PROOF OF INSURANCE (2023 - 2024) CLOSEDDATE(MMIDD/YYYY)
C"RV CERTIFICATE OF LIABILITY INSURANCE
5/2/2023
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 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 CON NAME: �HB'a'�tter Soriano
PHONE878-2820 FAIL (702)870-1263
Shank & Associates I ( 702 ) A/C N,rr
AdC Na.F i....._s.....) w
10091 Park Run Drive E-MAILheather@swartsmanning.com
ADDRESS;
Suite 200 INSURERS AFFORDING COVERAGE ___!LAIC #
Las Vegas NV 89145 INSURER A; Arch Insurance Com an
INSURED INSURER B : United Financial Casualt CO 11770
RAS Consulting & Investigations, LLC. INSURER C:sequoia Insurance Com an 22985
100 N. Pacific Coast Hwy INSURER D:
Suite 1000 INSURERS;
«wawa_
El Segundo CA 90245 INSURER F:
rnv�oer_�c r_FRTIFIr_ATF NIIMRFR•23-24 Master 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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.
WSR ADDL SUBR. ' POLICY EFF POLICY EXP LIMITS
I I TYPE OF INSURANCE POLICY NUMBER MM/00 MMIDDIYYYY
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
AMIAGE TO RENTED
100,000 $
A
CLAIMS -MADE 7 OCCUR
PRFMI Ea occurrence
—_
X
BIPKGO179304
4/21/2023
4/21/2024
MED EXP (An one person)
$ 5,000
PERSONAL & ADV INJURY
$ 1,000,000
GEN'LAGGREGATELIMITAPPLIESPER:
GENERAL AGGREGATE
—
$ 5,000,000
POLICY PRO LOG
L� JEC?' ❑
X
PRODUCTS - COMP/OP AGG
$ 5,000,000
$
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINOI E;' 9'YI41'kT
Ea +1C IIIynI
$ 1,000,000
BODILY INJURY (Per person)
$
ANY AUTO
ALL OWNED SCHEDULED
%
00938517-1
6/22/2023
12/22/2023
BODILY INJURY (Per accident
$
AUTOS AUTOS
NON -OWNED
X X
PROPERTY DAMAGE
..
$
'...... HIRED AUTOS .. ''. AUTOS
Per a cldenl
Hired/borrowed
$ 1,000,000
UMBRELLA LIAB
Id
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
DED RETENTION $
$
WORKERS COMPENSATION
X I PER OTH
T E
AND EMPLOYERS' LIABILITY Y / N
ANY
H ACCIDENT
E L EACT
$ 1,000,000
E.L. DISEASE -�EAEMPLOYEE$
1 000,000
C
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
NIA NIA
QWC1269607
1 11 2023
/ /
1 11 202q
/ /
E.L. DISEASE -
1 000 000
If yes, describe underDESCRIPTION OF OPERATIONS below
D
Errors & Omissions
BIPKG0179304
4/21/2023
4/21/2024
Aggregate Included
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
City of El Segundo is included as Additional Insured with respect to General Liability only per the
attached form OOGLO33400 04-08.
CERTIFICATE HOLDER CANCELLATION
City of El Segundo
350 Main Street
E1 Segundo, CA 90245
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Shank/BK
0 1988.2014 ACORD
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
INS025 (201401)
reserved.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BLANKET ADDITIONAL INSURED ENDORSEMENT
This endorsement modifies insurance provided underthe following:
Section II, WHO IS AN INSURED, is amended by adding
Any person, organization, trustee or estate:
a. to whom "you" are obligated by written contract to provide insurance such as
that afforded by this policy, or
b. specifically designated as an additional insured on an authorized Certificate of
Insurance received by "us" prior to any 'occurrence";
Coverage afforded under (a) or (b) is limited to liability arising out of "your work' for such
additional insured(s) and is caused by the negligent acts of the named insured.
This endorsement shall be excess of any other insurance available except coverage afforded by this
endorsement will be primary and non-contributory, but only if and to the extent required by written
contract
All other terms and conditions of the Policy remain the same.
00 G L0334 00 04 08 Page 1 of 1