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PROOF OF INSURANCE (2018 - 2019) CLOSED
,,w� TE(MMI � DA DDIYYYY) A�° q7� 1��;.✓'Ar�Maf.a► CERTIFICATE OF LIABILITY INSURANCE I2/31/2018 Ii/llO) 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). I PRODUCER Lockton Insurance Brokers,LLC I CONTACT NAMi CA License#OF15767 E-MAIL 725 S.Figueroa Street,35th Fl. PHONE FAx No..Ext): �,.(Are,No): Los Angeles CA 90017 tapta sus: (213)689-0065 INSURERS)AFFORDING COVERAGE NAIC# INSURER A:Atlantic Specialty Insurance Company 27154 INSURED uINSURER B:HICC(1X Insurance Company, Pl.,Ste. 102 INSURER C:Federal InsuranceC,om any Inc. 1302737 2201 20281 ,tl,l,li El Segundo CA 90245 INSURER D INSURER E INSURER F: COVERAGES PROSUOI CERTIFICATE NUMBER: 2',91 1 178 REVISION NUMBER: X''r;;'y XX X X 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 3OLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSA VD POLICY NUMBER (MMIDD/YYYY)_„.,IMM/DD/YYYY)I LIMITS A COMMERCIAL GENERAL LIABILITY y N 7110082470012 6/19/2018 6/19/2019 EACH OCCURRENCE $ 11000,000 I DAMdGE'tO HEWED CLAIMS-MADE � X IOCCUR PREMISES(Ea occurrence) $ 1,000,000 ME D EX P ny one person) s PERSONAL A&ADV INJURY $ ,1000 00,000 GENPOLICY JEMAPPLIES TGENERAL LOC PRODTS �COMP/OPAGG $ 2,0OO,000 'LAGGR AGGREGATE)LRO ... 0,000 01 HER $ • AUTOMOBILE LIABILITY N N 7110082470012 6/19/2018 6/19/2019 COMBINE[))INGLE i,IMlr(Farcci $ 000,000 ANY AUTO BODILYINJURY(Per person) $ X � . OWNED � SCHEDULED AUTOS accident) XXxXXX HIRED ONLAUTOS Y NON-OWNED ONLD PROPERIY E DAMAGE 2 e,nt) $ XXXXXXX XX Comn/Coll Ded $ 1,000 A X UMBRELLA LIAB EXCESS LIAB $ S,OOO� OCCURX_�CLAIMS-MADE N N 7110082470012 � 6/19/2018 6/19/2019 EACH AGGREGATE OCCURRENCE QOO 000 DED � �RETENTION$ $ XXXXXXX WORKERS COMPENSATION YIN Y X I PER O rH A AND EMPLOYERS'LIABILITY 406032131 12/31/2017 12/31/2018 STATUTE I I ER 1)i4°9,LWMFMOER EXCLUD RGEX ECUTIVE 'F-j NIA E L DISEASECIDENT EMPLO $ 1"`000,000 i'�yy-Si:'PdeTribe".ander c y in NN) (YI EMPLOYEE $.�r,000,000 I -ndaIP ION under OFERA"I"IONS boloy E L DISEASE-POLICY LIMIT " 1 .000.000 B Cyber N N 227318518 6/19/2018 6/19/2019 $5,000,000 Each Wrongful Act Technology Prof Liab $5,000,000 Limi Ikea. C 3rd Party Crime 8242-9026 6/19/2018 6/19/2019 $3,000,000 Lim/$I OK Ret DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) I The City,its officers,officials,employees,agents,and volunteers are an Additional Insured to the extent provided by the policy language or endorsement issued or approved by the insurance carrier.Waiver of Subrogation applies to the worker's compensation 30 Day Notice of Cancellation applies per attached endorsement. CERTIFICATE HOLDER CANCELLATION See Attachments 2911178 City of El Segundo City Clerk SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn: Administrative Services THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street,Room 5 El Segundo CA 90245 AUTHORIZED REPR. I ©1488-201 AC D CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Attachment Code:D498109 Certificate ID:2911178 POLICY NUMBER: 7110082470012 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s)or Organization(s): The City, its officers, officials, employees, agents, and volunteers. 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 is added to Section III- organization(s)shown in the Schedule, but only with Limits Of Insurance: respect to liability for"bodily injury", "property damage" or"personal and advertising injury"caused, in whole or If coverage provided to the additional insured is required in part, by your acts or omissions or the acts or by a contract or agreement, the most we will pay on omissions of those acting on your behalf: behalf of the additional insured is the amount of insurance: 1. In the performance of your ongoing operations; or 1. Required by the contract or agreement; or 2. In connection with your premises owned by or rented to you. 2.Available under the applicable Limits of Insurance shown in the Declarations; However: whichever is less. 1.The insurance afforded to such additional insured only applies to the extent permitted by law; and This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. 2. If coverage provided to the additional insured is 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 20 26 04 13 ©Insurance Services Office, Inc., 2012 Page 1 of 1 Attachment Code:D463006 Certificate M:2911178 UKKUM c June 20, 2018 City of EI Segundo City Clerk Attn: Administrative Services 350 Main Street, Room 5 EI Segundo, CA 90245 Re: Notice of Cancellation Clause To Whom It May Concern: As a service to our valued client, Lockton will provide at least thirty (30) days notice of cancellation to the certificate holder listed on the attached Acord 25 certificate of insurance should any of the policies described on the attached certificate be 1) cancelled by the insurer, other than for non-payment of premium (10 day notice for non-payment/non-reporting), and 2) cancelled more than 30 days prior to the expiration date of the policy (if such cancellation occurs less than 30 days prior to expiration, Lockton will provide as much prior notice as practicable). If notice is mailed, proof of mailing notice to the certificate holder to the postal mailing address as shown in the schedule will be sufficient proof of notice. Thank you and please contact our office if you have any questions. Regards, David Burgos Assistant Vice President Lockton Insurance Brokers THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be % of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description WHERE REQUIRED BY WRITTEN CONTRACT All Operations WC 04 03 06 (Ed.4-84) Attachment Code:D492298 Certificate ID: 2911178