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PROOF OF INSURANCE (2016) CLOSEDDATE (MMIDDhYYY' AC"R" CERTIFICATE OF LIABILITY INSURANCE 9/18/2015 lul 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 COk�E'rACi aJ S21b2� Arthur J. Gallagher Risk Management Services, Inc. PHONE 82 Fax .... 994 �� 250 Park Avenue fair! N F „ 3rd Floor A D ss, Sabnn_a_GarlbajQajg,COm New York NY 1 0177 INSURER(S) AFFORDING COVERAGE NAIC # �.. .. ......._ INSURER A: Insurance Companv of State of PA 19429 _ - -- - - - - - -- _... w....._ -- - - - - -- INSURED INSURER B: Commerce and Industry Insurance Com 19410 L -3 Communications Mobile- Vision, Inc. INSURER C: Hampshire Insurance Company 23841 c/o L -3 Communications Corporation - - - -- 600 Third Avenue INSURER D:__ New York NY 10016 1.14SURERE 5260677 (MA) INSURER F COVERAGE'S CERTIFICATE NUMBER: 1040733440 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, ........ INTSRR TYPE OF ... ,_.... ADD% SU'DR . . . . . ...... ........ ....---- --- -- - POLtCY EFF PON.fl(Y IwXP INSURANCE INSD WVD POLICY NUMBER (MMIDDIVVVV) fMWDDtYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY Y 6634112 /1/2015 /1/2016 EACH OCCURRENCE $1,000,000 " �CAMACF'1rIR�°"NT�D— - - CLAIMS -MADE � X OCCUR PRrMISES, ( pccdcrl�ncel $1.000,000 ...-- - -- X (Includes Produc MED EXP (Any one person) $10 000 X Liability) PERSONAL &ADV INJURY $1,000 000 GENN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000,000 PRO X POLICY F LOC PRODUCTS - COMP / OP AG $2,000 000 JECT OTHER: $ A AUTOMOBILE LIABILITY 5260679 (AOS) /1/2015 /1/2016 COMBINED $2,000 000 A 5260677 (MA) /1/2015 /1/2016 IfE 'a A X ANY AUTO 5260678 (VA) /1/2015 /1/2016 BODILY INJURY (Per person) $ ..... ....., ALL OWNED ,.._,_.. SCHEDULED BODILY INJURY (Per accident) $ NON -OWNED X X PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Pp/ epGigjOrf $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS CLAIMS -MADE AGGREGATE $ DED RFTFNTI0 S $ WORKERS COMPENSATION 017731433 CA I1I2015 /1/2016 IACCIDENT B Y p N 017731434 (FL) /1/2015 /1/2016 ---- C ANY ROPRIEEOR/PARTINERIEXECUTIVE 017731437 (ME) ( ) /1/2015 /1/2016 EL, EACH $1,000,000 'OFFICER/MEMBEREXCLUDED? �� NIA' ,ORH ,(Mandatory in NH) E,L. DISEASE - EA EMPLOYEE.. $1.000.000 If yes, describe under _ _......._._. _._._._. ........ .__...... ......__ -... DESCRIPTION OF OPERATIONS below EL, DISEASE- POLICY LIMIT : $1,000.000 '.. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 'WC Policy# 017731436( AK ,AZ,IL,KY,NC,NH,NJ,PA,UT,VA,VT) - INSURANCE CO OF STATE OF PA - 02/01/15 02/01/16 WC Policy# 017731435( AL, AR, CO, CT, DC, DE, GA, HI, IA, ID, IN, KS, LA, MD, MI, MN, MO, MS, MT ,NE,NM,NV,NY,OK,OR,RI,SC,SD,TN) - INSURANCE CO OF STATE OF PA - 02/01/15 02/01/16 WC Policy# 0177314389(MA,ND,OH,WA,WI) - NEW HAMPSHIRE INSURANCE COMPANY - 02/01/15 02/01/16 City of EI Segundo, its officials and employees are included as additional insured (blanket endorsement) as respects General Liability Policy See Attached... laK I It-ILA I t MVLUth( City of El Segundo 350 Main Street, Room #5 City Clerk 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 © 1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: GL 663 -41 -12 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or O�rgan'ization(s): ANY PERSON OR ORGANIZATION WHOM YOU BECOME OBLIGATED TO INCLUDE AS AN ADDITIONAL INSURED AS A RESULT OF ANY CONTRACT OR AGREEMENT YOU HAVE ENTERED INTO. [',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 persons) 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 your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the .erformance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 26 04 13 *Insurance Services Office, Inc., 2012 Page 1 of 1 0 AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Arthur J. Gallagher Risk Management Services, Inc. L -3 Communications Mobile- Vision, Inc. .......... -•�• - c/o L -3 Communications Corporation POLICY NUMBER 600 Third Avenue New York NY 10016 CARRIER C zh'A F1e NAIC CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE as evidenced herein on a primary/non- contributory basis as required by written contract with respect to work performed by the named insured, Notice of Cancellation: Should any of the above described policies be cancelled before the expiration date thereof, L -3 Mobile- Vision, Inc. would provide (30) days written notice of cancellation to the City of El Segundo. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Sandoval, Uli From: Shilling, Mona Sent: Monday, September 21, 2015 3:53 PM To: Turnbull, Robert (Captain) Cc: Sandoval, Lili; Cerritos, Maria Subject: RE: Services Agreement for Purchase of VIEVU BWC's Bob, Greatl Then the Waiver of Subrogation is not required. We will attach this email to ire proof of insurance. Please have the vender provide the endorsement for the Commercial General Liability. Thanks, Mona S From: Turnbull, Robert (Captain) Sent: Monday, September 21, 2015 3:45 PM To: Shilling, Mona Cc: Sandoval, Lili Subject: Re: Services Agreement for Purchase of VIEVU BWC's Mona, No vendor is coming on site. We are buying body worn cameras that will be shipped to us. Bob Turnbull, Captain Administrative Services Bureau El Segundo Police Department 348 Main Street El Segundo, CA 90245 310 - 524 -2250 Office 310 - 607 -9171 FAX Visit us on the web www,ElSe unndoPp.Or On Sep 21, 2015, at 3:43 PM, Shilling, Mona <MShillin else undo.or > wrote: Bob, I reviewed the proof of insurance for L3 with Lill. Could you please have the vender provide the endorsement for the Commercial General Liability. Regarding the Waiver of Worker's Compensation; doesn't the Purchase Order Requisition indicate the vender is coming on site? Thanks, Mona S