PROOF OF INSURANCE (2023 - 2024) CLOSED�� DA722/2!
MMIDD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE12/31/2023 19/2022
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
(TACT
p CON
PRODUCER
Lockton Companies NAME::
444 W. 47th Street, Suite 900 PHONE
C. No, E rtl .. ....,..,._ _.....
Kansas City MO 64112-1906 EMAIL (AIC, N?)..
(816)960-9000 AL1DREss
kcasu@lockton.com A ;.S INSURER afe"INSURER AFFORDING COVERAGE NAIC #
... National Casualty Corpt ra itsmsammmm 15.1m05
1507679 118 UNITED
SITE
RS ROAD, SUITE 10 I NC INSURER c..:.Allied ecial Insurance Commnd
UNITED SITE SERVICES OF CALIFORNIA, IINSURED R..............._
FLA
World Assurance Company (US.) Inc. 1 19489
WESTBOROUGH MA 01581 INSURER D :wA1GmmPr0pertyyCasua1ty Com any ... 19402
INSURER E
INSURER F
......�.-...+tee. I+Cr]TICI^AT= K111uoU0. 10AI.,4.1^e RFVICIAN NIIMRFR• 'k''"k"SC'V'%f`YY
V
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.
E
ILTR TYPE OF INSURANCE AWOL WWO POLICY NUMBER 14j►CllpCpIYYYY POLICY EXP"W""mm LIMITS
MM/OD
p�
;
COMMERCIAL GENERAL LIABILITY
N
N
GL4057787
12/31/2022
12/31/2023
EACH OCCURRENCE
$ 2,000 OOO
_
CLAIMS -MADE 1XI OCCUR
ff.A.. kro
RR WI, (a orcu rcrn t
$ 1,.000a000
MED EXP SAnywone person)
$ I O.000
PERSONAL &"ADV INJURY
$ 1.�000000
N'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 4 OOO
- q�, ....a0(10
X
PRO
POLICY JECT LOC
PRODUCTS - COMP/OP AGG
$ 4 OOO OOO
..
OTHER I�:
A
AUTOMOBILE LIABILITY
jv
N
CA6675838
12/31/2022
12/31/2023
COMBINED SINGLE LIMIT
Le ar�?¢R�ntl m,m,m,m
$ 3 OOOm�000
a
x ANY AUTO
BODILY INJURY (Per person)
$ xx'xxx r1'.X
OWNED SCHEDULED
BODILY INJURY (Per accident)
Is
AUTOS ONLY
HIREDwXXXXXXX
PFdOPER DAMAGE
$ �X��X
_........_ AUTOS ONLY AUTOS ONLY
I ar q�cildRio") ..
sW....---.-.
[
B
UMBRELLA LIAB X OOCCUR
N
N
US00076933LI22A
12/31/2022
12/31/2023
EACH O CURRENCEDEXCESS
I
LIAB MADE
BE011134269
12/31/2022
12/31/2023
ATE
_..... mm....
$ 10 000,000
DED RETENTION $
$ XXXXXXX
A
WORKERS COMPENSATION
N
LDS4047370
12/31/2022
12/31/2023
PER OTH
. X sTnruTER
---...-_
AND EMPLOYERS' LIABILITY N
ANY PROPRIETOR/PARTNER/EXECUTIVE YIN
EXCLUDED?:,N/A
ID
E.L. EACH ACCIDENT
$ � OOO OOO
OFFICER/MEMBER
(Mandatory in NH)
E.L. DISEASE - EMPLOYEE
w E
„$„„.1 0100 000
If yes, descrlkre under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
C
ENVIRON. SITE LIAB &
N
N
0311-5276
9/19/2021
9/19/2024
$3,000,000 EACH INCIDENT;
CONTRACTORS
$6,000,000 AGGREGATE
POLLTUION LIAB
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CITY, ITS OFFICIALS, AND EMPLOYEES ARE INCLUDED AS ADDITIONAL INSUREDS AS RESPECTS TO GENERAL LIABILITY AND AUTO LIABILITY PER
WRITTEN CONTRACT. GENERAL LIABILITY AND AUTO LIABILITY POLICIES SHALL BE PRIMARY AND NON-CONTRIBUTORY WITH ANY OTHER
INSURANCE IN FORCE FOR OR WHICH MAY BE PURCHASED BY THE CITY PER WRITTEN CONTRACT.
CERTIFICATE HOLDER t AN ELLA I IUN
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
18424196 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
CITY OF EL SEGUNDO
CITY CLERK 350 MAIN STREET, ROOM 5
EL SEGUNDO CA 90245-3813 AUTHORIZED REP'RESENTATIV
I
61988 015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
Attachment Code: D608142 Certificate 1D: 19035884
POLICY NUMBER: GL4057787
COMMERCIAL GENERAL LIABILITY
CG 20 10 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
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 Operations
As required by written contract or agreement when such
Location(s) of operations as per written
written contract or agreement is executed prior to an
contract or agreement between you and the
occurrence, offense or loss to which this endorsement
Additional Insured.
applies, but only for the limits agreed to in such contract or
the Limits of Liability providedby this policy, whichever is
less. Any individually scheduled additional insureds shall
not be construed to override nor negate this blanket
additional insured.
Information re uired to com fete 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.
CG 20 10 12 19
CA6675838
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESIGNATED ADDITIONAL INSURED
This endorsement modifies insurance provided under the following:
COMMERCIAL AUTOMOBILE COVERAGE PART
SCHEDULE
INFUTEre)It 11-1 0.
t� no,,�� ) "l�:it I�?
I:cd A Ji l Ln i) l`cf':.'L.
CHANGE
The person(s) or organization(s) shown in the Schedule above with whom you have agreed in a written
contract to provide insurance such as is afforded under this Coverage (Form, is included as an Additional
Insured subject to the below:
(1) Insurance for such Additional Insured(s) scheduled above shall be afforded only to the extent that such
Additional Insured is liable for "bodily injury" or "property damage" arising out of your operations and
resulting from the ownership, maintenance or use of covered "autos" by you while the covered "autos" are
on premises owned or leased by the above scheduled Additional Insured(s).
(2) The insurance afforded under this Coverage Form to such Additional Insured(s) applies only:
(a) If the "accident" takes place subsequent to the execution and effective date of such written contract:
and,
(b) While such written contract is in force, or until the end of the policy period, which ever occurs first.
(3) How Limits Apply to Additional Insured(s)
The most we will pay on behalf of the Additional Insured(s) scheduled above is the lesser of:
(a) The limits of insurance specified in the written contract or written agreement; or,
(b) The Limits of Insurance provided by the Coverage Form.
SNCA 02610 13 Safety National Casualty Corporation