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PROOF OF INSURANCE (2018 - 2019) CLOSED Client#: 294228 IXPCOR ACORDTM CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDD/YYYY) 03/12/2018 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: USI Insurance Services LLC PHONE6 PAX (A/c,No,Ext' 48,4 351-4 00 I(AIC,No): 610 537-4974 1787 Sentry Pkwy W.,Veva 16 E-MKlt. Suite 300 8OPRrsS.: INS.... URER(Sp AFFORDING COVERAGE NAIC# 23 Blue Bell, PA 19422 INSURER A:Associated Industries Ins.Co.,Inc. 140 INSURED INSURER B:St-Stone National Insurance Company 25496 IXP Corporation INSURER C:Travelers Commercial Insurance Company 36137 Princeton Forrestal Village, NatonalUp0orurrtalnwPlllsbu b PA 19445 103 Main Street Suite 100 INSURER°: rl INSURER E;Liberty Insurance Underwriters,Inc. 19917 Princeton, NJ 08540 INSURER F COVERAGES CERTIFICATE NUMBER: 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 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.... .... .... POLICY NUMBER ------- 'F ------ (., LIMI....,,,, q� ADDL SUE3R POLICY EFF POLICY EXP ....' TS IN,six , .. ...,,,, IN$R WVP POLICY (MMIDD/YYYY) CLAIMS-MADE LIABILITY DAMHGETORENTED $1,000,000 SE A A X COMMERCIALGENERALAES103569103 08/31/2017 08/3112018 OCCURRENCE V 4 . A X OCCUR DAMAGE S(Ea occurrence) $100000 MED EXP(Any one person) 50 PERSONAL&ADV INJURY $1,000,000 GEN'LAGGRiGATE � APPLIES IPER: EER.A....L...AGGREGHt . $2,000,000PO- POLICY JECT LOC PRODUCTS-COMP/OPAGG 52,000000 OTHER: $ A AUTOMOBILE LIABILITY AES103569103 08131/2017 08/31/201�Ce1MIJINEDSINa;�I.&iiWAIV (FcctdeuatY $1,000,000 ANY AUTO BODILY INJURY(Per person) 5 ,�,,,, OWNED SCHEDULED BODILY INJURY Per accident) $ x AUTOS ONLY AUTOS ( AUTOS OIJLY ,(Per acct„den $ HIRED ONLY x NON-OWNED PROPERTYDAMAGE, $ B UMBR S�..LA LIAB.. . _._ X EXCESS LIAB �CLAIMS-MADE 31/2016'AGGREGATE L OCCUR 59184D172ALI 0813112017 081 uRRENCE S5,000,000 I � ATE 56 000 000 DED I Xu RETENTION SO S C WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN UB003K766849 01/01/2018 01/01/2019 X PER GTH- _—S_TA.T ACCIDENT ER, $1,000,000... .......... OFFICER/MEMBER in N EXCLUDED? (� NIA E L EACH ANY PROPRIETOR/PARTNER/EXECUTIVE cC a M&>Q f YR,Im,$1,000,000 EL If TION OF OPERATIONS below E L DISEASE-POLI C Rescribe under DESG es ICY LIMIT $1,000,000 D Professional liab 018201855 8/31/2017 08/31/2018 $5,000,000 E Excess Liab- E04NAAS4JWOO6 8/31/2017 08/31/20181 Excess$5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Liability policies will be endorsed to name CITY, its officials,and employees as additional insureds under said insurance coverage and to state that such insurance will be deemed primary such that any other insurance that may be carried by CITY will be excess thereto.Such endorsement must be reflected on ISO Form No.CG 20 10 11 85 or 88,or equivalent. For purposes of this Agreement,equivalent insurance includes Form CG 20 10 04 13 and CG 20 37 04 13. t (See Attached Descriptions) , CERTIIF$CATE HOLDER CANCELLATION EI Segundo Police Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attention: Jaime Bermudez, Lieutenant ACCORDANCE WITH THE POLICY PROVISIONS. 348 Main St. EI Segundo,CA 90245 AUTHORIZED REPRESENTATIVE �%/�g -tL'N.4ru I �+'tMv;N,«”»t,tp�td"'i +�w •� �° ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD #S22678783/M22110214 SACCR DESCRIPTIONS (Continued from Page 1) The Workers Compensation Policy includes A Waiver of Subrogation when there is a written contract and allowed by law. i i i SAGITTA 25.3(2016/03) 2 of 2 #S22678783/M22110214 POLICY NUMBER:AES1035691 03 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSE S OR CONTRACTORS - SCHEDULED SON O ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered Operations .............................................m All persons or organizations where required by written contract with the Named Insured Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", "property This insurance does not apply to 'bodily injury" or damage" or "personal and advertising injury" "property damage"occurring after: caused, in whole or in part, by: 1. All work, including materials, parts or 1. Your acts or omissions;or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed;or However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law;and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 2010 0413 ©Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these 2. Available under the applicable Limits of additional insureds, the following is added to Insurance shown in the Declarations; Section III—Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable Limits of Insurance shown in the will pay on behalf of the additional insured is the Declarations. amount of insurance: 1. Required by the contract or agreement;or Page 2 of 2 ©Insurance Services Office, Inc., 2012 CG 20 10 04 13 POLICY NUMBER: AES1035691 03 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL IDIS - OWNERS, LESSEES O CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE ............................M.-..__.................................. Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations All persons or organizations where required by written contract with the Named Insured Information required to complete this 'Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to 2. If coverage provided to the additional insured is include as an additional insured the person(s) or required by a contract or agreement, the organization(s) shown in the Schedule, but only insurance afforded to such additional insured will with respect to liability for "bodily injury" or not be broader than that which you are required "property damage"caused, in whole or in part, by by the contract or agreement to provide for such "your work" at the location designated and additional insured. described in the Schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and CG 20 37 04 13 ©Insurance Services Office, Inc., 2012 Page 1 of 1 AVION TRAVELERS] WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 00 03 13(00) - 001 POLICY NUMBER: UB-3K766849-18-43-G 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 any one not named in the Schedule. SCHEDULE DESIGNATED PERSON: .�.,.. DESIGNATED ORGANIZATION: ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. DATE OF ISSUE: 12-15-17 ST ASSIGN: PAGE 1 OF