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PROOF OF INSURANCE (2016) CLOSEDEDUCF0R- 01.._.. ,,,,, m,,,MCMA,SDA CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 9122/2015 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 "GLOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED `RESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. h ORTANT: If t . e ce ._._ - rtificate holder is an ADDITIONAL INSURED, the policy(ies) must t 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................................................................................. ............................... yy NAME: 811aMad Madison Ave. (1C N 419 255 -1020 FAX A/ IC" , x) - - - - -- LAIC No) (419) 255 -7557 Toledo, OH 43604 RSS! toledo_timi @hylant.com COVERAGES CERTIFICATE NUMBER: mm _ REVISION NUMBER: THIS IS TO CERTIFY THAT T THE POLICIES OF INSURANCE LISTED BELOWHAVE A 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 ���..., .. TYPE OF INSURANCE INSD �VtIVp � POLICY NUMBER - IYYYY MMIODP LIMITS ��� �pY EPFI (VOLICYIY�Y ....... .. ... .. A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000' m g X 1 X PHPK1365939 07/02/2015 07/02/2016 ri�K�ASES(Ea,occurrencgl, 300 00_0 CLAIMS -MADE 9 OCCUR PREMGETOiE%YiE $ MED EXP (Any one person) $ 15,000 PERSONAL 8 ADV INJURY $ 2,000,000 GEN' LPO AGGREGATE APPLIES 2 000 000 PLIMIT tR: i IPE OPAGG $ PRODUCTSGCOMPA 4,000,000 OwMRµ . ... .' _. ._ ......... ....µ,,.. __ ._ ------- �.... AUTOMOBILE LIABILITY COMBINED S4NG4.au I.tlMIT I 0c05 rent) ....... $ 1,000,000 A ANY AUTO PHPK1365939 07/02/2015 07/0212016 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ -GE X X+ NON -OWNED PROP0 Y"DAMA $ HIRED AUTOS AUTOS nll_,___________ UMBRELLA- ......................... -� ,......... ......................... �r............................ .............__.........__..... LIAR - EACH OCCURRENCE $ ---....._.....__...__ —.._.. EXCESS LIAB CLAIMS -MADE AGGREGATE $ $ ..RETENTION$[OCCUR ...,.,, ....... ..._..... .......................... WORKERS COMPENSATION x OERH AND EMPLOYERS' LIABILITY N PR PRIETOR/PARTNER/EXECUTIVE Y "� EIG227687200 B A Y O STATUTE 09/18/2015 07/20/2016 E.L EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N ,.� N/A (Mandatory in NH) ----------- --........ E.L„ DISEASE - EA EMPLOYEE $ -- - ---- .------- 1,000,000 yes OF OPERATIONS below E.L. DISEASE - P POLICY $ 1,000,000 0 A EE Theft $30,000 PHPK1365939 07/02/2015 07/02/2016 Bus. Pers. Property 40,000 A PHPK1365939 07/02/2015 07/02/2016 Abuse /Mole station 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, . ... ... ..... ... ... may be attached if more space is required) The City of El Segundo, its officers, officials, employees, agents, and volunteers are listed as additional insured per written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of El Segundo y g ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE ............................ __.......................__ ... ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD