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PROOF OF INSURANCE (2018) CLOSED ACCOR � CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 12/31/20171 6/16/2017 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 Lockton Insurance Brokers,LLC CONTACT 725 S.Figueroa Street,35th Fl. L Ext): 0 M�N�a: CA License#01`15767 E.MAI Los Angeles CA 90017 816& (213)689-0065 INSUREWSI CORDING COVERAGE NAIC a INSURER A: Atlantic Specialty Insurance Company 27154 INSURED Prosum,Inc. INSURER B: Indian Harbor Insurance Company 36940 Y 1302737 2201 Park Place,Ste 102 INSURER c: Federal lnstirance Comnanv 20281 EI Segundo CA 90245 ,14suRER D: 1 INSURER E: III INSURER F: V COVERAGES 1TR0S1..I01 CERTIFICATE NUMBER: 2911178, REVISION NUMBER: X ,X X 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. ILNSRR ADDL SUBR POLtC'Y EFF POLtlC EXP LIMBS A COMMERCIAL GENERAL LIABILITY Y N 711008247 6/19/D2017 16/19/2018 PREMISES OCCURRENCE S 1,000.000 CLAIMS-MADE TYPE FU�OCCUR RANCE IM�SO MND fM D� AYYYYA OMMPDD YYYt( FDAMAGE�I�u��7afl'�ncei s 1,000,000 I'MED EXP(Any one person) $ 10,000 PERSONAL BADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE �$ 2,000.000 Pou ❑cY PRO JECTLoc — ....... ,�or�rs�ISED.s�NG�r.IOI�uTGGI$ 2.000,000 I' OTHER: $ A AUTOMOBILE LIABILITY N N 711008247 6/19/2017 6/19/2018 r[a a.,@dsnty $ 1,000,000 I X ANY AUTO BODILY INJURY(Per person) $ )MXYX'X OWNED SCHEDULED 1BOUll,Y"INJURY(Pot $ XXXXXXX AUTOS ONLY AUTOS HIRED NON-OWNEDyPI?4,7�P"ERTYrSAMAGE' $ =Y—XXX ONLY AUTOS ONLY 1'1'Per Bccdden 1 _ I('01111)NCf fl fed $ 1.000 — A X UMBRELLA LIABOCCUR N N 711008247 6/19/2017 6/19/2018 EACH OCCURRENCE '$ 5.000,000 EXCESS LIAR NCILAIMS-MADE AGGREGATE $ 5„000,000 N DED I V RETENTION$ $ XXX3 �X WORKERS COMPENSATION A AND EMPLOYERS'LIABILITY Y I N Y 406032131 12/31/2016 12/31/2017 X STATUTE I IFR ANY PROPRIETORIPARTNERfrXECU I IVE NIA NOEL EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E L DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below W i7,-,I DISFASF-POLIC.Y LIMIT 1.000.000 B 4'y'hrr N N MTP0041336 6/19/2017 6/19/2018 1$5,000,000 Fktcll WW'emr,t„lead Act B I'a^a@ aology ProfLiab MTP0041336. 6/19/2017 6/19/2018 $5,000,0001.iovS!5,1P(u(',1 Neten C lcrt f'`;lrly'Crime 8242-9026 6/19/2017 6/19/2018 $3,000,000 l,i,w$10,000 It. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) The City,its ol'ic rs,offro a&n,employees,agents,and v¢nIIl veers are an Additional Inswed to the extent provided by the policy language or endorsement issued or aipprowd by the ierauragnce carrier.Waiver of huubl'cngw ion applies to the worken,'c ompensation. CERTIFICATE HOLDER CANCELLATION See Amichments I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 291.1.178 AUTHORIZED REPRESENTATIVE City of EI Segundo City Clerk Attn: Adminlstfative Services 350 Main Street,Room 5 EI Segundo CA 90245 2 (2016/03) ©718-4201CX0 C RPORATION.All ri hts reserved ACORD 5( 0 ) 9 The ACORD name and logo are registered marks of ACORD N,A%LAN OP June 16,2017 City of El Segundo City Clerk Attn: Administrative Services 350 Main Street,Room 5 El Segundo,CA 90245 Re: Notice of Cancellation Clause To Whom It May Concern: As a service to our valued client,Lockton will provide at least thirty (30) days notice of cancellation to the certificate holder listed on the attached Acord 25 certificate of insurance should any of the policies described on the attached certificate be 1) cancelled by the insurer,other than for non-payment of premium(10 day notice for non-payment/non-reporting),and 2) cancelled more than 30 days prior to the expiration date of the policy (if such cancellation occurs less than 30 days prior to expiration,Lockton will provide as much prior notice as practicable). If notice is mailed,proof of mailing notice to the certificate holder to the postal mailing address as shown in the schedule will be sufficient proof of notice. Thank you and please contact our office if you have any questions. Regards, Loe David Burgos Assistant Vice President Lockton Insurance Brokers Attachment Code :D463006 Certificate ID :2911178 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be % of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization job Description WHERE REQUIRED BY WRITTEN CONTRACT All Operations WC 04 03 06 (Fd.4-84) Attachment Code:D492298 Certificate ID :2911178 POLICY NUMBER:711008247 COMMERCIAL GENERAL LIABILITY CG 20 26 0413 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s)or Organization(s): The City,its officers,officials,employees,agents,and volunteers. Information required to complete this Schedule,if not shown above,will be shown in the Declarations. A.Section If-Who Is An Insured is amended to include as an &With respect to the insurance afforded to these additional additional insured the person(s)or organization(s)shown in the insureds,the following is added to Section III-Limits Of Schedule,but only with respect to liability for"bodily injury", Insurance: "property damage"or"personal and advertising injury"caused, in whole or in part,by your acts or omisSiODS Or the,acts Or If coverage provided to the additional is sured is required by omissions of those acting on your behalf. contract or agreement,the most we will pay on behalf of the additional insured is the amOUnt Of inRLn-ft91Ce: L In the performance of your ongoing operations;or 1.Required by the contract or agreement;or 2.In connection with your premises owned by or rented to you. ft&A 2.Available under the applicable Limits of Insurance shown in However: the Declarations; ffiffi ........... 1.1'he insurance afforded to such additional insured only applies whichever is less. to the extent permitted by law;and Phis endorsement shall not increase the applicable Limits of 2.If coverage provided to the additional insured is required by a Insurance shown in the Declarations. contract or agreement,the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 26 0413 (0 Insurance Services Office,Inc.,2012 Page 1 of 1 Attachment Code:D498109 Certificate ID :2911178