PROOF OF INSURANCE (2026 - 2026)__� 0 DATE (MMIDD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
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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 CONTACT --
NAME; Lisa Burrill
Acrisure Southwest Partners Insurance Services, LLC PHONE" .. FAQ
4000 Westerly PlaceE-Mq..t XR1. 909-766-1758 ........ .,. µ( wro)
Suite 110 ADCREss liburrill acrisure coo
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Newport Beach CA 92660 IN$uRER � A�4�DFI�ING covE,....
tricense#: eft 18Q1.�7,A INsuRERA Continental Casualty Company f 20443
INSURED JANDBCO-01 INSURERS United Financial Casualtyr Company 1,1770
and B Communications Inc INSURER Insurance
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15424 Hawthorne Blvd INSURER American CasualtuCom an of Reading, 2..427 p y 0
Ste 201 B y 0427
Lawndale CA 90260 INSURER E
INSURER F
rnvooAr-oc PCDTICIf ATC N1I'.NA9ZR• 94RAV,7r,r, REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
.......,, ...............
RI POLYC'V EFF POLICYE XP
YNiPx { - ------TYPE OF INSURANCE ... ...._ ._.1�4,ODL-S71J .... .....INSO POLICY NUMBER .....�, .......... MMIDD I MMFDDdY'YYY.
G.TR
............ ..... LIMITS..........
A COMMERCIAL GENERAL LIABILITY Y 6074643400 4/6/2025 4/6/2026
OCCURRENCE_
�..,
000 000
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CLAIMS -MADE OCCUR
�.....� �X..�
DAMAta% i�'iS.F'�1=NT�b
PR.EMI$EB nce)
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$ 1 �000 000
(An one perso
MED EXPi
$ 10 000 ...
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PERSONAL.. ADV INJURY
I s2,000,000 e1
9ENt. AGGREGATE: LIMIT APPLIES PER:
ENERALAGGREGAT E
4
$,,,,,,,. 000
PO4.ICY I JE�fl` � LOC
COMPIOP AGG
PRODUCTS „s4,000,000
.... ..,,,__.
4
OTHER
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B
f AUTOMOBILE LIABILITY
Y
975466793
12I2612025
6/26/2026
GOMBIN eDrIt) F G1 LI MIT
(e w tffm)..
$ 1 000 000
f 1`` ANY AUTO
BODILY INJURY (Per person}
_
$
f X -.
I OWNED SCHEDULED
BODILY INJURY (Per accident)
$
AUTOS ONLY AUTOS
HIRED X NON -OWNED
f P6�.bPERTYDAMAGE
-
$
X„ AUTOS ONLY _, ._, AUTOS ONLY
1-�PP ,acc4,IJen)J"-
I
..$_ I
C
X
UMBRELLA LIAB i OCCUR
6074643414
4/6/2025
4/6/2026
�E ACH OCCURRENCE
$ 5 000 000
EXCESS LIAB CLAIMS MADE
l.A._,........,.
I
AGGREGATE
.. ........
$ .. ............... „
.
,. ... , ,.
ION $
DEDX in n
I
$
p "WORKERS
TI
COMPENSATION
COMPENSATION
6080710833
` 4/6/2025
4/6/2026
X PER OTH
FR
AND EMPL A
OFF RO RIETO REXCLUDEDo ECUTIVE Y / NI
�"
N / A
f E. L. EACH ACCIDENT
$ 1 000 000
(Mandatory in NH)
I E,L. DISASE EA EMPLOYEEi
$ 1.000 000
If yes, describe under
I LIMIT
$ 1,000,000
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY
i
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
City of El Segundo, its elected and appointed officials, employees, and volunteers are named as additional insureds.
ULK I II-1 ;A I t MULUtK
City of El Segundo
its elected and appointed officials
employees, and volunteers
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
Uc I VSt1-LU1 5 AGUKU UUKt'UKA I IUN. All rlgim:5 reberveu.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
Policy: 975466793
Form 2366 (02/11) M_CL
Blanket Additional Insured Endorsement
This endorsement modifies insurance provided by the Commercial Auto Policy, Motor Truck Cargo Legal
Liability Coverage Endorsement, and/or Commercial General Liability Coverage Endorsement, as appears
on the declarations page. All terms and conditions of the policy apply unless modified by this
endorsement.
If you pay the fee for this Blanket Additional Insured Endorsement, we agree with you that any person
or organization with whom you have executed a written agreement prior to any loss is added as an
additional insured with respect to such liability coverage as is afforded by the policy, but this insurance
applies to such additional insured only as a person or organization liable for your operations and then
only to the extent of that liability. This endorsement does not apply to acts, omissions, products, work,
or operations of the additional insured.
Regardless of the provisions of paragraph a. and b. of the "Other Insurance" clause of this policy, if the
person or organization with whom you have executed a written agreement has other insurance under
which it is the first named insured and that insurance also applies, then this insurance is primary to and
non-contributory with that other insurance when the written contract or agreement between you and
that person or organization, signed and executed by you before the bodily injury or property damage
occurs and in effect during the policy period, requires this insurance to be primary and non-
contributory.
In no way does this endorsement waive the "Other Insurance" clause of the policy, nor make this policy
primary to third parties hired by the insured to perform work for the insured or on the insured's behalf.
ALL OTHER TERMS, LIMITS, AND PROVISIONS OF THE POLICY REMAIN UNCHANGED.
ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS LIABILITY COVERAGE FORM
SCHEDULE
Name Of Person Or Organization:
SB300113D
(Ed. 6-16)
Information required to complete this Schedule, if not shown on this endorsement, will be shown In the Declarations.
It Is understood and agreed that the section entitled WHO IS AN INSURED Is amended with the addition of the following:
A. The person or organization shown in the Schedule is an Insured, but only with respect to such person or organization's
liability for 'bodily injury,' 'property damage' or 'personal and advertising injury* caused, In whole or in part, by your
acts or omissions or the acts or omissions of those acting on your behalf:
1. In the performance of your ongoing operations; or
2. in connection with premises owned by or rented to you.
B. However, If coverage for the additional Insured Is required by written contract or written agreement, subject always to
the terms and conditions of this policy, including the limits of insurance, we will not provide such additional insured
with:
1. coverage broader than required by such contract or agreement; or
2. a higher limit of Insurance than required by such contract or agreement.
C. The coverage granted by this endorsement does not apply to 'bodily injury' or 'property damage' Included within the
products -completed operations hazard.'
Any coverage granted by this endorsement shall apply solely to the extent permissible by law.
All other terms and conditions of the Policy remain unchanged.
S83001130 (Ed. 6-16)
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Copyright, CNA All Rights Reserved.
SB-300120-C
CAM (Ed. 06/11)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS -
SCHEDULED PERSON OR ORGANIZATION - WITH PRODUCTS COMPLETED
OPERATIONS COVERAGE
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS LIABILITY COVERAGE FORM
SCHEDULE*
Name Of Person Or Organization:
• Information re uired to complete this Schedule if not shown on this endorsement, will be shown In the declarations
A. The following is added to Paragraph C. Who Is An 1. The rendering of, or the failure to render any
Insured: professional architectural, engineering, or
4. Any person(s) or organization(s) shown In the
surveying services, including:
Schedule is also an additional insured, but only (a) The preparing, approving, or failing to prepare
with respect to liability for 'bodily injury,' 'property or approve maps, shop drawings, opinions,
damage' or 'personal and advertising Injury,' reports, surveys, field orders, change orders
caused, in whole or in part, by: or drawings and specifications; and
a. Your acts or omissions; or
b. The acts or omissions of those acting on your
behalf
In the performance of your ongoing operations for
the additional insured(s); at the location(s)
designated above; or
c. 'Your work' that Is included in the 'products -
completed operations hazard' and performed
for the additional insured, but only if this
Policy provides such coverage, and only if the
written contract or written agreement requires
you to provide the additional Insured such
coverage.
B. The insurance provided to the additional insured does
not apply to 'bodily injury,' 'property damage,' or
'personal and advertising injury' arising out of:
SB-300120-C
(Ed. 06/11)
(b) Supervisory, inspection, architectural or
engineering activities.
2. 'Bodily Injury,' 'property damage,' or 'personal
and advertising injury' arising out of any premises
or work for which the additional insured Is
specifically listed as an additional insured on
another endorsement attached to this Policy.
C. The following is added to Paragraph H. of the
Businessowners Common Policy Conditions:
H. Other Insurance
This Insurance is excess over any other insurance
naming the additional insured as an insured
whether primary, excess, contingent or on any
other basis unless a written contract or written
agreement specifically requires that this insurance
be either primary or primary and noncontributing.
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