PROOF OF INSURANCE (2017) CLOSED CLEOCOM-01 JV_)POER
TE(MMIi
CERTIFICATE OF LIABILITY INSURANCE I DATE
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(les)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 a dcorsome nns Ledger ...................... _
PRODUC
Williams-Manny
H app Ext. 83p 949-2227 6 68
p (AIC,N oa 0)949, 227 627 n com gAic No)J630 6 -4383
PO Box 5466
Rockford,IL 61125-0466 ce Group AX ss:7 Y
INSURER(S),,,
AFFORDING COVERAGE NAIC#
INSURER A:Sentinel Insurance Co 11000
22357
INSURED (Ns,I,JR,ERfA:Hartford Accident„&,Indemnit,y
Cleo Communication Holdings,LLC INSURER c:Hartford Insurance Group 22357
P.O.Box 15835 INSURER D:Philadelphia Insurance Co. 23850
Loves Park,IL 61132-5835
INSURER E:
INSURER F
COVERAGES CERTIFICA...,, ..................... ..
.TE NUMBER: _................................. ...........m.. REVISION
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 ADDL.".. ....... EACHOC:C;IJRIifmh7�:E..... .. ''0..,,
.........I�SI�...I§kms❑ tAPOLICY EYYL..IPOO ICY EXP
TYPE OF INSURANCE I POLICY NUMBER LIMITS
A X COMMERCIAL GENERAL LIABILITY 00,000
CLAIMS-MADE X I OCCUR Xt
83SBAPY2883 06101/2016 06101/2017 avr5
1,0„00
DAMAGETOS REN Il.0 0,000'
MED EXP(Anone
y person. ) ,000
PERSONAL&ADV
...... .........� � ..INJURY, $
1,000,,000
GEN'L AGGL LIMI"I"APPLIES PER: GENERAL AGGREGATE
2'000,000
pol.iCy
PRO- LOG PRODUCTS-COMAGG $ 00,000
tisiFRE ........................
$
B 000
AUTOMOBILE LIABILITY
COMBINED acSNED SBNGt,F t,IMI t
X ANY AUTO 83UECVV5997 07/10/2016 07/10/2017 BODILY INJURY(Per person)
,,,,,,,, ,�
AUTOS ONLY ED ,AU OSULED
N�[ C�Hpy� �p���y BODILY INJURY(Per accident) $
AiUTCY ONLY AIJIC} '�(3hd Y I'"i!.9P:cicle LIFAMiAd:"rE
A X .X OCCUR .. .....E OCCURRENCE .......m 10,000,000
000
UMBRELLA B .MADE 83SBAPY2883 06/01/2016 06101/2017 AGGREGATE $
O,
DEDEXCESS II RETENTION$ CLAIMSS ......m....,....��, ._...........
...m...., vfN BM1.4...0.... 06/011201fi 06/01/2017 $ .....
000 83WBC 9 ( OTH-
C WORKERS COMPENSATION .................................._._. X .S,T.ATUTIr J FR ......
AND EMPLOYERS'LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH $ 500,000
(;Dt':FI datoryEMBERn NH)EXCLUDED L t DISEASE•EA EMPLOYEE 4.",�YI�'� $ 500,000
aneiatory m NH) NIA A
If yes,describe under 500,000
D m Errors&Omissions OPERATIONS...........below PHSD1149840 07113/2016 07/13/2017 Each Claim EL DISEASE-POLICY LIMIT $ 1,000,00
D PHSD1149840 07113/2016 07/13/2017 Deductible 15,000
_..m_. W..
DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
City of EI Segundo is named as additional insured.
CERTIFICATE HOLDER CANCELLATION ..........,m„m,,,mmmm _.............
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
CI of El Segundo AUTHORIZED REPRESENTATIVE mm.....
City gAtt �(
350 City Clerk /” /I
350 Main St
ORATION. All rights
..
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ORD 25(2016/03) reserved.
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