PROOF OF INSURANCE (2016 - 2017) CLOSEDw 0 DATE (MMIDD/YYYY)
AC"RO CERTIFICATE OF LIABILITY INSURANCE 07/2612016
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(les) 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 ONCACT
MARSH USA, INC. PHONE I FAX
445 SOUTH STREET (AIC-No. /Fart) �
MORRISTOWN, NJ 07960 -6454 EMAIL
Attn: Morristown .certrequest @marsh.com Fax 212 -948 -0979 AI2IeS INSURER I
ING COVERAGE ,,,,,NAIC #
_. __ __.....IS AFFORD,..,.........
123456 GAWUP -15 -16 INSURER a Zurich American Insurance Company
16535
- . . ........
INSURED INSURER B ; N/A N/A
Onex York Holdings Corp. """" " " "' ......
and its Subsidiaries A n rxl�elt,lnlly Insurance Company 10717
INSURER C Asp on _. .............. _ _....--- - ........, ...... __.
1 Upper Pond Road INSURER D:
Building F, 4th Floor — . .............. ...__..
Parsippany, NJ 07054 INSURER E :
)NSURCR F :
COVERAGES CERTIFICATE NUMBER: NYC- 007224051 -21 REVISION NUMBER: 22
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... ADOL SUBR . POLICY EFF POLICY EXP .._
LTR TYPE OF INSURANCE POLICY NUMBER (MWDDN_Mi IMMfQQ I LIMITS
A X COMMERCIAL GENERAL LIABILITY CPO 5820234 -02 '12/15/2015 12/15/2016 EACH OCCURRENCE $ 1,000,000
----- -- -- ..IJAMAGE 1" RENTED... ..
CLAIMS -MADE OCCUR PRMS_(EaoceuRgnce). ,..,$ "t. 01.0_00N
MED EXP (Any one person) $ 5,000
PERSONAL & ADV INJURY $ 1,000,000
....._. ......... .-------- _._.. ._......— - -- -----....... ..
GEiNL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2000000
PRO. X _.. ._ ... ....... . .
POLICY _ l [ 1 LOG PRODUCTS COMP /OP AGG $ 00'"000"
00 000
JE "T -
OTHER; $
r M61NED$INGLE LIMIT 1000000
A AUTOMOBILE LIABILITY BAP 5820233 -02 12/15/2015 12115/2016 GO a cad rl91_ p
X ANY AUTO _
,BODILY INJURY (Per ,person) $ 1e,
ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
�.- _._...! AUTOS _._._..,. AUTOS .....
HIRED AUTOS AUTO WNED F%O EAR Y DAMAGE $
UMBRELLA LIAB OCCUR EACH OCCURRENCE $....
EXCESS LIAB CLAIMS -MADE AGGREGATE $
DED V RETENTION
A WORKERS COMPENSATION WC 5820235 -02 12/15/2015 12115/2016 X PER 0TH
AND EMPLOYERS' LIABILITY Y / N _4TAT.UTE R ,, ___....
ANY OFFICER /MEMBER /EXCLUDED? ECUTIVE " " "" E L 1 000 000
EACH ACCIDENT EMPLOYEE $
N N/A
(Mandatory in NH) E.L. D__ISEAS_E EA EM 1000 000
If yes, describe under
DESCRIPTION OF OPERATIONS below E L. DISEASE - POLICY LIMIT $ 1,000,000
C PROFESSIONAL LIABILITY LRO03TG16 '06/30/2016 06/30/2017 LIMIT 10,000,000
RETENTION: $1M (PER CLAIM) APPLIES TO CLASS ACTION CLAIMS RETENTION 500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
CITY OF EL SEGUNDO, ITS OFFICIALS, AND EMPLOYEES ARE INCLUDED AS ADDITIONAL INSURED WHERE REQUIRED BY WRITTEN CONTRACT WITH RESPECT TO GENERAL LIABILITY,
