PROOF OF INSURANCE (2026)4 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
2/1/2026 01/30/2025
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 Lockton Companies, LLC
DBA Lockton Insurance Brokers, LLC in CA PHONE
CJkaxrt __
CA license #0F15767 E-MAIL.
1185 Avenue of the Americas, Ste. 2010
New York NY 10036 INSURER..S AFFORDING COVERAGE NAIC #
(646) 572-7300 INSURER A: ACE American Insurance Company 22667
INSURED Pitney Bowes Inc. INSURER B: Indemnity Insurance Co of North America 43575
1554485 3001 Summer Street INSURER C ; ACE Fire UndgpEfttgrainaurance Cgrnpany 20702
Stamford, CT 06926 INSURER D ; --- SEE ATTACH ENT ---
INSURER E
INSURER F :
COVERAGES CERTIFICATE NUMBER: 2.13,55400 REVISION NUMBER: X XXXXX
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
S . E.�I tELIMITSS BE � >
INSR AODL SUB POLICY EFF POLICY EXP LIMITS
LTR TYPE OF INSURANCE INSD wVD POLICY NUMBER MMiI'DDIYYYY MWDDfYYYY
A X COMMERCIAL GENERAL LIABILITY HDO G48962531 02/01/202 02/01/202 EACH OCCURRENCE $ 2,000,0oo,—
CLAIMS-MADE OCCUR nA A P $ 2 000 000
MED EXP (An one erson $ 5 000
Y N PERSONAL. & ADV INJURY $ 2,000,000
__wwwwwwwwwwwwww__wwww
C,E,Prd L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000000
)( POLICY❑ P Loc PRODUCTs- COMP/OP air $ 4,090,000
OTHER: $
• AUTOMOBILE LIABILITY ISA H10819751 02/01/202, 02/01/202 ���P�cBcd��SINGLELuaPoIT $ 3,000,000
+ ANY AUTO BODILY INJURY (Per person) $ XXXXXXX
OWNED SCHEDULED N N BODILY INJURY (Per accident) $ )C)=XXX
- AUTOS ONLY 'AUTOS -- --
HIRED NON -OWNED IOPIf Y :AMAGE. $ XXXXXXX
• AUTOS ONLY AUTOS ONLY n�rxadcl e.I
$XXXXXXX
UMBRELLA LIAB OCCUR NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX
I
EXCESS LIAB CLAIMS-MADJ I�AGGREGATE $ X)=XXX
AND EMPLOYERS'
$ X C R . $
B DED s LIABILITY YIN WLR C72627763 02/01/202 02/01/202 —ANY PROPRIETOR/PARTNER/EXECUTIV�AIOS)
y O2/O1 /2O2 H.„„ FACk# ACCIDENT $ 2,000,000
A OFFICER/MEMBER EXCLUDED? � NIA N ) Y
C IMandat®ryinNH) SCF C72627805 A I GA) 02/01/202E 02/01/202 EL DISEASE EA EMPLOYEE $ 2-000,000
WLR C72632710 02 01 202
B byes, describe under 02/01 /202 2 Poo 000
DESCRIPTION OF OPERATIONS below E.L.. DISEASE POLICY LIMIT $
D Worker's Comp(Ohio Excess) See Attached 02/01/202 02/01/2026 See Attached
N N
.,....DES __............
CRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
rF:RTI'FIrATE HOLDER CANCELLATION See Attachment
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
21355400 AUTHORIZED REPRESENTATIVE
CITY OF EL SEGUNDO
OFFICE OF THE CITY CLERK
ATTN: PATTI ADLEN
350 MAIN STREET I 1
EL SEGUNDO CA 90245-3813
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
CONTINUATION DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED 9Y ENDORSEMhN IISYEDIAL FKUVI5IUNS IU;se omy Ir more
THE CITY OF EL SEGUNDO HAS BEEN ADDED AS ADDITIONAL INSURED ON GENERAL LIABILITY AS
RESPECTS OPERATIONS OF THE INSURED FOR THE SERVICING OF BUSINESS EQUIPMENT OR AS
RESPECTS LEASED EQUIPMENT.
ACORD 25 (2016/03) Certificate Holder ID: 21355400
Attachment Code: D660293 Master ID: 1554485, Certificate ID: 21355400
Worker'sComp Coverage - Ohio Excess
Pol i c #:
I WCU C72632679
Policy Term:
2/1 /2025-2/1 /2026
Issui n Co.:
ACE American Insurance Company
X _Per Statute
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Other
Employer's Liability Each Accident
$2,000,000
Employer's Liability Dis, Ea.
Employee
$2,000,000
Employer's Liability Dis Policy
Limit
$2,000,000