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PROOF OF INSURANCE (2018) CLOSED ��0 DATE(MMIDDIYYYY) �. CERTIFICATE OF LIABILITY INSURANCE 6/1/2017 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 riqhts to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Tina Coburn Arthur J. Gallagher Tacoma 2925 9 98401 R92Management Services, Inc. PHONE(IC,N ss xTi 253-238-1134Cob99 coIT1 FAX No);253-572-1430 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Travelers Casualty Insurance Co of 19046 INSURED INSURERB:Travelers Indemnity Company 25658 FileOnQ INSURER C: 832 Industry Drive Tukwila,WA 98188 INSURERD: INSURER E: INSURER F: COVERAGES C'ERTIF'ICATE NUMBER: 1417436543 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 ..ADDL SUER POLICY EFF I POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDDIYYYYI (MWDDIYYI'p_X) LIMITS A X COMMERCIAL GENERAL LIABILITY Y 6801H8791271742 6/1/2017 6/1/2018 EACH OCCURRENCE $1,000,000 CLAIMS-MADE 1 X OCCUR PREMd fist'a(xxwrr0noa,: $300,000 ..,, .,MED EXP(Any one person) $5,000 ..,, . PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY IIRO, I LOC PRODUCTS-COMP/OP AGO $2,000,000 JECT OTHER: $ A AUTOMOBILE LIABILITY 6801HB791271742 6/1/2017 6/1/2018 COMCfINr0'SiNGPLELIMIT $ ((:a acadt:,nt1 1,000,000 ANY AUTO BODILY INJURY(Per person) $ HIRED ONLY X NON--OWNED Pt OPrRTIAUTOS BODILY Y DAMA05JURY(Per acuder�t) S OWNED SCHEDULED AUTOS ONLY AUTOS ONLY $ S B X UMBRELLA LAB X CUP1H8791641742 6/1/2017 6/1/2018 OCCURRENCE $1,000,000 OCCUR EACH f EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED IX I RETENTION 5.000 $ A WORKERS COMPENSATION 6801HS791271742 6/1/2017 6/1/2018 PERTLITE FRH- P P AND EMPLOYERS'LIABILITY YIN X WA Stop Ga ANY NIA ACCIDENT S1,000,000 OMandat M iBER n NH)EXCLUDED PROPRIETOR/PARTNER/EXECUTIVE r— E L EACH E L DISEASE -EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $1,000,000 A Property Section 6801H8791271742 6/1/2017 6/1/2018 Contents Ded$500 613,998 Data Processing Electronic Data 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Evidence of Insurance. RE: EI Segundo Police Department City in EI Segundo and EI Segundo Police Department has been added an additional insured as per written contract per forms CG D105 04/94. 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 EI Segundo Police Department,Accounting ACCORDANCE WITH THE POLICY PROVISIONS. 348 Main Street EI Segundo,CA 90245 USA AUTHORIZED REPRESENTATIVE I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS: 1. WHO IS AN INSURED (SECTION 11) is amended in a written contract for this insurance to to include as an insured any person or organiza- apply on a primary or contributory basis. tion (called hereafter "additional Insured") whom 3. This insurance does not apply: you have agreed in a written contract, executed prior to loss, to name as additional insured, but a. on any basis to any person or organization only with respect to liability arising out of "your for whom you have purchased an Owners work" or your ongoing operations for that addi- and Contractors Protective policy. tional insured performed by you or for you. b. to "bodily injury," "property damage," "per- 2. With respect to the insurance afforded to Addi- sonal injury," or "advertising injury" arising tlonal Insureds the following conditions apply: out of the rendering of or the failure to render any professional services by or for you, in- a. Limits of Insurance — The following limits of cluding: liability apply; 1. The preparing, approving or failing to 1. The limits which you agreed to provide; prepare or approve maps, drawings, or opinions, reports, surveys, change or- 2. The limits shown on the declarations, ders, designs or specifications; and whichever is less. 2. Supervisory, inspection or engineering b. This insurance is excess over any valid and services. collectible insurance unless you have agreed o= a e. m� r= o� o CG D1 05 04 94 Copyright, The Travelers Indemnity Company, 1994. Page 1 of 1 Includes Copyrighted Material from Insurance Services Office, Inc. 005060 A�'� DATE(MMIDDIYYYY) �"'"A1�1{,..J',,,R/...rw"' CERTIFICATE OF LIABILITY INSURANCE 6/1/2017 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(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 CONTACT NAME, Tina Coburn Arthur J. Gallagher Risk Management Services, Inc. PHONE 253-238-1134 FAx 253-572-1430 P.O. Box 2925 LAIC„No,Ext): (A/G,Nal. E•MAiLTina Co ., j .Co(T1 Tacoma WA 98401-2925 ADDRESS; burnna INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Westchester Fire Insurance Company 10030 INSURED I INSURER B: FileOnQ INSURERC: 832 Industry Drive Tukwila,WA 98188 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1733941631 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 ADDL SUBRJ POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD VWD I POLICY NUMBER IMM/DDIYYYYI IMMIDDIYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE'10RE� N`I`tC0 CLAIMS-MADE I OCCUR PREM[13'F(Ea occurrrsme? $ MED EXP(Any one person) S PERSONAL&ADV INJURY S (� LOC PRODUCTS OELAGGREGATE S POLICY II LIMIT APPLIES PER GENERAL EN`L AGGREGATE D CTS-COMP/OP AGO S OTHER IS AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (ETI,acodent) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per acadenl) $ AUTOS ONLY AUTOS HIRED NON-OWNED IyROPE.iW''Y DAMAGE AUTOS ONLY AUTOS ONLY (I?rsu accident) S $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE, AGGREGATE S DFD I I RETENTIONS S ........ WORKERS COMPENSATION PER ANY PERO/MEMBOER/EXCLUDED?ECUTIVE YIN E L STATUTE OTRH AND EMPLOYERS'LIABILITY I"1 EACH ACCIDENTOFFS, IL..._._...f NIA .,., .., . (Mandatory in NH) EL DISEASE-EA EMPLOYEE,,$ DESCRIPTION OFunder below EL DISEASE-POLICY LIMIT Y S A Errors&Omissions G27604341003 6/1/2017 6/1/2018 Each claim 1,000,000 Aggregate 2,000,000 Retention 7,500 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: EI Segundo Police Department. 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 EI Segundo Police Department,Accounting ACCORDANCE WITH THE POLICY PROVISIONS. 348 Main Street 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