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PROOF OF INSURANCE (2018 - 2018) CLOSED ACC)kv CERTIFICATE OF LIABILITY INSURANCE 08/18/2017 — ............ —"THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE Cl�riiIF116ATE 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,ANDTHE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL i46-G—RED 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 endorsament(s). PRODUCER NAMC� Cheryl Trawick York Alternative Risk Soulions,LLC Pliotqc FAX 614-717-6371 333 City Blvd.West,Ste.l1500 WC No), Orange,CA 92868 E-MAIL Cheryl.Traw ick@yorkrsg.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A,:Ar,9.h.,Insuran eCom ppny11150 _'. . ��_ -, INSURED INSURER B Onex Yorlc Holdings Corp. and its Subsidiaries INSURER C: I Upper Pond Road Building F,4th Floor INSURER D: Parsippany,NJ 07054 INSURER E; INSURER F: COVERAGES CERTIFICATE NUMBER:5P7W7WGT 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 SUeR -PdLicVEF0 PbLJcyr;0: LIMITS 1 IN9D Wvo POLICY NUMBER (MM/DDIVyY'() lM%DDNYyY) A x COMMERCIAL GENERAL OAGluw 6L,0,820001 07101/2017 07/0112018 EACH OCCURRENCE 1,000,000 CLAIMS-MADE L_,K]OCCUR bA l,�,AG r TCVR rN I"Et) 300,000: MED EXP(AnV one person) $ 10.000 X ffn9NAL&ADV INJURY $ 1,000,000: GEN L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000 POLICY LOC PRODUCTS-COMPIOP AGG 2,000,000 OTHER: $ .......... A AUTOMOBILE LIABILITY7ACAT1811401 07101/2017 07fflI/2018 _37iMTq_P U71 NGt F I W f T ,000,000 AL"_L1qLkIwMl)_ 1 X ANY AUTO ZACATI 812101-State of MA only BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-ONED AUTOS ONLY AUTOS ONLY $ F:— W--- $ UMBRELLA LIAB 7 OEACH,,,.OCCURRENCE EXCESS LIAB 9"CLAIMS-MADE AGGR'EGATE F)F I I, F-1 RFTFN VION Sa. A WORKERS COMPENSATION T4 01 07101/2017 071Q1I PEP U101- AND EMPLOYERS'LIABILITY YIN _�Mlulfl_ ANY PROPRIETOWPARTNERIEXECUTIVE NIA E L.EACH ACCIDENT 1,000,0001 OFFICERIMEMBER EXCLUDED? uoutifil (Mandatory in NH) E L.DISEASE-EA EMPLOYEE If yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT 5 1,000.000 _DESCRIPTION OF OPERATIONS j`LOCAriows I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of El Segunc,Its Officials and Employees are included as Additional Insured with Respect to General Liability Where Required by Written Contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of El Segund Its Officials and Employees AUTHORIZED REPRESENTATIVE 350 Main Street El Segundo.CA 90245 JY Page 1 of a @ IM-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks,of ACORD Pk): 110',"IIAJMIMTI:°4A5�'hkl U:'.10110 1 [M"oAH'1 V 10� �12 04 113 i'H I M'i il"MCK AJV-341'4A-41A T t W' 'r If")�.j'c' fio�,i 014)�Y ;A J,I ADDITIONAL INSUR7-D --,- STATE OR GOVERNMENTAL NCY II C,0481100 SUBDIVISION - PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Govevrimental Agency Or SubdIvIslon Or PolItcal Subdivision: ALL PARTIES WHERE REQUIRED BY A WRITTEN CONTRACT. -information required to complete this Schej�le,if not shown above,will be shown In the Declarations. A, Section If — Who Is An Insured is amended to Z This insurance does not apply to: Include as an additional Insured any state or a. fly irl� I darnago" or in Ury"arising out govoromental agency or subdivision or IxAtical, a 1,7'a liscng subdivision shown In the Schedule, subject to Me of otxIrallons �or the federal following provlslon,,,, govei nuy.wt,stare or munielp:aIlty;or 1. This Insurance applies only with respect to b. �'Po(311 injuty" or "property daniago" operations perlorrrod by you or on your behalf whifln 1he '"products-(ximpluted for which the state'or goverrinx)nlal agency or nryiraflons hmard". subdivision or polltiGal subdivision has Issued E. With respect to the Insurance afforded to those a permit or authorization. addiflonal Insureds, the following Is added to However: Section III®Unfla Of lnsuranw; If c%weiigr provided to the adiciltional Insured Is a, The insurance afforded to such additional i ec�ulfod by a conlract or agreenv3nj, lite � sit we Insured only applies to the extent permitted v/11 I°my or,, bmhnil of the addiflonal insurod is the, by lriw;and araouni of InUflanN,): b. If coverage provided to the additional 1. squired by the contract or agreement;or insured is required by a contract or 2, Availal:jle under thaw Appliclblo Limits of agreement, the Insurance afforded to such Insurance shown In the Declatallons; additional insured will not be broader than that which you are required by the contract whichever is less. or agreement to provide for such additional This endorsement shall not increase the insured. applicable Limits of Insurance shown in the Declarations. C,Ci,20 1 :104 i,3 0 Insurance Services Office, Inc., 2012 1! +'u I of'i 1pa" pp '-uf 6 5 P V VO r 6 14"10 CONTRAC'TORS - SCHEDULED, PE,RS,ON OR ORG' W12' TIOW This endorsement modifies insurance provided Linder the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Adoltional Insured Ferson(s) OrOrganization(s) Localion(s)Of Covered Operations ALL PARTIES WHERE REQUIRED BY A WRITTEN CONTRACT, —119q'k—ilred to cornp!qtqAh!s StAwduie,If non 1hown Obove,VVIII beshowo In the Doolanalioriu, C6 20'600413 00 Insimance SeivIces(Yflce,inc.,2012 Pagel of Page 4 of 6 5P7W7WGT AGENCY CUSTOMER ID: LOC#: ADDITIONAL REMARKS SCHEDULE Pop 5 of 6 PRODUCER INSURED York Alternative Risk Solutions,LLC OnexYork Holdings Corp. and its Subsidiaries POLICY NUMBER CARRIER Y NAIL CODE ISSUE DATE: 08/18/2017 ................ ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE: NAMED INSUREDS t ADII4 HEALTHCARE, INC. ALAMED T(OLDINGS, INC, ARTC OF MISSISSIPPI, INC. ARROWOOD INVESTMENT GROUP, LLC ATLANTIC GATEWAY INTERNATIONAL (SAC) LTD ATTENTA SERVICES, LLC AXIS (EASTERN CARIBBEAN) LIMITED AXIS (,.JAMAICA) LIMITED AXIS INTERNM.'IONAL S'EkVI[CES LID DICKMORS SROWF REHABILITATION MANAGEMENT, INC.. CARWORKS OF OHIO LTD, LLC CAREWORICS TECH11TOLOCIES LTD, :LLC CAREWORKS USA LTD, GLC ChREWORKS, [,To CAREWORKS MANAGED CARE SERVI[CE.,,,INC. ('Cl INVESTMENTS, LLC CCU, INC. CMI1, A YORK. RISK SERVICES COMPANY, INC. COMPEVNI, DD EXAMS, LLC COMPPARTFERS, INC DONALD K SAMS & ASSOCIATES, INC. F.A. RICHARD & ASSOCIATES, INC. EARA ADJUSTING SERVICES, INC. PAP-A., BENEFIT SERVICES, INC. EARA BUSINESS SERVICES, INC., FARA CENERAL AGENCY, INC. FARP, ','E!,CUr,:X:Tf ST.-MVICES, INC. FAPT360 LLC / ft.a MANAGED CARE NETWORK SSRVICES, L1,C F01 HILI, HOLDINGS, r1,TC. FRANK CRATES (BUJU41-IDA) LTD. FRANK GATES ACCLAIM, INC, FRANK GATES OF NEW YORK, INC G2 TECHOOLOCIES, 'CNC. INTECRATED RISK ITUIAGEMEWT, INC, ,J1 SPECIAL RISKS INSURANCE AGENCY, TNTC JI SPECIALTY SERVICES, INC. JOSERIT IV'.( FINANCIAL GROUP, INC. LITIGATION SOLUTIONS, LLC MCMC INDEPENT)BITT EXAMS, LLC MCMC, LLC. NATIONA-L EMPLOYERS NETWORK ALLIANCE, INC, NEXUS ASSET ACQUISITION, CO, NORTTIZAr,'T .AS, MANAGEMENT, INC, (I11EAMI) OHP, INC OM.Ac AGENCY, INC., ONEX YORK FINANCE L.LC OBEX YORK FINANCE LP ON BX YORK ESI 1D CORP PER.s'r' ['['C i PUBLIC ENTITY RISK SERVICES OF LLC F'13f3I,T(' ENTITY RF�-,K 3FRvicF,,s of c)Hro, TNI. QUICK CAT, LLC RISK CONTROT., 360, LLC RISK MANAGEMENT SOLUTIONS, INC. PNS ACQUISITION, INC. ROCKPORT COMMUNITY NEIVORK, INC SAMS & ASSOCIATES, INC. SAM0. fNVESTIGATrONS UNLIMITED THE FRANK GATES COMPANIES, INC. t-rUnc.atedj ACORD 101 (2008101) 0- 2008 ACORD CORPORATION, All mighty reserved. The ACORD roarne and Ingo are Eeghtered marks of ACORD CERTIFICATE NUMBER:5P7W7WGT AGENCY CUSTOMER ID: LOC#: "4c"RT> ADDITIONAL REMARKS SCHEDULE Page 0 of 6 PRODUCER IHSURED York Alternative Risk Solutions,LLC Onex York Holdings Corp, and tis Subsidiaries POLICYNUMBER CARRIER MAIC CODE ISSUE DATE: 08/18/2017 ADDITIONAL RIEMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, F ....,....FORMNUMBER: FORTITLE: (continued from previous page) THE FRANK GATES SERVICE COMPANY THE FRANK GATES SERVICES COMPANY INTEGRATED MANAGED HEALTH CARE PLAN, INC. THE RISK MANAGEMENT PLANNING GROUP, INC VANTAGE HEALTH PLAN, INC. VISUAL RISK SOLUTIONS, INC VOCWORKS LTD, LLC KELLCOMP MANAGED CARE SERVICES, INC. York Alternative Risk Solutions LLC fka FRANK GATES ALTERNATIVE RISK, LLC YORK IOSURANCE HOLDINGS, INC. YORK INSURANCE SERVICES GROUP, INC. - CALIFORNIA YORK INTERNATIONAL ARGENTINA S.A. YORK RISK CONTROL SERVICES, LLC YORK RISK POOLING SERVICES, INC YORK RISK SERVICES GROUP, INC. YORK RISK SERVICES GROUP INTERNATIONAL HOLDINGS, LTD YORK RISK SERVICES GROUP, INC. - FLORIDA YORK RISK SERVICES HOLDING CORP. YORK RISK SERVICES ORGANIZATION, INC. YORK RSG (INTL) COLOMBIA SAS YORK RSG (INTL) LTD YORK RSG (INTL) MEXICO YORK SPECIAL INVESTIGATIONS, INC. YORK WMCS CORP. YORKPRO, INC ACORD101 (2008)01� 2008 ACORD All rights reserved, The ACORD namne and logo are registered marks of ACORD CERTIFICATE NUMBER:5P7W7VVGT DATE{MMIDDIYYYYI CERTIFICATE OF LIABILITY INSURANCE.'r 07121/2017 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 CONTACT MARSH USA,INC, NAMi1iI 445 SOUTH STREET PHONE No.grl!MORRISTOWN,NJ t9P ,Nel 960-6454 DAIM1. .R )_. N- Atttn:Morcstown•cert07ues@rnarsh.com Fox 212-948-0979 ° ' INSURER S AFFORDING COVERAGE 123456--Prof-17-18 INSURER A:NIA NIA INSU oIA _• „,NlA Onex York Holdings Corp INSURER 6„,N and its Subsidiaries iI SUR e R c,,:,Aspen Sppclally-Insurance Company 10717 1 Upper Pared Road _. ._ Building F,4th Floor INSURER D II ...................................................w,_,. ....w Parsippany,NJ 07054 @,INSURER E: VI INSURER F: COVERAGES CERTIFICATE NUMBER„ NYC-009981736-31 RE'VISIO'N NUMBER: 23 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PE _.W_.. RIOQ 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 RAID CLAIMS. In TR TYPE OF INSURANCE _•__•___ A(Y Dn vnPn ...... ...POLICY NUMB POucY EFF POLI DY f...w .... _ � ER IM1A�d3dD _ ll'YYYI IAw4M/D LIMITS COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE $ M� ua;rvTA`� EaTED.... CLAIMS-MADE 171 OCCUR PR..FMISES„(Ea occinenra) MED EXP A�nYR!n.f s6n.) S PERSONAL&ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: GIW��irE.aA,L,dk�Z:"';,I�EGATE pp S _., POLICY JLCI LOC PRODUCTS-COMP p -. S OG;APuW%�dq+dE ...__...._,_.._n..n..._...........e.._...................„ AUTOMOBILE LIABILITY 0;'illwiUi.0 LbtuRit $ IE,Am laccaovUl1 AINY AUTO F30DILY INJURY(Per person) S OWNED SCHEDULED 130DILY INJURY(Per accident) S AUTO., HIRED S ONLY AUTNON-OWNED i�...�.�.... ......... ...............I AUTOS ONLY �...,. AUTOS ONLY „Ip��r rbeckIeW10 S .......... 