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PROOF OF INSURANCE (2017) CLOSEDDATE (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 1/8/2016 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 CONTACT Julee Wnner Diversified Insurance Industries, Inc. NAME PHONE" 410 433 -3 FAx — --------- _ Ext).� 410- 433 -3440 Suite 155 West, 2 Hamill Road (A/C„NQ, _.-.. _ _ .. 3000 y (pv �m Baltimore MD 21210 -1873 E•MAII ulee.haoerCcIIIII ,cram A,, S_ X „ , . Y .,,., „ INSPRER( AFFORDING COVERAGE,.,. -NAIL, —. _. -- _..m...... ww_ ranee Co 20303 INSURER A rest Northern Insurance INSURED ENVIS -2 INSURER B: Federal Insurance Co.” 20281 Envisionware Inc .....................__— INSURER Chubb Inde mnit y Ins Co 12777 2855 Premiere Parkway, Suite A ......... _ .. _..... Duluth GA 30097 INSURER D t" r)VFPAr F f.FPTIFtt ^.ATF tuI IIVIRFR• 7719 -1R1R 01=k1mIR" ki IdtIafiDco. 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. R _..-- -- . .n...,..._...,,,.�,..�. A9�DL Si:3'S�k' .......... POLICY EFF P(7iLIC'V E')CP I R TYPE OF INSURANCE IN SO WVD POLICY NUMBER.�IMM /DD/YYYY M MIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y 35943516EUC _ _ 1/8/2016 1/8/2017 EACH OCCURRENCE $1,000,000 CLAIMS -MADE FX] OCCUR _ Pi�9 "Cy9- p�wfi�5��,r�nadma�cel $1.000,000 __....,I Ops 80022367, MED EXP (Any one person) $10,000 ......... ............................... PERSONAL & ADV INJURY $1, 000, 000 - GEN'L AGGREGATE LIMIT APPLIES PER: I I GENERAL AGGREGATE $2,000,000--- PI14' � I � _._ — X....... POLICY PET"T LOC PRODUCTS - COMPIOP AGG..., _ ...................................... ...........- - - - ...- .m....m; $2 000,000 OTHER: $ A AUTOMOBILE LIABILITY 73565308 1/8/2016 1/8/2017 DIJ,..... o Xf $1.000,000 .... X ANY AUTO BODILY INJURY (Per person) $ ALLO ED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) ..... _ ___ $ X .. X,... NON -OWNED (g0- -- .._ -- - -----_ .. HIRED AUTOS AUTOS (per accident B X UMBRELLA LIAB X OCCUR 79876897 1/8/2016 1/8/2017 EACH OCCURRENCE $2,000,000 EXCESS LIAB CLAIMS -MADE . ...- _. '.... AGGREGATE A.. $2,000,0 00 X D J FD RETENTION$0 ... _.....__.. $ C WORKERS COMPENSATION 71741378 1/8/2016 1/8/2017 PER OTH- X AND EMPLOYERS' LIABILITY Y / N ST;4TUTF FR _ ANY PROPRIETOR /PARTNER /EXECUTIVE E L EACH ACCIDENT $500 000 OFFICER /MEMBER EXCLUDED? NIA -- -•- (Mandatory in NH) E L DISEASE - EA EMPLOYEE $500,000 If yes. describe under _.......... me......... ..e...........W� ............. DESCRIPTION OF OPERATIONS below E.. L. DISEASE - POLICY LIMIT $500,000 B Errors & Ommission 82377145 1/8/2016 118/2017 Per Claim $1,000,000 Aggregate $1,000,000 Deductible $25,000 DESCRIPTION OF OPERATIONS (LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Regarding Bodily Injury & Property Damage under the General Liability, certificate holder is listed as Additional Insured for ongoing operations of Named Insured if required by written contract. CERTIFICATE HOLDER CANCELLATION City of El Segundo Attn: City Clerk 350 Main Street El Segundo CA 90245 -0989 ...,w 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 oNUBB Liability Insurance Endorsement Policy Period JANUARY 8, 2016 TO JANUARY 8, 2017 Effective Date JANUARY 8, 2016 Policy Number 3594 -35 -16 EUC Insured ENVISIONWARE, INC. Name of Company GREAT NORTHERN INSURANCE COMPANY nueeer ,�.,u. �._._� �, aw ..,, r...��_� m ue�.uc�. en.., -s :.c.v,,.__�,,. „o..,x „v.r.�sm�wsra•e�M�r»�,��.. oan. �,a,x:� aaxm,�..vx+s =, This Endorsement applies to the following forms: �...� GENERAL LIABILITY) INFORMATION AND NETWORK TECHNOLOGY BLENDED LIABILITY INSURANCE •.•::..;:HL�, 4M.i�::C.'�tY.;i,'�9i.t^:.F r.....::....."'�, ✓ra;�'�ft,s*�.R3 ... rF�...,.... Usi '�;SPfeiRgSt�ot!`.,,,i,.t7SeC fEkk�. t:: r�k,'A✓.C':'ba''k+k7�,;.rw v�`;w,, <...�.':✓.'+k ��.�. w'�Ar,•rw +, ;+..s r:. r: Ap- SkaS' r.+ 5k�.a""4"'w�°m', "s,.r"�.;�'7... r. < ?e>5. , 3dn�ia'�:4,: is Under Who Is An Insured, the following provision is added. Who Is An Insured ARL Additional Insured - Persons or organizations shown in the Schedule are insureds; but they are insureds only if you are Scheduled Person obligated pursuant to a contract or agreement to provide them with such insurance as is afforded by Or Organization this policy, However, the person or organization is an insured only: • if and then only to the extent the person or organization is described in the Schedule; • to the extent such contract or agreement requires the person or organization to be afforded status as an insured; • for activities that did not occur, in whole or in part, before the execution of the contract or agreement; and 11 • with respect to damages, loss, cost or expense for injury or damage to which this insurance applies. No person or organization is an insured under this provision: • that is more specifically identified under any other provision of the Who Is An Insured section (regardless of any limitation applicable thereto). • with respect to any assumption of liability (of another person or organization) by them in a contract or agreement. This limitation does not apply to the liability for damages, loss, cost or expense for injury or damage, to which this insurance applies, that the person or organization would have in the absence of such contractor agreement. v* �' �, ., R; A• x :�{- '.,.tl }+'�.'r:q.Wl„�i.1.r:r. oS�,✓'.. ��li'., in�% ti"+ ls... �Wxw:/ t��X `p�,�h',S'�4:,t�:�n�?1�4urn °K �i�?�mrak',.�.��"G^, r..a'Wi�a„vUu"wmJ� �.^�ewt /,.. si.� �S' 4A�" i`. i° 9�; XTa. S.. �pi�f .$tr•.�i.:x"a%�u'.^�F..G:�hs a".�n��N'�1 �..,x..,M.F1�t"�."�b,+.;4G�.9 `rrvziGd�`� Liability Insurance Additional Insured - Scheduled Person Or Organization continued Form 80.02- 2367(Rev.5 -07) Endorsement Page 1 Liablffty Endorsement (continued) Under Conditions, the following provision is added to the condition titled Other Insurance. Conditions Other Insurance — If you are obligated, pursuant to a contractor agreement, to provide the person or organization Primary, Noncontributory shown in the Schedule with primary insurance such as is afforded by this policy, then in such case Insurance — Scheduled this insurance is primary and we will not seek contribution from insurance available to such person Person Or Organization or organization. :::::: :xt'�:v:a�i:. :. ...... n.. n.n ?4i�.. ..tiMs�S �X.. Rtj :7:M +s�d. 2N... «4 e�..r• ar.M,w¢�,"wy$�$a.n.wrJ.w' MGM. w�' diratti $'.i�thYn.a�F:n.:ii:�1'Cv �l�a'"✓ F": k. L"!. s.. �' n5w.). �d'± ik" �, �G.6$..r....."�la�+f2 ✓.'�:..�.w xr' �y' k, 'n'4'S'?,•{Gi.vi...,:'r"r..... �: Schedule Persons or organizations that you are obligated, pursuant to a contract or agreement, to provide with such insurance as is afforded by this policy. All other terms and conditions remain unchanged, Authorized Representative C'I J Liability Insurance Additional Insured - Scheduled Person Or Organization last page �� ".... "_. Page 2 Form 130-02 -2367 (Rev. -6,07) Endorsement 9