CERTIFICATE HOLDER CANCELLATION
CITY OF EL SEGUNDO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
ITS OFFICIALS AND EMPLOYEES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
350 MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS.
EL SEGUNDO, CA 90245
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
Manashi Mukherjee �Cc>uao
@ 1988 -2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
01
Additional Insured — Automatic — Owners, Lessees Or ZURICH
Contractors
Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer No. I AddT Prem Return Prem,
5820234 12/15/2015 12/15/2016 12/15/2015 10099000 N/A N/A
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Named Insured: Onex York Holdings Corporation
Address (including ZIP Code): One Upper Pond Rd, Bldg F, 4th Floor, Parsippany, NJ 07054
This endorsement modifies insurance provided under the:
Commercial General Liability Coverage Part
A. Section II — Who Is An Insured is amended to include as an additional insured any person or organization whom you
are required to add as an additional insured on this policy under a written contract or written agreement. Such person
or organization is an additional insured 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 or "your work" as included in the "products- completed operations
hazard ", which is the subject of the written contract or written agreement.
However, the insurance afforded to such additional insured:
1. Only applies to the extent permitted by law; and
2. Will not be broader than that which you are required by the written contract or written agreement to provide for
such additional insured.
B. With respect to the insurance afforded to these additional insureds, the following additional exclusion applies:
This insurance does not apply to:
"Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or failure to
render, any professional architectural, engineering or surveying services including:
a. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys,
field orders, change orders or drawings and specifications; or
b. Supervisory, inspection, architectural or engineering activities.
This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the
supervision, hiring, employment, training or monitoring of others by that insured, if the 'occurrence" which caused the
"bodily injury" or "property damage ", or the offense which caused the "personal and advertising injury", involved the
rendering of or the failure to render any professional architectural, engineering or surveying services,
C. The following is added to Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit of Section IV —
Commercial General Liability Conditions:
U -GL- 1175 -F CW (04/13)
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The additional insured must see to it that:
1. We are notified as soon as practicable of an "occurrence" or offense that may result in a claim;
2. We receive written notice of a claim or "suit" as soon as practicable; and
3. A request for defense and indemnity of the claim or "suit" will promptly be brought against any policy issued by
another insurer under which the additional insured may be an insured in any capacity. This provision does not
apply to insurance on which the additional insured is a Named Insured if the written contract or written agreement
requires that this coverage be primary and non - contributory.
D. For the purposes of the coverage provided by this endorsement:
1. The following is added to the Other Insurance Condition of Section IV — Commercial General Liability
Conditions:
Primary and Noncontributory insurance
This insurance is primary to and will not seek contribution from any other insurance available to an additional
insured provided that:
a. The additional insured is a Named Insured under such other insurance; and
b. You are required by written contract or written agreement that this insurance be primary and not seek
contribution from any other insurance available to the additional insured.
2. The following paragraph is added to Paragraph 4.b. of the Other Insurance Condition of Section IV — Commercial
General Liability Conditions:
This insurance is excess over:
Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional
insured, in which the additional insured on our policy is also covered as an additional insured on another policy
providing coverage for the same "occurrence ", offense, claim or "suit ". This provision does not apply to any policy
in which the additional insured is a Named Insured on such other policy and where our policy is required by a
written contract or written agreement to provide coverage to the additional insured on a primary and non-
contributory basis.
E. This endorsement does not apply to an additional insured which has been added to this policy by an endorsement
showing the additional insured in a Schedule of additional insureds, and which endorsement applies specifically to
that identified additional insured.
F. With respect to the insurance afforded to the additional insureds under this endorsement, the following is added to
Section III — Limits Of Insurance:
The most we will pay on behalf of the additional insured is the amount of insurance:
1. Required by the written contract or written agreement referenced in Paragraph A. of this endorsement; or
2. Available under the applicable Limits of Insurance shown in the Declarations,
whichever is less.
This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.
All other terms and conditions of this policy remain unchanged,
U -GL- 1175 -F CW (04/13)
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Includes copyrighted material of Insurance Services Office, Inc., with its permission.