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PROOF OF INSURANCE (2015) CLOSEDOP ID: EM ACORO" TE CERTIFICATE OF LIABILITY INSURANCE DA 10 /01IDD/YYYY) � 1010112014 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 endorsement(s). PRODUCER ICONTACT Capstone Insurance LLC PHONE FAX Suite 551 _ ..... ........ .... ......... .I!uc� No) 300 Washington Street E MAbL Newton, MA 02458 PROS CER EVERB -1� Sean Coady ! UTOMERip1 -, .. .... , .......... 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. INSR LTR TYPE OF INSURANCE B POLICY NUMBER POLICY IIIYYYY M°. DNYVY. LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A ......^ .. X .-DAMAGE GRNTD- ... .......W -­­- 1,00 CLAIMS-MADE OCCUR 1 MED EXP (Any one person) $ 0,0 0 ....... ..... ..... ..,,.e...._ ,�._m„ _,�.,,..__„ ....�e....a. PERSONAL &ADVINJURY ,.._.,....e,. $ 1,000,00 . —..... .. GENERALAGGREGATE $ 2,000,00. GEN'LAGGREGATE LIMIT APPLIES PER PRO DUCTS : COM PIOP AGG 2,000,00 X PRO- POLICY _ LOC . µ $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 — (Ea accident) ANY AUTO BODI LY I NJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE X ''.. A HIRED AUTOS 7356 -08 -29 01/20/2014 01/20/2015 (PER ACCIDENT) $ A X NON-OWNED AUTOS 7356 -08 -29 01/20/2014 01/20/2015 $ X UMBRELLA LIAB X OCCUR ........ EACH OCCURRENCE . ............................... $ 5,000,0 ... ....................S,000,OO... A........ EXCESS LIAB CLAIMS -MADE ..............................E 7987-61-99 01/20/2014 01/20/ 2015 AGGREGATEnn .......................................................................................................................... $ ..............................0 ...X.. DEDUCTIBLE XS UMB ......................................................... ............................... $ 8,000,00 RETEN710N $ 0 $ WORKERS COMPENSATION OT X 4 AND EMPLOYERS' LIABILITY YI N 7QRY MIT$ ,. ,_ . ... - A ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? NIA 7174 -14 -69 01/20/2014 01/20/2015 E L EACH ACCIDENT ° °- ° ° °- -• $ .1 000 00 . -•.•.• ........................ _ (Mandatory (Mandatory In NH) " E,L� DISEASE - EA EMPLOYEE $ 1,000,00 If yes, describe under DESCRIPTION OF OPERATIONS below ,.� ... .............. .............. E L DISEASE - POLICY LIMIT .....,. ,. ,........ ..._....,.. $ 1,000,00 A Tech E &O 3592 -15 -58 01/20/2014 01/20/2015 Limit 5,000,0 C Excess Tech E &O BINDER 09/03/2014 01/20/2015 Limit 5,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) City of E1 Segundo is included as Additional Insured, as their intest may appear, with respects to General Liability, as required by written contract. CERTIFICATE HOLDER CANCELLATION _. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo ACCORDANCE WITH THE POLICY PROVISIONS. Attn: City Clerk 350 Main Street AUTHORIZED REPRESENTATIVE El Segundo, CA 90 b� ` ©1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD F 52 err -1l� M Liability Insurance Endorsement Policy Period Effective Date Policy Number Insured Name of Company Date Issued This Endorsement applies to the following forms: GENERAL LIABILITY Who Is An Insured JANUARY 20, 2014 TO JANUARY 20, 2015 JANUARY 20, 2014 3592 -15 -58 BOS EVERBRIDGE INC FEDERAL INSURANCE COMPANY JANUARY 24, 2014 Under Who Is An Insured, the following provision is added: Scheduled Person Or Subject to all of the terms and conditions of this insurance, any person or organization shown in the Organization Schedule, acting pursuant to a written contract or agreement between you and such person or organization, is an insured; but they are insureds only with respect to liability arising out of your operations, or your premises, if you are obligated, pursuantto such contract or agreement, to provide them with such insurance as is afforded by this policy. However, no such person or organization is an insured with respect to any: assumption of liability by them in a contract or agreement. This limitation does not apply to the liability for damages for injury or damage, to which this insurance applies, that the person or organization would have in the absence of such contract or agreement. damages arising out of their sole negligence. Schedule PERSONS OR ORGANIZATIONS THAT YOU ARE OBLIGATED, PURSUANT TO WRITTEN CONTRACT OR AGREEMENT BETWEEN YOU AND SUCH PERSON OR ORGANIZATION, TO PROVIDE WITH SUCH INSURANCE AS IS AFFORDED BY THIS POLICY; BUT THEY ARE INSUREDS ONLY IF AND TO THE MINIMUM EXTENT THAT SUCH CONTRACT OR AGREEMENT REQUIRES THE PERSON OR ORGANIZATION TO BE AFFORDED STATUS AS AN INSURED. HOWEVER, NO PERSON OR ORGANIZATION IS AN INSURED UNDER THIS PROVISION OF THE WHO IS AN INSURED SECTION OF THIS POLICY (REGARDLESS OF ANY LIMITATION APPLICABLE THERETO). Reference Cop Liability Insurance Additional Insured - Scheduled Person Or Organize continued Form 80-02 -2367 (Rev. 8 -04) Endorsement Page 1 Liability Endorsement (continued) Llabillty Insurance Form 80-02 -2387 (Rev. 8 -04) All other terms and conditions remain unchanged. Authorized Representative Q,--QNk- Reference Copy Additional Insured - Scheduled Person Or Organization Endorsement last page Page 2