualty Company 00001 0000000000 21179 0 N 820bO871-0750.470a-bcc4-19755249ce95