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PROOF OF INSURANCE (2014) CLOSEDAC� ® DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE Page 1 of 1 07,29/2013 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). Hillis of New York, Inc. ... -. r'difNF Lf AX �. . c/o 26 Century Blvd. gMAra¢;r rip „�x�� _ 877-945-7378 +�t��.h(�,��> 888 -467 237T P. o. Box 305191 E-MAIL - Certificates will' COm Nashville, TN 37230 -5191 °° _ - - -� ° ° - - -- -�- __- NSUREIR'gS)AF ^'FORDING COVERAGE NAIC # INSURERA Mitsui Sumitomo Insurance Company of Amer 20362 001 �. ,..._. _ P _ INSURED Berlitz Corporation INSURERS: Mitsui Sumitomo Insurance USA Inc 22551-001 400 Alexander Park INSURER C' - ..ww -a Princeton, NJ 08540 INSURER D: INSURER E___ INSURER F: COVERAGES CERTIFICATE NUMBER: 20172758 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. - -- ' . DD 'SUBI POLICY EFF POLIC- Y _ LTR TYPEOFINSURANCE LICYNUMBER ��- - - - - -- EXP LIMITS A NE _ AL LIABILITY PKG3000272 8/1/2013 8/1/2014 —x`000 � Y XE COMMERCIAL GENERAL LIABILITY DAMAGE f 0 RrNTED RRCMOCC iu RE.NCEnce CLAIMS -MADE OCCUR MEDEXP(Anyoneperson) $ 10 00Q PERSONAL &ADVINJURY .. GENERAL AGGREGATE $ _ 2 2,000,000 ... GE N'LAGGREGATELIMITAPP LIES PER: P_ RO. DCTS- COMP /OPAGG $ 1 A000 �� 0 0 PR(- LOC X I POLICY m $ I B AUTOMOBILE LIABILITY BVR8302170 8/1/2013 8/1/2014 OMBINEDt INUL T9ff (-... ) _,- $ 1, 000, 000 ANY AUTO ....... _,.,.,.,- .. �.mm.....�...._........... —, BODILY INJURY(Perperson) Is ALLOWNED SCHEDULED AUTOS AUTOS BODILYINJURY P INJURY( Per accident) $ X HIRED AUTOS X -OWNED IsItOERTIYRF�'u .NON ... ..... AUTOS A X.... UMBRELLALIAB X OCCUR UMB5500107 10,000,000 8/1/2013 8/1/2014 EACH OCCURRENCE $ 10r�L^ _-.. EXCESS LIAB CLAIMS -MADE ,.. , AGGREGATE w. 000 000 10 ,n r DED X RETENTION$ 10,000 �, A WORKERS COMPENSATION WCP9001200 8/1/2013 8/1/2014 X A AND EMPLOYERS' LIABILITY Y T 3Y I�9MaITm �_ E_R °N ANY PROPRIETOR /PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? �_ N/A EL EACH ACCIDENT $ 1, 000, 000 � Mandatory in NH) f yes. describe under CL DISEASE EA EMPLOYEE $ 1,000 000 _...._m �.., DESCRIPTIONOFOPERATIONSbelow E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION Or OPERATIONS F LOCATIONS/ VEHICLES (Attach Acord 101, Addit*nal Remarks Schedule, if more space is required) It is agreed that City of EL Segundo, the officers, official's', employees and volunteers are included as Additional Insureds as respects to General Liability policy. It is further agreed that such insurance as is afforded shall be primary and non - contributory with any other insurance in force for or which may be purchased by Additional Insureds. CERTIFICATE HOLDER CANCELLA'T'ION 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 EL Segundo 350 Main Street E1 Segundo, CA 90245 Co11:4167646 Tp1:1682827 Cert:20172758 © 88 2010ACORDCORPORATION .Allrightsreserved. ACORD 25 (2010/05) The ACORD name and logo are registered markso' f ACORD 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) Or Organization(s): Location(s) Of Covered Operations City of EL Segundo, the officers, officials, employees and volunteers Information required to complete this Schedule, if not shown above, will be shown in the Declarations. H. Secdon it — who is tin 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; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. 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: 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. CG 2010 07 04 © ISO Properties, Inc., 2004