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PROOF OF INSURANCE (2024 - 2024) CLOSED
A�--�C 1 �® �V/� CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 06/15/2023 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 Bannister & Associates Insurance Agency CA License #0691071 CONTACT NAME: Jonathan Severson PHONE FAX A/C No Ext: (714) 536-6086 A/C No: (714) 536-4054 E-MAIL ADDRESS: onathan@bai-ins.com 305 17th Street Huntington Beach CA 92648 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:West American Insurance Company 44393 INSURED Carter Services, Inc. INSURERB:Homesite Insurance Company 17221 INSURERC:Republic Indemnity Company of CA 43753 INSURERD: 2807 Oregon Court, F3 INSURER E7 Torrance CA 90503 INSURERF: (310) 618-2600 COVERAGES CERTIFICATE NUMBER: Cert ID 13657 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. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE Ix I OCCUR y BKW57181955 06/15/2023 06/15/2024 DA 1REM SESTOEa oN.TEDence $ 1,000,000 MED EXP (Any one person) $ 51000 PERSONAL & ADV INJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER : GENERAL AGGREGATE $ 2,000,000 POLICY � jRO- ECT LOC PRODUCTS - COMP/OPAGG $ 2,000,000 lEmpl Benefits Liab $ 1,000,000 OTHER I AUTOMOBILE LIABILITY COMBINEDSINGLELIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ A ANY AUTO BAW57181955 06/15/2023 06/15/2024 OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY B UMBRELLA LIAB X OCCUR CXP-020734-00 06/15/2023 06/15/2024 EACH OCCURRENCE $ 5,000,000 X AGGREGATE $ 5,000,000 EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ C WORKERS COMPENSATION Y/N AND EMPLOYERS' LIABILITY y 25566402 04/01/2023 04/01/2024 X STATUTE EERH ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N /A E.L. DISEASE - EA EMPLOYEE $ 11000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) The City of E1 Segundo, its officials and employees are named as additional insureds with respects general liability policy limits. Primary and non-contributory wording applies with respects general liability policy limits. Waiver of subrogation applies with respects workers compensation policy limits. 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 E1 Segundo City Clerk AUTHORIZED REPRESENTATIVE 350 Main Street, Room 5 E1 Segundo CA 90245 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Page 1 of 1