PROOF OF INSURANCE (2025)CERTIFICATE OF LIABILITY IN�SURANCE
Page 1 of 2
DATE (MM/DDlYYYY)
06/20/2024
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 an
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER __CO_NTACT WTW certificate8945-7378 ®rater .., ... F �, w 1----467-237a --
Willis Towers Watson Northeast, Inc. "PHONE AtC No:
c/o 26 Century Blvd E-MAIL
P.O. Box 305191 ADORES ,... mwoo.com
E- AIL r certificates wt. co.com
Nashville, TN 372305191 USA INSURERLB)AFFORDINGCOVERAGE_ NAILmm
— —
INSURERA: ACE American Insurance Company 22667
INSURED IINSURER B: Indemnity Insurance Company of North Ameri43575
Pitney Bowes Inc.3001 Summer .... ... Street INSURER C.?. ACE Fire Underwriters Insurance Company . 20702
...... ......................
StamforCT06926 INSURER D..
11 :IRT*I;9
..,,rr-rAA^_Mo ncortctr+Arc KIIIIh,ara M. W31931595 AIII N11MAI R:
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.
tNSR W TYPE OF INSURANCE Abl)CSUaki
LTR
POLICY NUMBER MM DO YYY ,... M� vE YY I „LIMIT$ ..
X COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 2,000,000
CLAIMS MADE „K OCCUR
O iT
Pi L N I E a Q , 2a a�rr rep j
v q
. .
______, _,,, 2, 000, 00..
...
A
j
MED EXP fAn ens person) f
$ 5, 0001
Y
ADO 048899213 07/01/2024
07/01/2025 PERSONAL & ADV INJURY
$...........a 2,000,000 ,
YY
APPLIESPII
GENERAL
XMdIPOLICYYLL_ J OI-
jr LOC
PRODUOT5 COMPAOPwAGG
5 4,000,000
�
� OTIIER° I
AUTOMOBILE LIABILITY
C(?CUVBINEO aSIdC LL LIPAT
S 3,000,000
X 1 ANY AUTO
BODILY INJURY (Per person)
$
A
OWNED SCHEDULED
ISA H10823377 07/01/2024
07/01/2025 BODILY INJURY (Paraccidanq
$
AUTOS ONLY AUTOS
HIRED NON-OWNED
m-)
6'F;L7PERT4"C7APu4Ae;�
--.-_������ ...�
$
AUTOONLY AUTOS ONLY
il'er4e4d�rrE).
... _
,
I$
UMBRELLA OGCCUR
EACH OCCURRENCE
1
LIAR
1 EXCESS LIAR MADE
AGGREGATE
$
DED PETENTION$
_
$
WORKERSCOMPENSATtON
OTH-
X J STATUTE_�.
�
B
AND EMPLOYERS' LIABILn Y
ANYPROPRIETOR!PARTNER/EXECUTIVE YIN
NoI NIA
WLR C55519122 07/01/2024
........ Y
E,L. EACH ACCIDENT
07/01/2025 -
$ 2 000,d001
OFFICERIMEMBEREXCI.I.
'"
E.L.DISEASE EA EMPLOYEE
2, 000, 000
(Mandatory In NH)
_.... ........
.
it yes, describe under
1 DESCRIPTION OF OPERATIONS below
E.L. DISEASE • POLICY LIMIT
$ 2,000,000
A 'Work44rs Compensation and I
WLR C55519031 07/01/2024 07/01/2025*. L, Each Accident
$2,000,000
!Employers' Liability
E,L, Disease - EA Emp,$2,000,000
per Statute
IE,L, Disease-Pol LMTI$2,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
SEE ATTACHED
CITY OF EL SEGUNDO
OFFICE OF THE CITY CLERK
ATTN: PATTI ADLEN
350 MAIN STREET
EL SEGUNDO, CA 90245-3813
ACORD 25 (2016/03)
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
pt •c am a 2'°i"
01988-2016 ACORD CORPORATION, All rights reserved.
The ACORD name and logo are registered marks of ACORD
sR It): 26037168 BATCH: 3r09775
9266: 2 " of 2
AGENCY CUSTOMER ID:
LOC #:
ADDITIONAL REMARKS SCHEDULE
AGENCY NAMED INSURED
Willis Towers Watson Northeast, Inc. Pitney Bowes Inc.
3001 summer Street
POLICY NUMBER Stamford, CT 06926
See Page 1
CARRIER
See Page 1
NAIC CODE
See Page 1 EFFECTIVE DATE: See Page 1
Page 2 Of 2
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance
THE CITY OF EL SEGUNDO HAS BEEN ADDEDASADDITIONAL INSURED ON GENERAL LIABILITY AS RESPECTS OPERATIONS OFTHEINSURED
FOR THE SERVICING OF BUSINESS EQUIPMENT OR AS RESPECTS LEASED EQUIPMENT.
INSURER AFFORDING COVERAGE: ACE Fire Underwriters Insurance Company NAIL#: 20702
POLICY NUMBER: SCF C55519201 EFF DATE: 07/01/2024 EXP DATE: 07/01/2025
TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT°
Workers Compensation and E.L. Each Accident $2,000,000
Employers' Liability E.L. Disease - EA Emp $2,000,000
Per Statute E.L. Disease-Pol LMT $2,000,000
INSURER AFFORDING COVERAGE: Indemnity Insurance Company of North America NAIC#: 43575
POLICY NUMBER: SCF C5551929B EFF DATE: 07/01/2024 EXP DATE: 07/01/2025
TYPE OF INSURANCE:
Workers Compensation and
Employers' Liability
Per Statute
ACORD 101 (2008/01)
LIMIT DESCRIPTION:
E.Z. Each Accident
E.L. Disease - EA Emp
E.L. Disease-Pol LMT
LIMIT AMOUNT:
$2,000,000
$2,000,000
$2,000,000
0 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
SR ID:26037168 BATCH:3509775 CERT. W33931595
9265: 2 of 2