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PROOF OF INSURANCE (2023) CLOSEDCERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDDNYYY)
08/24/2023
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 ri hts to the certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
MARSH USA, LLC. vHOHE.......---------- ....................
1166 Avenue of the Americas "............ ..
New York, NY 10036 t MAOL
Attn: NewYork.Certs@marsh.com Fax: 212-948-0500 tR'1
'.,....�...... NSU ER S AFFORDING COVERAGE _ .. ............... .....",,,,,,,,,,,,,,,,,,,N,AIC
#
INSURER A SOm 0 America
p Insurance m.
n---------
11126
INSUREDonan
INSURER B Tokio Marine America Insurance COm�any
10945
Canon USA, Inc.
-One
......
Canon Pak
I
INSURER c : Sompo America Fire 8 Marine Insurance Company
38997
Melville, NY 11747
INSURER D :
INSURER E :
rnVFRAAFC rFRTIFIrATF NIIMRFR• NYC-011681413-01 REVISION NUIMRFRr 1
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,
SUCH EEN REDUCED BY PAID CLAIMS.
H POLICIES. LIMITS SHOWN MAY HAVE B EXCLUSIONS AND CONDITIONS
mOF .,,..
Atlb " Su �'v. .. POLICY "' _ ..______.— ._. .... ....- "....
EFF EXP
MMLICY
INTR TYPE OF I NUMBER MMl1)D pp LIMITS
B
X COMMERCIAL GENERAL LIABILITY
GLD6404741-12
11/0112022
''11/01/2023
EACH OCCURRENCE
$ 1,000,000
........ . ....MX
DAMgGIC
...".,
0
1,000,000
CLAIMS -MADE OCCUR
.., FRE tiL E: ,tLa occugTu';n54.
$
MED EXP (Any one person)
..._......._
$ 5,000
,.................. ....,.,.,.
..�..-. ,...... .,..,., .. .. ... ..............
PERSONAL S ADV INJURY
$ 1,000,000
.......... .....0,
GEN'LAGGREGATE LIMIT APKtES_........
PER:
..,..,.....�.....,A
GENERAL AGGREGATE
$ 2,000,000
1 POLICY X ..
PRO LOC
JECT
PRODUCTS-COMPIOPAGG
$ 1,000,000
OTHER.
$
A
AUTOMOBILELIABILITY
AAL30026136800
11101/2022
11/01/2023
COMBINED SINGLE UMII
1Oci.+.edrruwD
$ 1,000,000
...... ...... ._....,....,....... ,.,,,,,,
X j ANY AUTO
BODILY INJURY (Per person)
$
OWNED SCHEDULED
$
AUTOS ONLY AUTOS
,BODILYINJURY(Peraccident)
-..
HIRED NON -OWNED
PROPERTY DAMAGE
$
AUTOS ONLY ......._.... AUTOS ONLY
..„(F'er Rggi ent ___
..
COMPICOLL DED
$ 1,000
UMBRELLALIAB OCCUR
...-.......
EACH OCCURRENCE
........._.................... _._—.
$ ....... . ,...,.... ,.,..
EXCESS LIAB CLAIMS -MADE
"
AGGREGATE
$
p
DED I RETENTION $ I
$
C
WORKERS COMPENSATION
JCD40017RO 1 I
11101 0023
X STATUTE
AND EMPLOYERS' LIABILITYYIN
'^^ ERH
ANYPROPRIETOR/PARTNER/EXECUTIVE
E L EACH ACCIDENT
is 1,000,000
OFFICER/MEMBEREXCLUDED?
N/ A
mm
1,000,000
(Mandatory in NH)
E L DISEASE- EA EMPLOYEE
i $
If as, describe under-�
DESCRIPTION OF OPERATIONS below
E.L. DISEASE- POLICY LIMIT
$ 1,000,000
I
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
350 Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
El Segundo, CA 90245 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
9 talc 'Lt.S�f-G'.L�G�
@ 1988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
POLICY NUMBER: FTA40003DO
COMMERCIAL AUTO
CA20481013
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESIGNATED INSURED, FOR
COVERED AUTOS LIABILITY COVERAGE
This endorsement modifies insurance provided under the following:
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 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 does not alter coverage
provided in the Coverage Form.
