The URL can be used to link to this page

PROOF OF INSURANCE (2019) CLOSED AC CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) �'' 1 2/20/2018 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 riqhts to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Arthur J. Gallagher Risk Management Services, Inc. PHONE E Ext);212-994-7100 FAX 250 212-994-7047 250 Park Avenue, 5th Floor E MANL New York NY 10177 AUORESS� INSURER(S)„AFFORDING„COVE,RAGE„ NAIC# INSURER A:Insurance Company of State of PA 19429 Re:Amerlcan Home Assurance Company 380 INSURED L3 - (INSURE ...., .... L-3 Communications Mobile-Vision, Inc. INSURERC,Commerce and Industry Insurance Company 19410 c/o L3 Technologies, Inc. INSURER D•New Hampshire Insurance Company 23841 600 Third Avenue New York NY 10016 INSURER E INSURER F: ..., .. COVERAGES CERTIFICATE NUMBER: 702914560 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, INSR TYPE OF INSURANCE ADDLISUBR` ”""" """"' POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MMIDDIYYYY) (MM/DD/YYYY)v A X ICOMMERCIAL GENERAL LIABILITY 4611510 2/1/2018 2/1/2019 EACH OCCURRENCE $1,000„000 UAKVIOE YO CLAIMS-MADE I X I OCCUR „PREMISES La occur eUnce) $1„000„000 X Includes Product MED EXP(Any one person) $10,000 X Liabilitv PERSONAL&ADV INJURY $1„000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2„000,000 PRO- TS-COMP/OPAGG $2,000,000 X POLICY LOC PRODUC OTHER: $ 2/1/2018 2/1/2019 C^(')MOINEDSINGLELIMIt $2,000,000 A AUTOMOBILE LIABILITY 7093465(AOS) (L,a accadenf,),,, A 7093464(MA) 2/1/2018 2/1/2019 person ANY AUTO 2/1/2018 2/1/2019 BODILY INJURY(Per p ) $ '°` X 7093463(VA) OWNED AUTOSSCHEDULED AUTOS ONLY BODILY INJURY(Per accident) $ Y 0AMAUt XX AUTOS ONLY HIRED ”' NON-OWNED "Y�R('„M F"R,' AUTOS ONLY „(Per accrrl�ew�G) UMBRELLA LIAB I4 OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I RETENTION$ ry $ B WORKERS COMPENSATION 014122580(CA) 2/1/2018 2/1/2019 XII PTA'C '(y9C, !I ETH C AND EMPLOYERS'LIABILITY Y/N 014122581(FL) 2/1/2018 2/1/2019 D ANY ' ECUTIVEV014122583(ME) 2/1/2018 2/1/2019 ACCIDENTEL EACH 1,000,000 ORIMEMBREXCLNN/A (Mandary H) EL DISEASE $1„000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E L,DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) WC Policy#014122579(AK,AZ,IL,KY,NC,NH,NJ,PA,UT,VA,VT)-INSURANCE CO OF STATE OF PA-02/01/18 02/01/19 WC Policy#014122584(AL,AR,CO,CT,DC,DE,GA,HI,IA,ID,IN,KS,LA,MD,MI,MN,MO,MS,NE,NM,NV,NY,OK,OR,RI,SC,SD,TN,TX,WV)- INSURANCE CO OF STATE OF PA-02/01/18 02/01/19 WC Policy#014122582(MA,ND,OH,WA,WI,WY)-NEW HAMPSHIRE INSURANCE COMPANY-02/01/18 02/01/19 See Attached.. CERTIFICATE HOLDER CANCELLATION' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of EI Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 Main Street,Room#5 ACCORDANCE WITH THE POLICY PROVISIONS. City Clerk EI Segundo CA 90245 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ENDORSEMENT This endorsement, effective 12:01 A.M. 02/01/2018 forms a part of Policy No. GL 461-15-10 issued to L3 Technologies, Inc. by The Insurance Company of the State of Pennsylvania ADDITIONAL INSURED-WHERE REQUIRED UNDER CONTRACT OR AGREEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Section II -Who is an Insured, 1., is amended to add: f) Any person or organization to whom you become obligated to include as an additional insured under this policy, as a result of any contract or agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy, but only with respect to liability arising out of your operations or premises owned by or rented to you. However, the insurance provided will not exceed the lesser of: 1. The coverage and/or limits of this policy, or 2. The coverage and/or limits required by said contractor agreement. W Y� �d tltl M AUTHORIZED REPRESENTATIVE 61712 (9/01) AGENCY CUSTOMER ID: L3COMMU-09 .............. .............................._...................................................... LOC#: " ADDITIONAL REMARKS SCHEDULE Page mm� of AGENCY NAMED INSURED Arthur J. Gallagher Risk Management Services, Inc. L-3 Communications Mobile-Vision, Inc. ................................................................................................................................................................................................................................................................. ................................................ ....... c/o L3 Technologies, Inc. POLICY NUMBER 600 Third Avenue New York NY 10016 CARRIERNAIC CODE .... ....... .......... .... .. ... ..........................['111111111 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE ........... City of EI Segundo, its officials and employees are included as additional insured(blanket endorsement)as respects General Liability Policy as evidenced herein on a primary/non-contributory basis as required by written contract with respect to work performed by the named insured. Notice of Cancellation: Should any of the above described policies be cancelled before the expiration date thereof, L-3 Mobile-Vision, Inc. would provide(30)days written notice of cancellation to the City of EI Segundo. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Sandoval, Uli I I'll,From: Shilling, Mona Sent: Monday, September 21, 2015 3:53 PM To: Turnbull, Robert (Captain) Cc: Sandoval, Lili; Cerritos, Maria Subject: RE: Services Agreement for Purchase of VIEVU BWC's Bob, Greatl Then the Waiver of Subrogation is not required. We will attach this email to to proof of insurance. Please have the vender provide the endorsement for the Commercial General Liability. Thanks, Mona S From:Turnbull, Robert (Captain) Sent: Monday, September 21, 2015 3:45 PM To:Shilling, Mona Cc: Sandoval, Lili Subject: Re: Services Agreement for Purchase of VIEVU BWC's Mona, No vendor is coming on site. We are buying body worn cameras that will be shipped to us. Bob Turnbull, Captain Administrative Services Bureau EI Segundo Police Department 348 Main Street EI Segundo, CA 90245 310-524-2250 Office 310-607-9171 FAX Visit us on the web v;wv 6.Il qLgtincioPD.Or On Sep 21, 2015, at 3:43 PM, Shilling, Mona <MSliillinR@_r-l,seattndo.org>wrote: Bob, I reviewed the proof of insurance for L3 with Lili. Could you please have the vender provide the endorsement for the Commercial General Liability. Regarding the Waiver of Worker's Compensation; doesn't the Purchase Order Requisition indicate the vender is coming on site? Thanks, Mona S