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PROOF OF INSURANCE (2018 - 2018) CLOSED DATE(MMIDD/YYYY) ACC>R" CERTIFICATE OF LIABILITY INSURANCE 12/21/2017 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 NAME: Mary Poiar ISG-Dunlap Agency PHONE (714)838-3158 Ext): (714)838-3158 I"talc,No): (714)922-6157 AIC,N ..........._.......................................-_......._.ww 700 West 1st St Suite 8 ADDRESS: mary@dunlapins,C0m INSURERIS)AFFORDING COVERAGE NAIC p Tustin CA 92780 INSURERA: Sentinel Insurance 11000 ' INSURED INSURER B: Preferred Employers Ins,Co 10900 Matrix Imaging Products,Inc INSURER C: Gemini Ins.Co, 10833 ._......W__ww. 20512 Crescent Bay, INSURER D Suite 100 INSURER E: Lake Forest CA 92630 INSURER F: I COVERAGES CERTIFICATE NUMBER: 2017-2018 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 IN R AUUL 5Ulirc POLICY EFF POLICY EXP LTR TYPE OF INSURANCE Ip yyyp POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) I LIMITS ._.,.,..-.,_..............................................-. ._. W._.. ............... 'X COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE $ 1,000,000 DAMAGE TO REN`IED CLAIMS-MADE 19 OCCUR I PREMISES(Ea occurrence 1,000,000 $ MED EXP(Any one person) $ 10,000 A 72SBABD3913DX 10/17/2017 10/17/2018 I PERSONAL&ADV INJURY $ 1,000,000 ..__ ............................. Gi=q'LAGGREGATE LIMITAPPLIES PER. I GENERAL AGGREGATE $ 2,000,000 2,066,000 + + POLICY ,gFc;r Loc I PRODUCTS-COMPIOPAGG $ OTHER Employee Benefits $ 1,000,000 AUTOMOBILE LIABILITY FIE� MBINED SINGLE LIMIT $ 1,000,000 vxidgnK'I ..,ww-. ANY AUTO DILY INJURY(Per person) $ A OWNED SCHEDULED 72SBABD3913 DX 10/17/2017 10/17/2018 I BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIREDPX $NON-OWNED PR'OPER'TY C;YAhJAG'E $ AUTOS ONLY AUTOS ONLY I i Per occ6enlI X UMBRELLA LIAB OCCUR _ EACH OCCURRENCE $ 4,000,000 ---- ........................... A EXCESS LIAB CLAIMS-MADE 72 SBABD3913 10/17/2017 10/17/2018 I AGGREGATE is 4,000,000 DED V X)ppRETENTION $ 10,000 I$ 'XECUTIVE ...................... ........................ E,LIEACHATE ENT 0TH- WORKERS COMPENSATION X SPER TATUTE I ER AND EMPLOYERS'LIABILITYY I N ANY PI7t,rI'+rylt!-:°I'OWPARrrt FRIT,•., $ 1,000,000 C OFI�I'CERWEMUEREXI,LVDED7 NIA WKN157011-4 12/01/2017 12/01/2018 IMandatoryInNTT) EL DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ Professional Liability Deductible:$2,500 $1,000,000 D Network Security VNPL002393 06/17/2017 06/17/2018 Deductible:$2,500 $250,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLE .........,Wr..,..,.._ S (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The City of EI Segundo,its officials.and employees are named as additonal insured Insurance on the Certificate is Primary Thirty(30) days notice of Cancellation required CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of EI Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main St AUTHORIZED REPRESENTATIVE �1 EI Segundo CA 90245 G.� r l4 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD MATRIX IMAGING PRODUCTS, INC POLICY NUMBER: 72SBABD3913 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED-OWNERS, LESSEES OR CONTRACTORS (Form B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: The City of EI Segundo, its officials and employees (If no entry appears above, information required to complete this endorsement will be shown in the Declaration as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the schedule, but only with respects to liability arising out of your work preformed for that insured. CG 20 10 07 04 Copyright, Insurance Services Office, Inc. 2004 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed.4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule The City EI Segundo, Its officials and employees This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective:8/30/2017 Policy No. WKN157011-3 Endorsement No. 1 Insured: MATRIX IMAGING PRODUCTS, INC. Premium$0 Insurance Company: Employers Countersigned by Dean Dunlap WC 00 03 13 (Ed. 4-84) Copyright 1983 National Council on Compensation Insurance.