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PROOF OF INSURANCE (2016) CLOSEDAC6 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) ' 11/16/2015 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 pollcy(les) must be endorsed, If SUIBROGATION 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 Krista Dean Altus Partners, Inc P N J Nags (610) 526-2021 919 Conestoga Road M cert' es @altus artners com Buildin g 3 , Suite 311 P PRODUCER 00000023 Rosemont PA 19010 I ......... ......... I INSURER(S) AFFORDING COVERAGE N NAIC # _.___.... . INSURER American Insurance . CO.,. 2667 INSURE_R.R..ACE......Ame.r.1. can......._.. m COVERAGES CERTIFICATE NUMBER:15 -16 Std 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. TYPE OF INSURANCE � inico nnm (]LICE /YYVY .. ....... U BE !MM /ra ........ ............. INSR � � _ ��� AgYC7L Sf71'BR ...� —� " POLIFY EFF POLICY EXP LIMITS C . -- n. I MMdDO +"NYYY ', GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 -- _ , 00 A CLAIMS-MADE E X LIABILITY OCCUR SL G27398595 11/30/201511/30 /2016 M XP(Any one oersonl $ 1 O10,000 X COMMERCIAL X $lmm SIR PERSONAL & ADV INJURY $ 1,000,000 ..... .... . .......... ....._ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGO $ 2,000,000 „.�. ..... - - - -- .. ............... . X POLICY Ll PR n' ..,,,. -..._ LOC _ .................- ..�....... $ B AUTOMOBILE LIABILITY H08865413 (H &NO) .1/30/2015 11/30/2016 COMBINED SINGLE LIMIT $ 1,000,000 ANY AUTO 08865425 (Owned) 11/30/2015'11/30 /2016 (Ea accident) .................. .........., BODILY INJURY (Per person) $ B X ALL OWNED AUTOS -- - --- .................. ................................... .......... ., BODILY INJURY (Per accident) $ SCHEDULED AUTOS ......... "`$. ..... ........... PROPERTY DAMAGE X HIRED AUTOS (Per accident) ..X.- ------ .......... ..... ...................... ......... .............. NON -OWNED AUTOS $ ........ .......... ............ ...........: .. .............. _$ C X UMBRELLA LIAR X OCCUR S27926691 11/30/2015 11/30/2016 EACH OCCURRENCE $ 5,000,000 - m...� - -- - - EXCESS LIAB CLAIMS - MADE''. AGGREGATE $ 5,000,000 DEDUCTIBLE m� LE $ ......,... ............... ....- ,.......,,,,.n..m....,,,.. _,,.... m ....---- ........................ .. X RETENTION $ 100,000 $ " WC STATU OTH- ANDEROPRIOTOREPA LIABILITY YIN '. NIA 48591292 (CA /MA) 11/30/201511/30 /2016 E.L1. EACH —I1 iinn1. cQ �" �00'.. ANY D Ma CER/ /Min NH) EXCLUDED? 48591322 (TN) 1/30/2015 11/30/2016 E,L DISEASE _ T $ . - If es, describe under 48591310 (WI) EL DISEASE - POLICY LIMIT EA E pYE DESCRIPTION OF OPERATIONS below 11/30/2015 11/30/2016 000 . 000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Certificate issued as evidence of insurance per policy terms,conditions and exclusions. Certificate holder is an additional insured on the general liability insurance policy per the written agreement. A waiver of subrogation in favor of certificate holder applies to the workers compensation insurance policy per the written agreement. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of E1 Segundo1 350 Main Street " El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE�____��� Krista Dean /KMD ACORD 25 (2009/09) ©1988 -2009 ACORD CORPORATION. All rights reserved. INS025 (200909) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of E1 Segundo1 350 Main Street " El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE�____��� Krista Dean /KMD ACORD 25 (2009/09) ©1988 -2009 ACORD CORPORATION. All rights reserved. INS025 (200909) The ACORD name and logo are registered marks of ACORD ADDITIONAL INSL)RED - 131ESIGNXTED PERSON OR ORGANIZA rim Number AflegIs Group ft El Xl FG27398595 1 1113012015 to 1113012016 Mued By �Nama of Insurance Company) AGE Amedcarr Insurance Corripany WWIMIAOcynonlbor, Me mma"00414H]" MW avidOMWIMV is Wo Pn)P8,rawn asp W01 POUCY T1 HS ENDORSEMENT C11AINGES Tl1E P01-11CY. IN EASE READ rT CAREFULLY. T'Ns endorsernent rnodiifies insurance provided under the following- EXCESS It GE14ERAIII LIABILITY POLICY 4 SCI-MOULE Narne of Pen on or Organization: Any person or organization whom you have agreed to include as an adftorml Insured under a wrMen conlract, provIded sucl,-o contract was executed prior to the date of loss,, P� Section 11 , Who Is An Insured is amended to include as an additional Insured the pwson(s) or orgpNzat(cn(s) shown in the SchedLJO, tout o0y Mth respect to HaWlity for "bodHy Injury", "property damage" or "p: eirsonal and advertsing injury" caused, In whole or in pad, by your acts or omissiions or the acts or o nissions of those acUng on your behalf., In the performance of your ongoing operations; or 2. In connection w1iffi your, p: rendses owned by or rented to you,, However ,i., "rfie [visurance afforded to sudh additional Hsured only appfies to the extent permitted by iaw; and 1 If coverage pro,Wded to the additk)naf 'i nsurad is required b, a contract or agreernent, the insurance V afforded to siudl--n adidWonal insured WH not be broader than 11hat md,kh you are required by the contract or agreement to provide for such addItIonall insured, B. With respect to the Insurance affarded to these addWonal kisureds, the following Is added to SecUors IIH — Limits Of insurance And Retained Lirnit: If coverage provided to the addiltlor-0 Insured is requVad by a contract or agreernent, the most we Will pay on behalf of the additIonall insured is the arnount of insuranow 1. Rc�quiredbyilhiecoritractoii-,agreernenlf,,,rear 2. Avaflall:k under the app0caNe 11 In1ts of hisurance shown in the Declarations; whichever is Iess. "rhis endorsernent shall not increase the appiical* Lknils of Insurance shown inn the DncWafions. Auffiorized RepreserflatNe XS-6W251b (0411) Bran i,ides copy0ghked rnaleflall of IInasurarnce SerAces Office, liw., Wth iLs perMsMon. Page I of I SIGNATURES - - – ----- -------- ------------------ - ---- — — - — — ----- — ------ — — — ---- Named InskWed Aftgis Group ft Endorsement Nuirinber 3 #:ioicy ......... . ... .. . ...... IP V anu6axcN — — — - — ------- - - - - . ........ - - — ------- EffecUve IDale or Endorsement XSL G27398595 11/30/2015 TO 11/3012016 nsuumre cornpiny) ACE American Insurance Company fted the MAky numW.'nw remeMer of unman Womadan us to be compleWd oMywhen fts endarsemeM u9 Waued subsequent to ffie pmparetWn of ft pky THE ONLY SIG14ATURES AI::1PUCABLE TO "I "HI 11::10LICY ARE ri-iOSE REPRESENTING "rHE COMPANY NAMED ON THE FIRST 1::1A GE OF T1 tE DISC LARATtONS,, By Mgnu ng and defivedng the poky to you, we state that it U s a vaUd corgract, 436 Walnut Street, P.O., Box 1000, PhffadelpNa, Per-u-tsylvania'19,106-3703 M��'OKCA L COLUNS, Secretaq J011-IN J. LUNCA, Piresident Auflk)dzed RepresenlaUve CC2,4180c (0,3114) Page I of I 11-30-2015 TO 11-30-2016 ERlCA and Emp$oyers'Llabllky Policy ement Number PaNey Numb ®r -Symbol: WLR Number: C48591309 go'jcjj-veDaje of Endorsement 11-30-2015 This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule, ANY PERSON OR ORGANIZATTOPI AGAINS'1' F,11H014 YOTI HAVE AGREED TO WAVVIE YOUR RIGHT OF RECOVE11iY IN A WPITTV�,N (MITTRACT, PROVIDED SUC111 CONTRACT' wAS E)CECUTED PRIOR TO THE DATE OF LOSS. For the states of CA® UT, TX, refer to state specific endorsements. This endorsement Is not applicable in KY, NH, and NJ. Autho6zed Agent wc� ............. . . 0 03 i� 1105) told. U.S.A. Copyright 1982-83, National Coundl on Compensation