3 UMBRELLA LIAR OCCUR „EACNOCCURRINCE CESS LIAR LAIMS-MADE ECREGATF 5 Y WORKERS RP�TENTN . PTATt,ITF,.I�� FrRS DIF WORKERS COMPENSATION 'I� I PER C)TH- OYERS'LIABILITY YIN "' ANYPROPRIETORIPARTNER IAC IDENT OFFICECryIrIEMBER EXCLUDED?/ ECUTNE �•".N � NIA I E.L.DpEp.ASE�EAEMPLOYEE'.� ...... ... $ If yes,dosCMAG under """"' DESCRIr-TION OF OPERATIONS below E.L.DISEA'SL-'-POLICY LIMIT S C PROFESSIONAL LIABILITY LRO03TG17 0613012017 0613012018 EACH CLAIMIAGGREGATE 1O,OOD,CN70 DEDUCTIBLE 500,000 _ I DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD tet,Additional Remarks Schedule,maybe attached if more space is required) 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 WITTA THE POLICY PROVISIONS. EL SEGUNDO,CA 90245 AUTHORIZED REPRESENTATIVE 01 Marsh USA.Inc. Manashi MukherJee (D 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 2S 12016103) The ACORN name and logo are registered marks of ACORD �d. DATE IMMIDD/VYYY) CERTIFICATE OF LIABILITY INSURANCE 6/30/2018 8/18/2017 F"T_His 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), PRODUCERLoc�ton Comparties 444 W.47th Street,Suite 900 PHONE rc,ttr._CMR �IANC,Iaq} Kansas City MO 641 1 2-1 906 N (816)960-9000 APDRESS: INSURERJS)AFrORDING COV.11RAGE NAIC# INSURER A:Chubb Insurance Company of New Jersev 41386 INSURED ONEX YORIC HOLDINGS CORP. INSURER 0: 1421009 ONEUPPERPOND ROAD INSURER C: BLDG F,4TH FLOOR INSURER D: PARSIPPANY,NJ 07054 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: t49093(A REVISION NUMBER: xxxxxxx 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 RAID CLAIMS. INSR �AWL SUek- ia6w1dVIfFF7P_OLJcY_Exp LTR TYPE OF INSURANCE I INSD 1ARID POLICY NUMBER IMMIPPYYYY) IMMIDDNYYY) LIMITS COMMERCIAL GENERAL LIABILITY NOTAIPLICABLE EACH OCCURRENCE $ xxxxxxx OCCUR CLAIMS-MADE xxxxxxx. J MED EXP(Any one personl $ xxxxxxx PERSONAL It ADV INJURY $ xxxxxxx GEN'L AGGREGATE LIMIT APPLIES PER: GEM RAI NLiGIRPGATE $ xxxxxxx PRODUCTS-COMPIOPAGG $ XXX)CXXX POLICY jECT 1 0 P n Pi iv:" $ AUTOMOBILE LIABILITY NOTAPPLICABLE iW $ xxxxxxx ANY AUTO BODILY INJURY(Per person) $ xx=xx OWNED SCHEDULED AU rOS ONLY AUTOS BODILY INJURY(Per dv6dreori $ )ayj)(XXX HIRED NON-OWNED PRO PI 0,1 1;'DAMACC AUTOS ONLY AUTOS ONLY $ xxxxxxx .................................................. s xxxxxxx . ......................................... UMBRELLA LIAR i_— OCCUR NOTAPPLICABLE FACH 0C,'�CUNIRLNCE $ xxxXxxx EXCESS LIAR CLAIMS-MADE AGGRff9ATE S xxxxxxx nFD RETENTIONS S xxxxxxx PER OTH- ruTE FR WORKERS COMPENSATION NOTAPPLICABLE AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORiPARTNER]EXECUTIVF NIA E L EACH ACCIDENT $ xxxxxxx OFFICERIIMEV�Zrr EXCLUDED� (Mandatory in NH) E L DISEASE-EA EMPLOYEE 5 XXXXXXX If y0s, tinder describe DESCRIPTION OF OPERATIONS belowt-POLICYLIMIT $ XXXXXXX .............. ... _ .1111 11.................................. A N 116800-5714 6/30/2017 6/30/2018........ LIMIT:$10,000,000 AGG�GKrl] (10VIHIHJ\GE DESCRIPT[ON OF OPERATIONS/LOCATIONS I VEHICLES�ACORD 101,Additional Remarks Schedule,may be aktached it more space is required) CERTIFICATE HOLDER CANCELLATION 14909366 CITY OF EL SEGUNDO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BErORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ITS OFFICIALS AND EMPLOYEES 350 MAIN STET ACCORDANCE WITH TFIC POLICY PROVISIONS. RE EL SEG DG, CA 10115 AUTHORIZED REPRESENTATPIY� (D 198R'1201 5 ACORD CORPORAT*14. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD