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PROOF OF INSURANCE (2018) CLOSED Page 1 of 1 DATE(MMIDD/YYYY) Ac"Rvv' CERTIFICATE OF LIABILITY INSURANCE 07/21/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS "iRTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED ,PRESENTATIVE 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 endorsement(s). PRODUCER ICONTAC'f' NAME: Willis of New Jersey, Inc, PHO .Aycr.,BXf): 45 7378 1FAX No) - 1 2378 ... ,. c/o 26 Century Blvd E-MAIL P.O. Box 305191 AppRE„�y; certificates Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Kit--i Sumitomo Insurance Company of America 20362 INSURED INSURER B: Mitsui Sumitomo Insurance USA, Inc, 22551 Herlitz Corporation ..... ..... ... ... . 7 Roazel Road INSURERC,,,, .. .. Princeton, NJ 08540 INSURER D INSURER E INSURER F; C COVERAGES CERTIFICATE NUMBER:W3065569 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 ...., ..,,,,, AWL'SUER X 60. CY I.TR TYPE OF INSURANCE IVSD WVD POLICY NUMBER _,(M_M9Q(YK .Y) fMMDDVYY M.1.....„ LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE �, --p DAMAGE ToRENTED X( OCCUR PREMISES(Ta occurrence) $ 1,000,000 A MED EXP(Any one person) $ 10,000 Y N PKG3000272 08/01/2017 08/01/2018 1,000,000 PERSONAL$ADV INJURY $ _GE_VN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY F]JECT PRO-- C X LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHEf2 $ AUTOMOBILE LIABILITY COMBINED S4UNGLE LIM'ill $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED N N BVR8302170 08/01/2017 08/01/2018 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED F5e NON-OWNED PROPERTY DAMAGEAUTOS ONLYtl AUTOS ONLY ,_(P'ras_ paelru_u4V $ pV $ II , B X UMBRELLA LIAB X I OCCUR EACH OCCURRENCE $ 10,000,000 EXCESSLIIIAB n CLAIMS-MADE N N UMB5500107 08/01/2017 08/01/2018 AGGREGATE $ 10,000,000 DED X V RETENTION$10,000 $ WORKERS COMPENSATION XII STER ATUTE ERH AND EMPLOYERS'LIABILITY YIN' A ANYPROPRIETOR/PARTNER/EXECUTIVE E L,EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED? [No N/A N WCP9001200 08/01/2017 08/01/2018 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ .......... DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) It is agreed that City of EL Segundo, the officers, officials, employees and volunteers are included as Additional Insureds as respects to General Liability policy. It is further agreed that such insurance as is afforded shall be primary and non-contributory with any other insurance in force for or which may be purchased by Additional Insureds. CERTIFICATE 14OLDER 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. AUTHORIZED REPRESENTATIVE ty of EL Segundo pp 350 Main Street /J��y El Seguudo,, CA 90245 O�/ ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD SR In:_14864874 BATCH: 390906