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PROOF OF INSURANCE (2017) CLOSED .�' DATE(MMIDD/YYYY) CCW" CERTIFICATE OF LIABILITY INSURANCE 114,­- '" I 12/2212016 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 have ADDITIONAL INSURED provisions or 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 t SJ Street, Suite 300 PHONE No, 720 50112805 (A/cdN Denver, 502 E MAIL.. 520 arket L eIa( NAM[, �1tl: pater,itus.com A�D�rwx�sS: ndk, .. !NSURER(S)AFFORDING COVERAGE NAIL p www.jitus.com A Atlantic lantic Specialty Insurance Company 27154 , INSURED tIp' Cer L6ALD INSURER c: can Insurance Company 22667 L-��Cer Management Inc INSURERS: marl 435 Weaver Pkw Suite 330 INSURERD: W'arrenville IL 50555 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 33405236 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 NLTR TYPE OF INSURANCE N,SD WVD POLICY NUMBER (MMIDD/YYYY1 (MMLDDIYYYYI LIMITS A f/" COMMERCIAL GENERAL LIABILITY 711-01-23-92-0005 2/17/2016 2/17/2017 EACH OCCURRENCE $ 1,000,000 c PRE_MISFS Fa OCCUrrence), CLAIMS-MADE ✓ ( OCCUR $ 500,000 MED EXP(Any one person) $ 1 0,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 ✓ POLICY (: LOG PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER $ A AUTOMOBILE LIABILITY 711-01-23-92-0005 2/17/2016 2/17/2017 (FO:MBI^QED SINGLE IjMIT � $ 1,000,x,000 ANY AUTO BODILY INJURY(Per person) $ OWNED i SAUTOS CHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY V„ HIRED � NON-OWNED PROPERTY DAMAGE AUTOS ONLY I/ VI AUTOS ONLY (f'er accidenl) $,,,,,,,,,,, $ UMBRELLA LIAB ( OCCUR EACH OCCURRENCE $ EXCESS LIAB ( CLAIMS-MADE AGGREGATE $ _ DED RETENTION$' $ A WORKERS COMPENSATION 406-03-68-99-0005 2/17/2016 2/17/2017 PER O TH-EMPLOYERS'LIABILITY STAT YN OFFlCERPRIETOR/PART ER /E ECUTIVE I !. N/A E L EACH(ACCIDENT FR ,000 (Mandatory in NH) E L DISEASE-EA EMPLOYEE $ 500 If yes,describe under QQQ DESCRIPTION OF OPERATIONS below E L Mz E-ASE"POLICY iLIM11 $ 500,000 B Technology&Internet E&O G24308170005 2/1712016 2/17/2017 $2M/claim,$2M aggregate,$10K retention DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of El Segundo, its officials,and employees are additional insureds,and coverage is primary and noncontributory as required by written contract,per policy terms and conditions. CERTIFICATE HOLDER CANCELLATION! CIty OP C:I Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 350 NYBNn Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN El Segundo Street 90245 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE r Nik Patel ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 33905236 1 16-17 GL AU WC E&0 I Nik Patel 1 12/22/2016 9:27:16 AM (MDT) I Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NZ;-or T'AG FOI GENERAL LIABILITY TECHNOLOGY COMPANIES This COMMERCIAL GENERAL LIABILITY COVERAGE FORM ng The following schedule lists the coverage extensions provided by this endorsement. Refer to the individual provisions to determine the extent of your coverage. SCHEDULE OF COVERAGE EXTENSIONS 1. Additional Insured - Broad Form Vendors 8. Coverage Territory - Worldwide 2. Additional Insured-by Contract,Agreement or 9. Duties in Event of Occurrence, Claim or Suit Permit relating to: 10. Expected or Intended Injury (PD) o Work performed by you 11. Incidental Medical Malpractice o Premises you own, rent, lease or occupy 12. Medical Payments o Equipment you lease -13. Mobile Equipment Redefined 3. Aggregate Limit Per Location 14. Newly Acquired or Formed Organizations 4. Blanket Waiver of Subrogation 15. Non-Owned Aircraft 5. Bodily Injury Redefined- Mental Anguish 16. Non-Owned Watercraft 6. Broadened Named Insured 17. Personal and Advertising Injury 7. Broadened Property Damage 18. Product Recall Expense o Borrowed Equipment 19. Supplementary Payments Increased Limits o Customers' Goods o Use of Elevators 1. ADDITIONAL INSURED - BROAD FORM VENDORS Section II -Who Is An Insured is amended to include as an additional insured any person(s) or organization(s) (referred to below as vendor) with whom you agreed in a written contract or agreement to provide insurance, but only with respect to"bodily injury" or"property damage"arising out of"your products"which are distributed or sold in the regular course of the vendor's business, subject to the following additional exclusions: a. This provision 1 .does not apply to: (1) "Bodily injury" or"property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; (2) Any express warranty not authorized byyou; (3) Any physical or chemical change in the product made intentionally by the vendor; (4) Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; (5) Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection wijh the distribution or sale of the products; (6) Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; (7) Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or VCG 207 11 13 Includes copyrighted material of Insurance Services Office,Inc. Page 1 of 8 Copyright,One Beacon Insurance Group LLC INSURED (8) 'Bodily injury"or"property damage"arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (a) The exceptions contained in Subparagraphs 4.or 6.; or (b) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. (9) Any vendor, person or organization if the "products-completed operations hazard" is excluded either by the provisions of the Coverage Form or by endorsement. b. This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products.