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PROOF OF INSURANCE (2016) CLOSED�1 ACORO° CERTIFICATE OF LIABILITY INSURANCE DA 6 TE (MM/DD /15/20 YYYY) 12/31/2015 6/15/2015 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 Lockton Insurance Brokers, LLC 725 S. Figueroa Street, 35th Fl. CA License #OF15767 IA/C. No. Extl: lAIC No Los Angeles CA 90017 (213) 689-0065 NCIIRFri /Cl AF FfI RrIINf, f t1VFRAf F NAIC n �, INSURERA: OneReacon Insurance Comnanv 21970 INSURED Prosum, Inc. ''. INSURER e : Indian Harbor Insurance Comnanv EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 6940 1302737 2321 Rosecrans Ave., Ste. 422 INSURER C: Atlantic Specialty Insurance Company POLICY NUMBER 27154 El Segundo CA 90245 LIMITS A X COMMERCIAL GENERAL LIABILITY Y INSIIRFR n INCIIR FR F 711008247 6/19/2015 6/19/2016 EACH OCCURRENCE I SIIRFR F _ MAl'" RENTED Mt l.. Ea occur t: r,0 a 1,.000.000 r° r%u t!i AY" -°. C D0nQ'F 1A] A^C0T1E11 -AT'F Nil! IUAA.DIZOp. 10 1117R 09:%fIQ.Ir K1 AI:11"Cuiz'R• "It'`"1t'VV°k!'"'(Y 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. IN R TYPE OF INSURANCE ADDL INen SU1FWi POLICY NUMBER C Y FF P L Y E, P LIMITS A X COMMERCIAL GENERAL LIABILITY Y N 711008247 6/19/2015 6/19/2016 EACH OCCURRENCE 1,000,000 MAl'" RENTED Mt l.. Ea occur t: r,0 a 1,.000.000 CLAIMS -MADE X OCCUR MED EXP (Anv one Derson) R 10,000 PERSONAL & ADV INJURY S 1.000.000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE ''.. s 2.000.000 POLICY❑ PRO ❑ LOC PRODI_CTS- COMP /OP AQQ $ 2.,000.000 ''OTHER $ A AUTOMOBILE LIABILITY N N 711008247 6/19/2015 6/19/2016 9&,11 NL IN LE LIMIT IL $ 1,000,000 BODILY INJURY (Per person) $ XXXXXXX ANY AUTO I AUT OWNED SCHEDULED AUTOS BOODIL'Y INJURY (Per accident $ XXXXXXX fftraP�:RI"`r+nI�AMA.xE $ XXXXXXX HIREDAUTOS NON-OWNED Comn /Col I Ded $ 1 -000 A UMBRELLA LIAB OCCUR N N 711008247 6/19/2015 6/19/2016 EACH OCCURRENCE $ 5.000,000 EXCESS LIAB N CLAIMS -MADE. AGGREGATE $ 5.000,000 l DED I RETENTION $ $ XXXXXXX C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y. / N ANY PROPRIETOR/PARTNER/EXECUTIVE p�N OFF ER/y m NH) EXCLUDED? A`a NIA Y 406032131 12/31/2014 12/31/2015 X STATUTE Fla EACH ACCIDENT W HL S l .000 -000 - D YYYY YYYY VV..... EASE EA EMPLOYEE A 1.000.000 If yes, describe under DESCRIPTION OF OPERATIONS below E R D!sEAF - PQI Ir_:Y I IMIT Q 1.000.000 B Prof. Liability Claims Made N N MTP0041336 6/19/2015 6/19/2016 $5,000,000 Ea Wrongful Act $5,000,000 Total Limit $50,000 Retention DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City, its officers officials, employees, it t ntv and volunteers are an Additional Insured to the extent provided by the policy language or endorsement issued or approved by the insurance carrier £I1 rcr ctf Subrogation applies to the workers' compensation. arna�eatlat+a�sa�auiL *s�1 ■:I�� .- -- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 2911178 City of El Segundo City Clerk Attn: Administrative Services 350 Main Street, Room 5 El Segundo CA 90245 ACORD 2512014/011 ©1 SMII.20141ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 711008247 COMMERCIAL GENERAL LIABILITY CG 2010 07 04 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 See Description of Operations section on attached volunteers. Certificate of Insurance Information required to complete this Schedule, if not s 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; hown above, will be shown in the Declarations. 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: 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. CG 2010 07 04 Attachment Code: D452802 Certificate ID : 2911178 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. © ISO Properties, Inc., 2004 Page 1 of 1 June 15, 2015 City of El Segundo City Clerk Attn: Administrative Services 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 such cancellation occurs less than 30 days prior to expiration, Lockton will provide as much prior notice as practicable). 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, 1� David Burgos Assistant Vice President Lockton Insurance Brokers Attachment Code: D463006 Certificate ID : 2911178 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA 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 Vj WHERE REQUIRED BY WRITTEN CONTRACT All Operations WC 04 03 06 (Ed. 4 -84) Attachment Code: D492298 Certificate ID: 2911178