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PROOF OF INSURANCE (2019 - 2019) CLOSED Client#:294228 IXPCOR ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDD/YYYY) 8/29/2018 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(ies)must have ADDITIO1.NAL INSURED pro11 v 11 i 11 si1.o 1.ns 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: USIInsuraceSvicesLLC Vyq�"'o,.Xt�484351-4600 I c,N 10537-497,4 H, o..... 6 1787 SentryPkwyW. Veva 16 E-MAIL Suite 300 INSURER S)AFFORDING COVERAGE NAIC Blue Bell PA 19422 (....o.......................................... # Associated Industries Ins.Co.,Inc. ........................................................................ 123140 INSURER A: _ INSUREDStarStone.Nati INSURER B: National Insurance Company '25496 IXP Corporation INSURER C:Travelers Commercial Insurance Company 136137 Princeton Forrestal Village, INsuRRD:NationalunionFirelnsPlnsbar9l,P................................... _....__......................_.. A 19445 103 Main Street Suite 100 INSURR.E......L,be.............u,r, ......__1._.......... ._. rly Insurance Underwriters,Inc. 19917 Princeton,NJ 08540 INSURER F t 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. SUBR POLICY POLICY AR COMMERCIAL NS LWVD AES1035691 04 08/31/2018108/31/2019IEACH OCCURRENCE LIMITS$1,000,0„ POLICYNCE NUMBER MM/DD/VY F) I p T 00 ............L............ CLAIMS-MADE 41 OCCUR ,PREr lO,21I�S�iEaFc�acc�rD,e„irace,).. .$,100,000 1 MED EXP(Any one person) $0 ............I ........................... . 1 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 1 GENERAL AGGREGATE $2,000,000 PRO- PRODUCTS-COMP/OP AGG,.,, Z- ._.....� POLICY I,,,,,,X„ 000 OOO JECT LOC R................? OTHER: $ A AUTOMOBILE AES103569104 08/31/2018 08/31/2019GOMRnNFD)RIP�Lp LIMIT1,0 00,00 0 �-�a� �d�rm ---_11-1111- ........_.._ ANY AUTO BODILY INJURY(Per person) $ IOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY X X P,r 1. AUTOS ONLY AUTOS HIRED AUOTOS ONLY p�Pc den4ERTY�DAMAGE ...............�,...........$........................ .... ...,.-,,...., $ B EX............LLA.................. .i. occuR 59184D183ALI 08/31/2018 08/31/2019(EACH OCCURRENCE $5 — CESS IAB AIMS MADE AGGREGATE $5,000,000�OOO,UU UMBRELLA LIAB x _X QED XI RETENTIO)N$O L C WORKERS COMPENSATION ... .................. .................................................UB003K766849 01/01/2018 01/01/2019... .....P�Eh.. .... AN000EMPLOYERS LIABILITY YIN PTAT ACCIDENT .FR 1,000, ❑ �OTH OF (Mandatory In NH) EXCLUDED? N/A E.L.DISEASE-EA EM„ $ �OOOr f)0 6°'ERAA�¢MBERYEXCLNER/EXECUTIVE E L EACH PLOYEE $ p . If yes,describe under DESCRIPTION OF OPERATIONS b,el,ow, _ I E L,DISEASE-POLICY LIMIT $1,000,000 D Professional Liab 18336672 08/31/2018 08/31/2019 $5,000,000 E Excess Liab- E04NAAS4JW006 08/31/2018108/31/2019 Excess$5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS!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 2010 04 13 and CG 20 37 04 13. CERTIFICATE HOLDER CANCELLATION EI Segundo Police Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE g P 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 ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S23762116/M23761305 AXYZP POLICY NUMBER:AES1035691 04 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL II SU 'ED - OWNERS, LESSEES O CONTRACTORS - SCHEDULED 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) Location(s)Of Covered 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 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 This page has been left blank intentionally. �" Vi�L �I WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 00 03 13(00)- 001 POLICY NUMBER: UB-3x766849-18-43-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