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PROOF OF INSURANCE (2016) CLOSED0 F_ ATE (MMIDD/YYYY) AC"R" CERTIFICATE OF LIABILITY INSURANCE 6/19/2016 12/14/2015 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). ACT PRODUCER Lockton Insurance Brokers, LLC NAME: 725 S. Figueroa Street, 35th Fl. PHONE FAX CA License #0F 15767 E-MAIL annLos Angeles CA 90017 ------------------------------------------------------------------------------ 77- _7e ---------- (213) 689-0065 "� !NfG�PPYE�ARE�___ """ "" :e' euee INSURER A: Atlantic S peci a-fly Insurance Compla 27154 INSURED Prosurn Inc. 1302737 2201 Park Place, Ste 102 El Segundo CA 90245 INSURER D: INSURER E COVERAGES PROSUOI CERTIFICATE NUMBER: 2911178 REVISION NUMBER: XXXXXXX 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' A66CSUBIR " I idi V T POLICY EXP LTR TYPE OF INSURANCE INSD POLICY NumBrR (MMIDDIYYYYI IMM/DD1YYYY1 LIMITS M A COMERCIAL GENERAL LIABILITY Y N 711008247 6/19/2015 6/19/2016 EACH OCCURRENCE, ��sIfl),9090,09-0- _X CLAIMS-MADE Ex OCCUR bAMAOE RYREKfrt . PREMISES (Ea acc ....... 0) LOIDU00 �n - I I�ED EXP (Any one person) �S 10000 PERSONAL & A D V INJURY s 1 000,000 GENERAL AGGREGATE $ 2.000.0 00 G E N'L A G GR E GATE LIMi r APPLIES PER: ... .. .. . . ............. '01 ICY IL.0 PRODUCTS - COMP/OP AGO s 2.000.000 A AUTOMOBILE LIABILITY N N 711008247 6/19/2015 6/19/2016 r."XIM11INEI)SINGI E UMIT 't"wrv'Mont $ 1.000.000 aa .- -) — X ANY AU TO BODILY INJURY (Per person) $ XXXXXXX ALL OWNED SCHEDULED BODILY INJURY (Per accident) XXXXXXX AUTOS AUTOS NON -OWNED 4- F;R (0, E 0 11( vAmAG XXXXXXX HIRED AUTOS AUTOS I (Por norsiora) I I I " I T)"I s 1,000 A UMBRELLA LIAB XI OCCUR N N 711008247 6/19/2015 6/19/2016 EACH OCCURRENCE $ _5000.000 __X EXCESS LAB CLAIMS MADE AGGREGATE s 5,000,000 .)L_ :L L I RETEN TION $ I $ XXXXXXX — I—. RKERS COMPENSATION Y 406032131 A AND EMPLOYERS' LIABILITY ......... . . .... V 1/2016 ;A lU7. OTH 12/31/2015 12/3 X is Y�N ANY PROPRIETOR/PARTNERJEXECU fIVE NIA' EL EACH ACCIDENT S (Imandatory in Nll1 EL DISEASE - EA EMPLOYEE J 1 000,000 dorcriho undor D ; SCRIP11014 Of-, OPERA I ONS helow E,L, DISEASE - POLICY LIMIT 1.000.000 B Cyber and Technology Prof. N N MTP0041336 6/19/201 6/1 $5,000,000 Ea Wrongful Act Liab - Claims Made $5,000,000 Total Limit $50,000 Retention . .............. DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Fhe 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 2911178 City of El Segundo City Clerk SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Administrative Set-vices ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street, Room 5 El Segundo CA 90245 AUTHORIZED REPRMKTA'n' 7,� 88-201 CO CORPORATION. All rights reserved. kW ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 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. Regards, 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 WHERE REQUIRED BY WRITTEN CONTRACT All Operations WC 04 03 06 (Ed. 4 -84) POLICY NUMBER: 711008247 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 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 your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: B. With resl,ect 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. 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. 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. CG 20 26 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 Attachment Code: D498109 Certificate ID: 2911178