PROOF OF INSURANCE (2025)A,CCERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDDIYYYY)
10/15/2024
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).
COVERAGES
CERTIFICATE NUMBER: 328469606
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 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„
EXCLUSIONSAND CONDITIONS OF SUCH POLICIES LIMIT MAY HAVE BEEN REDUCED BY PAID CLAIMS.
........_ ......... ...._
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INSRm "," AODLi�li�lr� POLICY'EFr' POLICY EXP
,.,,........_ ._. ......�.. I
LIMITS
TYPE OF INSURANCE POLIC
LTR NUMBER MMIDO MMIDD
B
X COMMERCIAL GENERAL LIABILITY
GL0789871503
7/1/2024
7/1/2025
000,000
. m_.--
$2000.000
CLAIMS -MADE I X OCCUR
pRLM y C n tp)
t
I_ _.
X Deductible $100K
000
�
PERSONAL& ADV INJURY
$ 25
000 000
C. N't, AGGREGATE LIMIT APPLIES PER:
xE
AGGREGATE
$ 4,000 000
POLICY PEST 1:1 LOC
PENERAL
RODUCTS - COMPIOP,AGG
$ 4,,000 000 _
$
B
I OFHEW
AUTOMOBILE LIABILITY
BAP787962503
7/1/2024
7/1/2025
I C"OM111NE�D SINGLE.I.WiT'
I, wncx8fl n . ..
$ 1,000,000
X ANY AUTO
BODILY INJURY (Per person)
$
OWNED SCHEDULED
G----
BODILY INJURY (Per accident)
$
AUTOS ONLY ,, AUTOS
HIRED rr NON -OWNED
IPROPERTY DAMAGE
$
I AUTOS ONLY AUTOS ONLY
fPer aC l4 r i)...r --.
X i Comp 51,000 X COO $1.000
$
UMBRELLA LIAB OCCUR
........... .... ...
d .........-.
�..EACHOCCURRENCE.... .......$...----
EXCESS LIAB CLAIMS -MADE
WAGG
............ ..... ...,..
. ..
IDRETENTION$
I
-
A
1r
WORKERS COMPENSATION
WC787962403
7/11/2024
7/1/2025
STAATE
Ix PER
OERTH-
. ..
B
ANDEMPLOYERS'LIABILITY YIN
WC787962903
7//2024
7/1/2025
E.L. EACH
$ANYPROPRIETOR/PARTNERIEXECUTIVE
OFFICER/MEMBEREXCLUDED? N
(Mandatory in NH)
E.L. DIS SE EA EMPLOYEE
.... �'.,,,,.., .........
$ 1,000.000
......,.._._..... ...
If yes, describe under
E.L. DISEASE- POLICY LIMIT
$ 1.000,000
DESCRIPTION OF OPERATIONS below
'.. DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
RE EgUiniX LA3 and LA4 locations at 1920 E. Maple Avenue and 445 N, Douglas Street,
"your
The City of El Segundo„ its officers, agents and employees are included as additional insured with regard to liability and defense of suits arising from
work" performed by or on behalf of the named insured regardless of whether liability Is attributable to the named insured or a combination of the named and the
additional insured.
�+r1 ttla.l�L1Ll Ir W , .
City of El Segundo, Public Works Department
El Segundo City Hall
350 Main Street
El 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
V 1tPtftf-YU19 AI.UKLJ %,UKrVrv+1 [VIM. All rI9IILS rtlatlrvCU.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
THIS CERTIFICATE SUPERSEDES PREVIOUSLY ISSUED CERTIFICATE