PROOF OF INSURANCE (2024 - 2025)DATE (MMIDDIYYYY)
CERTIFICATE OF LIABILITY INSURANCE 06/10/2024
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
Agency; g g PNONEhber CISR, CLCS
Pacific Agents Alliance Insurance A enc ; Julie Trau hber Insurance A enc 8 FAX �.
CONTACT VI
MAME: Julia
.mow N9, �Iti (18) 201. -1. ..... ... �_ p Ix�.�.. $2 ) 799 7051
524 S Rosemead Blvd E-MAIL
nnn IL iuliela'�iulietrauahberins.com
Pasadena
INSURED ..
CA 91107 INSURER A: Ohio Security Insurance
INSURERB: Twin City Fire Insurance
._ ....
Phoenix Group Information Systems INSURER c : Houston Casualty Comp
2677 N Main St, Suite 440
INSURER D.....mm..a,.....,.._..�....�._..__............,..-_
Santa Ana CA 92705
COVERAGES CERTIFICATE NUMBER:
REVISION NUMBER:
24082
29459
42374
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 ------- INSURANCE ..... 7ywtltL�S ,�-.,m,�,......,POLICXHUMBER .,..,,._..-..�..,I..P.00LICYEF
TYPE OF INSD
W
/ MO/ODYMYMLIMITS .,...�...._.._.,. --- .�.
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 2,000,000
CLAIMS -MADE OCCUR
rJAN4�CJ REFk'r1)
PREMS 'S (E., pcg+ .2ncel ,,
$2,000,000
��. . 2 OOO OOO
_ ._. , _ ....._
MED EXP An one erson
15 000
A
_
X
BKS58373560
10/01/2023
10/01/2024
PERSONAL & ADV INJURY
�REGATE.__....._,.�„
$ 2,000,000
.......m __. ,,.,._ _,...
OEI'd°dr
dnGGRE4;�ArE IMf'0"APPLIESPE.�.........�
R:
GENERAL AGGREGATE
$ 4,000,000_
_
PRO,.
POLICY E J JECT LOG
PRODUCTS-COMP/OPAGG
$ 4,000,000�
OTHER:
$
AUTOMOBILE LIABILITY
T
COMBINED SINGLE I IMIT
&ia ucl�l.nl) .,
.. $ 1 000,000
ANY AUTO
BODILY INJURY (Per person)
$
4
OWNED SCHEDULED
AUTOS ONLY AUTOS
BAS58373560
10/01/2023
10/01/2024
_m _....
BODILYINJURY(Peraccident)
$
HIRED NON -OWNED
�,! AUTOS ONLY AUTOS ONLY
PROPERTY OAMAl3E
_Lnrc6.d$n!h ,
— _
$
m.., ...
$
UMBRELLA LIAB OCCUR
EACH OCCURRENCE
$
EXCESS LIAB CLAIMS -MADE
AGGREGATE
$
..,.RETENTIONS _. .. ,m.,.._,
_
.....�.-.....,
DED
$
WORKERS COMPENSATION
PEROTH-
AND EMPLOYERS' LIABILITY Y P N
TAT R
ANYCERIMEMBEREXCLUDEDXECUTIVE I NIA
A OFFICERIME I OR EXCLUDED? XWS58373560
ACCIDENT
10/01/2023 101012024 . E L EACH _
$ 1,000,000
_. _ U .,
(Mandatory lnNH)
E.L. DISEASE - EAEMPLOYE S 1,000,000
desc der
IIESRRIPTIONun
_.......
D OPERATIONS Below
E.L. DISEASE
EASE - POLICY LIMIT
$ 1 ,000,,000
Errors & Omissions Liability plus
Errors&Omissions Lia
$3,000,000
C Tech/Guard Cyber Liability I H24TG31831-02
02/0812024 02/08/2025 Tech/Cyber Liability
$3,000,000
11
Deductible
$30,000
DESCRIPTION OF OPERATIONS! LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
It is agreed that the City of El Segundo is named Additional Insured wlregard to General Liability coverages and all coverages are subject to the terms and
conditions of each policy.
email: jsolano@eisegundo.org
0-t: C I lr*ltoA I t PIUL.LA I+t CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of El Segundo ACCORDANCE WITH THE POLICY PROVISIONS.
Police Department AUTHORIZED REPRESENTATIVE
348 Main Street e
ElSegundo CA 90245
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