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PROOF OF INSURANCE (2018) CLOSED OP ID: CO DATE(MMIDDIYYYY) ., . ' CERTIFICATE OF LIABILITY INSURANCE I 09/26/2017 � 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 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 MEn CONTACT NAACristina Ontiveros PIASC Insurance Services,Inc. �__m - - Lic.#0747420 PHONE E'xt)t 323-728-9500 ,N; 323-248-9930 P.O.Box 910936 E-MAIL APPR0. . Los Angeles,CA 90091-0936 PRODUCE. Crlstina�pi'asc.or .. CER HOUSE ACCOUNT In#,MARTIN2 INSUREDNAIC# Martin&Chapman CompanyINSURER A:The Hanover Insurance Group COVERAGE ]36064 Attn: Scott Martin p' 1951 Wright Circle INSURER S:Preferred Employers Ins.Co. G10900 Anaheim,CA 92806-6028 INSURER C: INSURER P: INSURER E: INSURER F: COVERAGE'S 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 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 IL RR TYPE OF INSURANCE INSR MD POLICY NUMBER t F"r3LN�G�''MYY' I WDWiCY EXP MMI'DDIYYYY't [MMP'DD�fYY'YYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMA E' R El4TFff A X c 1,000,000 (Any oacrwperson) $ 10,000 COMMERCIAL IX 1 OCCUR ZH3 9012496 O6 2/18/2017 02/18/2018 MED EXP(,Any one per,l�re PERSONAL 8 ADV INJURY $ 1,000,000 X GL BROAD FORM END GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY h IIF Loc Empl.Ben $ 1,000,000 AUTOMOBILE LIABILITY X COMBINED SINGLE LIMIT $ 1,000,000 A X ANY AUTO Awa 9033498 Os 02118/2017 02/18/2018 (Ea accident) BODILY INJURY(Per person) $ ALL OWNED AUTOS .................................... BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY""" DAMAGE X HIRED AUTOS (PER AC $ CIDENT) X NON-OWNEDAUTOS $ III$ EXCESSL......B.......................... OCCUR LAIUMADE ..AGGREGATE �_ .....,,,,,,,.................. A UH3698997606 02118/2017 02118/2018 X UMBRELLA .X....�..... M„ ................. E OCCURRENCE $ 3'000,000 ............................... DEDUCTIBLE $ _ X RETENTION $ 0 $ WORKERS COMPENSATION ] WCSTATU- B OFFICER/MEMBER EMPLOYERS' EXCLUDED?PROPRIETOR/PARTNER/EXECUTIVE Y'N NIA WKN 122873-14 06101/2017 0610112018 EL EA�CH�ac DE r R �$ 1,0,0,0,,0,0,0 (Mandatory In NH) ""PROOF OF COVERAGE ONLY` EL DISEASE-EA EMPLOYEE$ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT II$ 1,000,000 A Errors B.Omissions ,ZH3 9012496 06 02118/2017 02118/2018 Each Occu 1,000,000 Ded.$25,000 —SPECIAL FORM*** Ann.Aggre 2,000,00C, DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional RsmaOD S(,,hudulle,0 more space is required) Certificate holder is named ADDITIONAL INSURED per polic form 421-2915 12 14 with respects to services provided and/or performeal by the Named Insured, CERTIFICATE HOLDER CANCELLATION CITYELS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of EI Segundo ACCORDANCE WITH THE POLICY PROVISIONS. Attn. Office of the City Clerk 350 Main Street AUTHORIZED REPRESENTATIVE EI Segundo,CA 90245 .• ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD