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PROOF OF INSURANCE (2017) CLOSEDBERLCOR-01 GAIKWADSM CERTIFICATE OF LIABILITY INSURANCE DATE MM/DDIYYYY) . ,. ��ww, --_- -- ,� 1 111.._. „ ....................._ __.. 8/1/2016 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 'RESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. RTANT: If the certificate holder Is an ADDITIONAL INSURED, the olic les mu � „�sed.����If _.- ____OG -__-m- „„ - -..... -..e._ ..-.�,,,-- ��„„- ._ .............. p y(' ) must be endorsed. If SUBROGATION IS WAIVED, subject to 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( %). . -. _m .. ........ �, wu ... _ .. _� ... ��� ���m... �.... -- — ���...��� . 1111... . . . _.. ......... „.W �........... PRODUCER NACOME: NTACT Willis Towers Watson Certificate Center Willis of New Jersey, Inc. PHONE FAX C/o 26 Centu P tvd (A/p,4l., ( )„ No! �888) 467 2378 Q 877 945 -7378 I P.O, Box 305 91 ADDRESS: certificates @willis.com Nashville, TN 37230 -$191 INSURER(S) AFFORDING COVERAGE_ NAIC # Mitsui Sumitomo Insurance Company „� ������ ���„ ����������� INSURER A: p ny of America 20362 INSURED INSURER B: ... 1111 ae11itz Cor Oration% B p INSURER C . 1111... — .... - -- ._..._._ ___ --------- - - 7 Roszel Road INSURER D r Princeton, NJ 08540 _._._._. 1111 — ----- 1111..._ 1111 - 1111.._ INSURER E „ — rn - - - - -11 - __ - -- INSURER F ;: ....... _....._. — ......... ....... COVERAGES CERTIFICATE NUMBER: 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. INSR 111,1 1,11,1,.. „ ... .......... AbbL X069- ,,.,.. ._ 1111-----.,, 1111. POLICY -EFF POLICYEXi'......... „LTR... E OF INS,- ^^ -. ... TYP „.. URANCE .IN.�I? �I,�„ POLICY NUMBER ........., -- - ---111.1.. _ (MIDDY) (�MM /DDIYYYY) 1111... 1111.. LIMITS .... A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000,''. �,,.,,., X X PKG3000272 08/01/2016 08/01/2017 LrAAtAuL i LtEiJ1ELs 1 „ „.....� CLAIMS MADE OCCUR PREMISESlEa,gccurre�ce,) ,,, '""00"0"000 $ . .......m 1111.,. ..........�., -, 1111..___. _,.. MED EXP (Any one person) $.„. 10,000' , PERSONAL &ADVINJURY $ 1,000,000'. -$ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000 000'' X PRO- ❑ LO � JECT PRODUCTS COMP /OP AGG- 000' $ 1,000,000 OTHER: $ _ . J.. TOMOBILE „.0 „... LIABILITY eWµ .........,m.......... _.._, - - t,i7h4k'INk`f'I "aIN'1✓ra9 E LIMIT (�ae Sr��di iv2i $ 1,000,000' A ANY AUTO BVR8302170 08/01/2016 08/01/2017 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident ) $ AUTOS AUTOS X X NON -OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS , (Per prr_idenll ,..... X ..�,,,,, UMBRELLA LIAB X _.. OCCUR ...— 1111.. ... „.......... ... 1111. „...._.. ......... ......... .........�... .1111,. EACH OCCURRENCE $ 10,000,000 A EXCESS LIAB �,..._ CLAIMS MADE UMB5500107 08101/2016 08/01/2017 AGGREGATE $ 10,0 00 000 ,. .. _._ - ,1111 1111. 11 C X- RETENTION $ 10,000 D___ ENTIO- - 1111... $ ................. WORKERS -- -- -- 1111 COMPENSATION ... „1111._,.. ... ... 1111. ..„........... ........ -, ,.„ ���� -���� ._._ - -- �� -- -- - X PER OTH AND EMPLOYERS' LIABILITY STATUTE ER A ANY PROPRIETOR /PARTNER/EXECUTIVE WCP9001200 08/01/2016 08/01/2017 E L EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? NNI NIA 1,000,000 (Mandatory in NH) E,L., DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below .E- L, -PO IC ,,,,,,,,,,,,, „.000, 00 POLICY LIMIT $ 1 0 -- -.. .. ...... ........_ ................ .............._ . ............... _ _. 1111_._. 1111...__ ......_... ---............. ...... ........... 1111.. 1111... DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) It is agreed that City of EL Segundo, the officers, officials, 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 maybe purchased by Additional Insureds. _._.__ CERTIFICATE HOLDER -- ......... .�. „ „. ............. -------­- .. 11,,....11 .. ..111 ............._ CANCELLATION _ „ „_.e_- 1_11 1... .. „.,.. „. ..............-...- -..__ 1111 1111.. 1111 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED RN ACCORDANCE WITH THE POLICY PROVISIONS. - __._.___. _- _1 ................ 1_11 -.__ AUTHORIZED REPRESENTATIVE City of Segundo 350 Main Street d - -- - IEIt�qundo, CA 9'02- 45........., m.,,,_ -- -- -- _1111. _... �/ . � -.. r.. ACORD CORPORATION. All rights O 1988 -2014 AC II rights reserved„ ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD