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PROOF OF INSURANCE (2017) CLOSEDQt DATE (MM /DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 12/10/2015 . THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS _ NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 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. _. .. ..... _ww. ................. .. . JIPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the .erms 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 ondor°sement(s). CONTACT PRODUCER NAME WILLIS OF ILLINOIS, INC. PHONE 8 780-5381 �rA !A/C. No. ..6atth � 8 _ 8 � _.0- ..,, _ I���_N�I• (8 /7) 737-8498 233 S WACKER DR,SUITE 2000 E-MAIL ADDRESS: Ce rtlfl Cate a- hanover.com CHICAGO, IL 60606 INSURERS) AFFORDING COVERAGE NAIC # INSURER A, : Citizens Ins Co of America 31534 _ . Allme. __ „. _.__ INSURED INSURER 8: rica Financial Benefit 41840 BUCKNAM & ASSOCIATES INC INSURER C Hanover Insurance Co 22292 25004 LA PLATA DRIVE _ INSURER D: LAGUNA NIGUEL CA 92677 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, ..... ............ .......... .TYPE OF INSURANCE............_ .... VADDC SUBfE . POLICY--- --- .,, ..,,.. . R POLICY EFF POLICY EXP INSR6 NUMBER MM /DD/YYYY MMIDDIYYYY„1, LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL ), p 1 O D EXP (An one person) $ 1 OOO OOO CO CLAIMS -MADE LIABILITY MRF�MISFSOEaOCCiarren .,. ce A X OBC A405022 02 01/02/2016 01/02/2017 E.. n) $ 000 m....._. .,,... _......._.__.._ ........... .. PERSONAL &ADV INJURY $1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN1 AGGREGATE LIMIT APPLIES __ PER: PRODUCTS $ 2,000,000 .. POLICY.m Q LOC AUTOMOBILE LIABILITY � ANY AUTO BODILY INJURY (Per person) §�OOO,OOO ALL OWNED SCHEDULED OBC A405022 02 01/02/2016 ' 01/02/2017 � "I U a �` AUTOS DAMAGE AUTOS PROPERTDAMAGE dent) $ X HIRED AUTOS X ANOTN,OVVNED jeer acddenti er acre„ $ OCCUR j�''''''— q ^� EACH OCCURRENCE $4,000,000 X UMBRELLA LIAB X.., p 1 A EXCESS LIAB CLAIMS- MADE.P 1 OBC A405022 02 01/02/2016 01/02/2017 AGGREGATE $ 4,000,000 AND EMPLO YERS LIABILITY .._.... �Ri ImC rU OI"F8 ANY ROPRIETOR/PARTNER/EXECUTIVE E T ACCIDENT WORKERS COMPENSATION X DED B OFFICE/MEMBEREXCLUDED? 17 N/A F X W2C A401794 02 01/02/2016 01/02/2017 Si, CIDENT $ 1,000,000 L EACH A (Mandatory in NH) E.L DISEASE EA EMPLOYEE $ 1,'000,0`0'0 If yes, describe under _ EL DISEASE POLICY LIMIT $ 1, CRlPDQMQEFQHBA11QN5hWaw ................. ___. 000,000 C Profess onal hers Liability f F LHC A505932 01 01102/2016 01/02/2017 $1,000,000 Per Cla Claims -Made Coverage $1,000,000 Aggreg,, a ` P DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES Attach ACORD 101, Additional Remarks Schedule, if mores .,�.,... ,,,,..... .._._..,,,,�,,...,�. ....... _ �,.,,.._.� ..........�-- . —.___ space is required) RE: All Operations of the Named Insured Waiver of subrogation as provided by: WC040306 (California Form) CERTIFICATE HOLDER CANCELLATION LLAT n...... ION City of El Segundo Attn: Maryam Jonas 350 Main St. El Segundo, CA 90245 ACORD 25 (2010/05) 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 O 1988 -2010 ACORD CORPORATION. PORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD