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PROOF OF INSURANCE (2027)D, DAT'(�O MNUDD SYYY) . CERTIFICATE OF LIABILITY INSURANCE 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. It SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this tD certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT 'O ADD Risk Services Northeast, Inc„ NAME 866-283-7122 FAX (800) 363-0105 at Aon Risk Services Northeast, Inc. (Ah0,No( EXt)! avG,No.: 'o NY NY Office ADDRESS: 0 One Liberty Plaza 165 Broadway, Suite 3201 New York NY 10006 USA INSURER(S) AFFORDING COVERAGE NAIC # 'INSURED INSURER A: AllianZ Global Risks US Insurance Co.: '35300 Bureau Veritas Technical Assessments LLC INSURER B: Hartford Fire Insurance Co„ 19682 6021 University Blvd. Stes. 200-210 Ellicott City MD 21043 USA INSURERC: Trumbull Insurance Company 27120 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570117117295 REVISION NUMBER., a THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE, INSURED NAMED ABOVE FOR THE POLICY PERIOD T W 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. Limits shown are as requested IN A1111 LTR TYPE OF INSURANCE iNSD 'WVD POLICY NUMBER t)(D{d9YYYy pyMph,OgYyyy LIMITS X COMMERCIAL GENERAL LIABILITY USL EACH OCCURRENCE $2 , OOO , 00O SIR applies per policy terns & conditions $1,000,000 CLAIMS -MADE OCCUR PREMISES. (Ea occurrence. MED EXP (Any one person) $10 , 000' PERSONAL & ADV INJURY 12,000,000 GENLAGGREGATELIMITAPPLIESPER: r GENERAL AGGREGATE $2,000,000 POLICY O PRO ,, LOC JECT PRODUCTS - COMP/OP AGG $2 , 000, 000' n L- ,J OTHER: SIR $50, 000 B AUTOMOBILE LIABILITY 10 AB S41202 01/01/20,26 01/01/20271 COMBINED SINGLE LIMIT $2 , 000, 000 ADS V.P20 _ X ANYAUTO BODILY INJURY ( Per person) 0 '.. OWNED SCHEDULED BODILY INJURY (Per accident) ) AUTOS ONLY ... AUTOS ''.. HIRED AUTOS NON -OWNED PROPERTY DAMAGE Per aocidon4) p :�- ONLY AUTOS ONLY Comp Deductible $1, 000 y A X UMBRELLA LIAB X I OCCUR USLOO1 63 26 1 01 2 01/01 2027 EACH OCCURRENCE $1,000,000, U EXCESS LIAB CLAIMS MADE AGGREGATE $1,000,000 DED X RETFNIQN $250,000... C WORKERS COMPENSATION AND 1 WNS41200 6176172 6 1 1 " 0" 7 X PER STATUTE OTRH^ LOYERS' LIABILITY PROPRIETOR/ PARTNEREXECUTIVE Y R d+t See State Policy Addendum E.L. EACH IDENT �, OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A E.L. DISEASE -EA EMPLOYEE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 -AF Architects & Engineers USF00248026 01/01/2026 01/01/2027 Each claim $1,000,000---- Professional claims Made Aggregate $1,000,000 SIR applies per policy ter s & conditions SIR $250,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) insurance. The Architects & Engineers includes coverage for Professional Liability and Contractors Pollution Evidence of policy Liability. Certificate Holder, The City of E1 Segundo, it's officials and Employees are included as Additional Insured in - accordance with the policy provisions of the General Liability coverage, Business Auto coverage & Umbrella Liability 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 350 Main street El Segundo CA 90245 USA IQC c /latrf rD� ✓L Q ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000048582 LOC #: ADDITIONAL E A. S SCHEDULE Page _ of _ AGENCY NAMED INSURED Aon Risk Services Northeast, Inc. Bureau Veritas Technical Assessments LLc POLICY NUMBER See certificate Number: 570117117295 CARRIER NAIC CODE See certificate Number: 570117117295 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR POLICY NUMBER POLICY WVD EFFECTIVE DATE POLtCY EXPIRATION LIMITS DATE (MM/DD/YYYY) (MMIDD/YYVY) AUTOMOBILE LIABILITY B 10 AB s41202 01/01/2026 01/01/2027 collision $1,000 ADS Deductible AUUHU 101 (2008/U1) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000048582 LOC #: ADDITIONAL REMARKS SCHEDULE Page _ of AGENCY NAMED INSURED Aon Risk Services Northeast, Inc. Bureau Veritas Technical Assessments LLC POLICY NUMBER See Certificate Number: 570117117295 CARRIER NAIL CODE see Certificate Number: 570117117295 EFFECTIVE DATEt ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Workers compensation/Employers Liability IOWNS41200 01/01/26-01/01/27 Trumbull Insurance AR,DC,IN,LA,NE,RI,UT 1OWNS41200 01/01/26-01/01/27 Twin City Fire Insurance Company FL,ND,OH,WA,WY 10WNs41200 01/01/26-01/01/27 Hartford Insurance Company of the Midwest AK,ID 1OWNS41200 01/01/26-01/01/27 Hartford Casualty Insurance Company MO,WV 1OWNS41200 01/01/26-01/01/27 Nutmeg Insurance Company CT,IL 10WNs41200 01/01/26-01/01/27 Hartford Fire Insurance Company NH,OR,PA 10WNs41200 01/01/26-01/01/27 Hartford Accident and Indemnity Company AL,GA,KY,MI,MT,NY,TN,VT IOWNS41200 01/01/26-01/01/27 Property & casualty Ins Co of Hartford CA,CO,DE,ME, MN,MS,SC 1.0WNs41200 01/01/26-01/01./27 Hartford Insurance Company of Illinois TX IOWNS41200 01./01126-�01.101127 Hartford Insurance Company of the southeast KS,MD IOWNs41200 01/01/26-01/01/27 Hartford Underwriters Insurance Company AZ,HI, NC,N7,SD,VA 1OWN541200 01/01/26-01/01/27 Sentinel Insurance Company, Limited IA,NM,NV,OK IOWBRS41201 01/01/26-01/01/27 Twin City Fire Insurance Company wI 10WBRS41201 01//01/26-01/01/27 sentinel Insurance Company, Limited MA N ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD