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PROOF OF INSURANCE (2025) CLOSEDl DATE(MMIDDNYYY) CERTIFICATE OF LIABILITY INSURANCE 06/27/2024 4N�1 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. It 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 2D certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT AOn Risk services Northeast, Inc. NAME� ;) 283-7122 (A%,Noj� (800) 363-0105 New York NY office (NC. one Liberty Plaza E-MAIL 0 165 Broadway, suite 3201 —ADDRESS: 1: New York NY 10006 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: Tokio marine America Insurance Company 10945 ZOLL medical corporation INSURER B: Trans Pacific Ins Co 41238 and subsidiaries 269 Mill Road INSURER C. SoMpo America Fire & marine Insurance Co 38997 Chelmsford MA 01824-4105 USA INSURER D: Mitsui Sumitomo Insurance USA Inc. 22551 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER. 570106884894 REVISION NUMBER- THIS EXCLUSIONS THISIS 0 CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO, THE INSLJRE01 NAMED ABOVE FOR THE POLICY PERIOD H IS' RESPECT TO WHICH THIS INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM 08 CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH IC CCERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAD CLAIMS. Limits shown are as requested INSR TYPE OF INSURNCE A11 IW INSSU LTA y VYI M (Wyyyy X COMMERCIAL GENERAL 4% wVoM POLICY NUMBER Dot LIABILITY CLL64097b 710112024 071 11202 CLAIMS -MADE El OCCUR PREMISES (Ea occurrenceL_ $100,000 MED EXP (Any one person) $5,000 PERSONAL& ADV INJURY $1,000,000 7 GENLAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $2,000,000 X POLICY PRO- ❑Loc PRODUCTS - COMP/OP AGG Excluded JECT F LIMITS EACH OCCURRENCE P R."SE, Ea occurrence) M E ' EX P (Any one P. r..n7 P 0 & ERS � AL AV INJURY GENERAL AGR 'GATE �I :i OTHER: AUTOMOBILE LIABILITY CA6409761-07 07/01/2024 0710112025 COMBINED SINGLE LIMIT $1,000,000 iEa accide!20 x ANYAUTO BODILY INJURY ( Per person) — SCHEDULED BODILY INJURY (Per accident) OWNED AUTOS ONLY AUTOS HIREDAUTOS NON -OWNED PROPERTY DAMAGE — ONLY — AUTOS ONLY (Per EXS52 0217 $10,000,000 UMBRELLALIAB OCCUR 07701/2 EACH OCCURRENCE X EXCESS LIAB CLAIMS -MADE AGGREGATE $10,000,000 EEDJ_TRETENTJON C WORKERS COMPENSATION AND JCD40122w0 0776172024 67/5172625 x I PER STATUTE MET, H. EMPLOYERS' LIABILITY Y�N ADS C ANY PROPRIETOR / PARTNER i ­tC. I — E.L. EACH ACCIDENT $1,000,000 OFFICER]MEMBER EXCLUDED? N N/A JCR40013N0 107/01/2024 07/01/2025 (Mandatory In NH) WI E.L, DISEASE -EA EMPLOYEE $1,000,000 If Yes, describe under 'E _LEEASE-POLICY LIMIT 000,000 DESCRIPTION OF OPERATIONS below $1 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additlonal Remarks Schedule, may be attached If more space is required) RE: Premises/operations. City of El Segundo is included as Additional Insured in accordance with the policyprovisionsof the General Liability policy. A waiver of subrogation is granted in favor of City of El Segundo in accordance withthe policy provisions sions of the workers' compensation policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of El Segundo AUTHORIZED REPRESENTATIVE Attn: Carol Lynn Anderson EA 350 main Street El Segundo CA 92045-3813 USA '14011a JL @1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 0) 4 co co C) u� 0 Z lC t: tv WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) POLICY NUMBER: JCD40122WO 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 PARTIES WITH WHOM THE INSURED HAS ENTERED INTO A WRITTEN WAIVER AGREEMENT PRIOR TO THE DATE OF LOSS. ***THIS ENDORSEMENT DOES NOT APPLY TO KENTUCKY, NEW HAMPSHIRE, AND NEW JERSEY. For policies or exposure in Missouri: Any person or organization for which the employer has agreed by written contract, executed prior to loss, may execute a waiver of subrogation. However, for purposes of work performed by the employer in Missouri, this waiver of subrogation does not apply to any construction group of classifications as designated by the waiver of right to recover from others (subrogation) rule in our manual. DATE OF ISSUE: 07-14-21 WC 00 03 13 (Ed. 4-84) © 1983 National Council on Compensation Insurance.