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated
below.
Named Insured: Canon U.S.A., Inc.
Endorsement Effective Date: 11/1/2020
SCHEDULE
Name Of Person(s) Or Organization(s):
As required by written contract
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
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 Paragraph A.1. of Section II —
Covered Autos Liability Coverage in the Business
Auto and Motor Carrier Coverage Forms and
Paragraph D.2. of Section I — Covered Autos
Coverages of the Auto Dealers Coverage Form.
CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1
POLICY NUMBER: CLL6404741-10
COMMERCIAL GENERAL LIABILITY
CG 20 10 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OIL
CONTRACTORS SCHEDULED PERSON O
ORGANIZATION
This endorsement modifies insurance provided under the following;
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization(s) Locations Of Covered O erations
Any erson or organization if you are required to do so under As require y written contract with a Named insured
a wra"tten contract„ agreement or permit pro\Med the "bodily
injury,, or "prop,perty damage"" occurs subsequent to e
e cecution of tt�e contract, agreement or permit.
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", "property
damage" or 'personal and advertising injury"
caused, in whole or in part, by:
1. Your acts or omissions; or
2. The acts or omissions of those acting on your
behalf,
in the performance of your ongoing operations for
the additional insured(s) at the location(s)
designated above.
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 additional
exclusions apply:
This insurance does not apply to "bodily injury" or
"property damage" occurring after:
1. All work, including materials, parts or
equipment furnished in connection with such
work, on the project (other than service,
maintenance or repairs) to be performed by or
on behalf of the additional insured(s) at the
location of the covered operations has been
completed; or
2. That 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
engaged in performing operations for a
principal as a part of the same project.
CG 20 10 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 2
C. With respect to the insurance afforded to these
additional insureds, the following is added to
Section III — Lirrdts 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 shown in the Declarations;
whichever is less.
This endorsement shall not increase the
applicable Limits of Insurance shown in the
Declarations.
Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13
POLICY NUMBER: CLL6404741-10
COMMERCIAL GENERAL LIABILITY
CG 20 37 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OIL
CONTRACTORS S - COMPLETED, OPERATIONS
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 Descril2tion Of Com leted Operations
Any person or organization if you are required to do
so under a written contract, agreement or permit
provided the "bodily injury" or "property damage"
occurs subsequent to the execution of the contract
As required by written contract with a Named Insured
agreement or permit.
Information re uired 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 shown in the Declarations;
whichever is less.
This endorsement shall not increase the applicable
Limits of Insurance shown in the Declarations.
CG 20 37 04 13 O Insurance Services Office, Inc., 2012 Page 1 of 1
Policy #CLL6404741-10
COMMERCIAL GENERAL LIABILITY
CG 20 01 0413
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY ANC NONCONTRIBUTORY --
OTHER INSURANCE CONDITION
This endorsement modifies insurance provided under the following
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCT51COMPLETED OPERATIONS LIABILITY COVERAGE PART
The following is added to the Other Insurance
Condition and supersedes any provision to the
contrary:
Primary And Noncontributory Insurance
This insurance is primary to and will not seek
contribution from any other insurance available
to an additional insured under your policy
provided that:
(1) The additional insured is a Flamed Insured
under such other insurance; and
CG 20 01 0413
(2) 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
additional insured.
® Insurance Services Office, Inc., 2012
WmpanY COPY
Page 1 of 1
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY VIrG 00 0313
(Ed. 4-84)
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
As required by written contract
*"THIS ENDORSEMENT DOES NOT APPLY TO KENTUCKY, NEW HAMPSHIRE, AND NEW JERSEY.
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. IThe
information below is required only when this endorsement is issued subsequent to preparation of the policy.)
Endorsement Effective:1110112020 Policy No.JCD40017R0 Endorsement No.
Insured: CANON U.S.A., INC. Premium: INCL.
Insurance Company: Sompo America Fire & Marine Insurance Company Countersigned by
WC 00 0313
(Ed. 4-84)
01993 National Council on Compensation Insurance.