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PROOF OF INSURANCE (2018) CLOSED CERTIFICATE OF LIABILITY INSURANCE D11 `�or�o"1";°"�"' i THIS CERTIFICATE IS ISSUED AS A(NATTER 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: H the certificate holder is an ADDITIONAL INSUYED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed H 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 endomement(s), PRODUCER CONTACT Marsh USA,ft. Ii PHONE pp FAr( j 1166 Avenue of the Americas [ANAESS- __LNSURE C ..N0.Cadl, e.�_�.....,�,. ... ........WL[ -NO! ... New York,NY 100136 9 ML Attn:NewYork.Celts@marsh.com Fax:212-946-05W {{ R,IS) ,. ,AFFORDINGCOVERAGE NAICtr ,.,..... .., ._........._. INSURER A:Sompo America Insurance Company 11126 INSURED Artlerica Inc. INSURER B:Tokio Marine America Insurance Company 1(X945 Canon Solutions425 N.Martingale Road,Suite 1700 INSURER C: Schaumburg,IL 60173 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: WC-009352820-21 REVISION NUMBER: 2 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. NSRIN POLICY NUMBER YMMID.�Y _ (LTR AL7W4.g5Ulik' r+MIDD EFr° P'GMUoo E.XP µ,TR TYPE OF INSURANCE .�R DI'1'+f'M`Y% PMMIODd1rYY'YW LIMITS B X COMMERCIALGENERALUABIUTY CLL6404741-07 11/0112017 1110112018 EACH OCCURRENCE $ 1,000,OOD� -�-�� DAMAGE'rOHtNitO ^„^ �CLAIMS-MADE �.- u1 OCCUR PREMI'SE'S(En rrvncel I S 1,00011100 5,000 PERSONAL&ADV INJURY $ 1,0�,000I ........................._ .. ....... ............ GEdCLAGGREGATE LIMIT APPLIIS .,.,. SPER: GENERAL AGGREGATE 1$ mm..... .�... ............2...,2,D00,002,D00,000PsRO' POLICY LOC PRODUCTS-COMP/OPAGG $ 1,000,()00 A AUTOMOBILE LIABILITY FTA40003DO(AOS) 11/01/2017 11101/2018 COMBINED$INGLELIMIT $ 10DO,000 G�RRP41211............ .W.... A X ANY AUTO ACV40995RO(MA) 11101/2017 1110112018 BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLYAUTOS AUTOS ONLY .._.-- NON-OWNED ONLY ktrOnG^ad ut})`,%I A E ,.,.$............................................................— AUTOS COMP/LOLL DED $ 1,000 UMBRELLAUAB CLAIMS-MADE OCCUR ...^_. AGACGRGATERRENCE„.....v...... $ EXCESS UAB A WORKERS COMPENSATION N$ WCD40058G0 AOS it $ DEDI ( ) 11101/2018 X. _ _E H AND EMPLOYERS'LIABILITY STATUTE A ANYPROPRIETCRIPARTNER,'EX',FCUT'4VE WCR40003D0 WI 1110112017 1110112018 $ 1,000,000 (Mandatory in NH) N N f A” E L DI... , ...w...-.,�...,-............�,.... DESCRIPTION OF OP'ERATION'! k ok,w E.L.DISEASE-POLICY LIMIT $ ......._._....,...�..............._-._,_.................,...... ................................... DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The City,its officials,and employees are additional insured(except workers'compensation)where required by written contract- This insurance is primary and non-contributory over any existing insurance and limited to liability arising out of the operations of the named insured and where required by written contract. Waiver of subrogalion Is applicable where required by written contract l CERTIFICATE HOLDER CANCELLATION City of EI Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 350 Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN EI Segundo,CA 90245 ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE of Marsh USA Inc. William Mollica _ p ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: CLL6404741-07 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONNTRACTORS - SCHEDULED PE SON: 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) Location(s)Of Covered Operations As required by written contract with a Named Insured, but As required by written contract with a Named Insured only if such contract is executed prior to a loss. 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 20 10 04 13 ©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 eclarations;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 0413 POLICY NUMBER: CLL6404741-07 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations As required by written contract with a Named Insured, As required by written contract with a Named Insured but only if such contract is executed prior to a loss. 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 organization(s) shown in the Schedule, but only Section III—Limits Of Insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured is "property damage" caused, in whole or in part, by required by a contract or agreement, the most we your work" at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement amount of insurance: performed for that additional insured and included in the "products-completed operations 1. Required by the contract or agreement; or hazard". 2. Available under the applicable Limits of However: Insurance shown in the Declarations; 1. The insurance afforded to such additional whichever is less. insured only applies to the extent permitted This endorsement shall not increase the applicable by law; and 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 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 CLL6404741-07 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION i ti This endorsement modifies insurance provided under the following: C p COMMERCIAL GENERAL LIABILITY COVERAGE PART PROD UCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance;and i i; I 1- i i i I CG 20 01 04 13 ©insurance Services Office, Inc.,2012 Page 1 of 1 POLICY NUMBER:FTA40003DO COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY,. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following; AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Canon USA, Inc. Endorsement Effective Date: 11/1/2017 SCHEDULE Name Of Person(s) Or Organization(s): As required by written contract Information required to complete this Schedule. if not shown above. will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured"for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.I. of Section II — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed.4-84) ....................................................�. 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 anyone not named in the Schedule Schedule As required by written contract ***THIS ENDORSEMENT DOES NOT APPLY TO KENTUCKY, NEW HAMPSHIRE,AND NEW JERSEY, This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective: 11/01/17 Policy No.WCD40058G0 Endorsement No. Insured: CANON U.S.A., INC. Premium: INCL. Insurance Company: Sompo Japan Insurance Company of America Countersigned by WC 00 0313 (Ed. 4-84) ©1983 National Council on Compensation Insurance.