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PROOF OF INSURANCE (2014) CLOSED 4D DATE(MMIDDIYYYY) A " CERTIFICATE OF LIABILITY INSURANCE 12/31/2013T2r2111 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 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 endorsements. PRODUCER Lockton Insurance Brokers,LLC E C 725 S.Figueroa Street,35th Fl. PHONE CA License#OF15767 EMAIL .. 11.._ ........ Los Angeles CA 90017 (213)689-0065 INSURERS:AFFORDING COVERAGE NAIC fe... INSURER A:OneBeacon America Insurance Company 20621 INSURED INSURER B:Indian Harbor Insurance Comnanv a: 1$79193'Prosum,Inc. 2321 Rosecrans Avenue,Ste.422 INSURER c El Segundo CA 90245 INSURER D: INSURER E: INSURER F COVERAGES PROSU-! CERTIFICATE NUMBER; 2911178- REVISION NUMBER: C ; 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. p BS ADDL SUER POLICY`EFF POLICY EXP LIMITS L'I"R TYPE OF INSURANCE INSR un"n POLICY NUMBER fMM'DOIV 1 fMMIDD/YYYY1 A _GENPRALLIABILITY Y N 7110082470007 6/19/2013 6/19/2014 "' "" e 110, n nn MFD ESE (E one person) 000,00 MMERetALGCNER�1,. SILIG•)" 0 ULARM I4dA01:. �m� OOC`UR DAMAGE TO RENTED n nnn PREMISES(Ea occurrence) $ 1�� PERSONAL&ADV INJURY $ 1,000_,000 GENERAL AGGREGATE $ {inn nnn „0EN'l.AGGREGATE LIMIT APPLIES PER: PRnnUrrG_COMP/OP AGG s 2,000,000 POLICY PRA LOC $ AUTOMOBILE LIABILITY 7110082470007 6/19/2013 6/19/2014 A N N Ea COMBINED s I nnn nnn ANY AUTO ._..� BODILY IN JURY(Par person) $ XXX ALL OWNED SCHEDULED BODILY INJ RY(Par accident) AUTOS -••-•-• AUTOS PROPERTY RTY DAMAGE $ XXXXXXX PROPE HIRED AUTOS AUTOS Ice. Comp/Coll Ded s 1,000 A X UMBRELLA LIAB X OCCUR N N 7110082470007 6/19/2013 6/19/2014 EACH OCCURRENCE $ 6(100 000 A EXCESS LIAR CLAIMS-MADE Inc].WC Coverage B AGGREGATE S OTH DED RETENTION$ -_ f WORKERS COMPENSATION Y 406032131 12/31/2012 12/31/2013 X RY LIMIT ER A AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 1 nnn nnn OFFICER/MEMBER EXCLUDE 07 ❑N NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ L0101000 If yes,describe under E L.DISEASE-POLICY LIMIT s nnn nnn hP12r,PlPTION OF OPFRATIONS haloes Prof.Liability B N N MTP0041336 6/19/2013 6/19/2014 $5,000,000$a Wrongful Act , Claims.Made $5,000,000 Total Limit $50,000 Retention DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) THIS CERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR THIS HOLDER,APPLICABLE TO THE CARRIERS LISTED AND THE POLICY TERM(S)REFERENCED. The City,its officers,officials,employees,agents,and volunteers are an Additional Insured to the extent provided by the policy language or endorsement issued or approved by the insurance carrier,Waiver of Subrogation applies to the workers'compensation. CERTIFICATE HOLDER CANCELLATION See Attachments 1I, L� SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE O p THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN rw ,mo ACCORDANCE WITH THE POLICY PROVISIONS. d �Igtti. v, 2911178 �„'` � 'AUTHORIZED REPRESENTATIVE I �v City of El Segundo City Clerk Attn: Administrative Services <' 350 Main Street,Room 5 El Segundo CA 90245 A ORD 2 (20110105 s g The ACORt7 name and logo are registered marks of ACORD t"3813-, 11 ORD CORPORATION.All rights reserved P COMMERCIAL GENERAL LIABILITY POLICY NUMBER:7110082470007 CG 2.01007047�,r THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ` ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Location(s)Of Covered Operations: Or Organization(s): The City, its officers, officials, employees, agents, and volunteers. Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. Section II -Who Is An Insured is amended to include as an additional insured the person(s)or organization(s)shown in the Schedule, but only with respect to liability for"bodily injury", "property damage"or"personal and advertising injury"caused, in whole or in part, by: 1.Your acts or omissions; or 2.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 of the the additional insured(s)at the location(s)designated above. B.With respect to the insurance afforded to these additional insureds,the following additional exclusions apply: This insurance does not apply to"bodily injury"or"property damage"occurring after: 1.All work including materials parts or equipment furnished in connection with such work,on the project(other than service, maintenance or repairs)to be performed by or on behalf of the additional insured(s)at the location of the covered operations has been completed; or 2.That portion of"your work"out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 ©ISO Properties, Inc., 2004 Page 1 of 1 Attachment Code:D452802 Certificate ID:2911178 LOCKTON® July 3, 2013 `' City of El Segundo City Clerk „ , Attn: Administrative Services �NUef i. 350 Main Street, Room 5 El Segundo, CA 90245 Re: Notice of Cancellation Clause To Whom It May Concern: As a service to our valued client, Lockton will provide at least thirty (30) days notice of cancellation to the certificate holder listed on the attached Acord 25 certificate of insurance should any of the policies described on the attached certificate be 1) cancelled by the insurer, other than for non-payment of premium (10 day notice for non- payment/non-reporting), and 2) cancelled more than 30 days prior to the expiration date of the policy. If notice is mailed, proof of mailing notice to the certificate holder to the postal mailing address as shown in the schedule will be sufficient proof of notice. Thank you and please contact our office if you have any questions. Regards, 1.4��X_�” David Burgos Assistant Vice President Lockton Insurance Brokers Attechmenl Code:D463OD6 CertiOcate ID:2911176 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT- CALIFORNIA C, 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,) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be % of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description As per Written Contract City of El Segundo City Clerk 350 Main Street,Room 5 A Segundo,CA 90245 WC 04 03 06 (Ed.4-84) Miscellaneous Attachment:M452232 Certificate ID:2911178 Shilling, Mona From: Garcia, Angelina Sent: Wednesday,July 03, 2013 3:59 PM s. To: Klingaman, Larry J. Cc: Shilling, Mona , Subject: RE: Certificate of Insurance - Prosum Accepted. Angelina Garcia From: Klingaman, Larry J. Sent: Wednesday, July 03, 2013 3:58 PM To: Shilling, Mona Cc: Garcia, Angelina Subject: FW: Certificate of Insurance - Prosum Hi Mona, Here is the updated Insurance I received from the vendor. Larry Klingaman Information Systems Manager City of El Segundo 310.524.2392 From: Amy Chidthai rrloko , nl Chidthai rosum.c irrj, Sent: Wednesday, July 03, 2013 3:49 PM To: Klingaman, Larry J. Subject: FW: Certificate of Insurance - Prosum Hi Larry, Hopefully this takes care of it. Please confirm receipt, I am sending from my phone and want to make sure you get it. My cell is listed below, please ferl free to call me with any questions. Thanks Amy Chidthai 714-224-2537 1