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PROOF OF INSURANCE (2019) CLOSED DATE(MM/DD/YYYY) ►� '"�'� CERTIFICATE OF LIABILITY INSURANCE 3/19/2018 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 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 JLT Specialty LISA NAME: JILT'Specially USA 1520 Market Street, Suite 300 INc�No Ext), 72&501.2800 INC,FAXO) Denver, CO 80202 EMAIL ADDRESS' INSURER(S)AFFORDING COVERAGE NAIC# WWW.JIIUS corn INSURER A: Atlantic Specialty Insurance Company 27154 INSURED INSURER B: ACE American Insurance Company 22667 ycer LLC Manag DC INSURER C: Great American Insurance Company 16691 Brycer55 Weaver Pkwyt Suite 330 INSURERS 1arrenville IL 5055 INSURER F: COVERAGES CERTIFICATE NUMBER: 40878210 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 INS(2 TYPE OF INSURANCE ADDLISUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICYNUMBER (MMIDD/YYYY) (MWDD/YYYY) A �,�' COMMERCIAL GENERAL LIABILITY 711-01-23-92-0007 2/17/2018 2/17/2019 EACH OCCURRENCE $1,000,000 DAvAGCLAIMS-MADE ✓ OCCUR PREMISES� 'S'ILV^'tnt�N'IED ') $-5000.000 urruay,t:u„ MED EXP(Any one person) S10,000 PERSONAL&ADV INJURY S1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s2,000,000 �------ r ✓ POLICY L----J 'Jr C°) -, LOC PRODUCTS-COMPtOPAGG 52,000,000 OTItE,R $ A AUTOMOBILE LIABILITY 711-01-23-92-0007 2/17/2018 2/17/2019 �'�mt'."PINE�-.�tSINGLE�.,l�Al'I° $1,000„000 ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS ONLY AUTOS HIRED NON-OWNED la'ROPk''4R,'s'Y'D,A}M/„GE S AUTOS ONLY w! AUTOS ONLY (Peq„IMrc:1J&A), $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE S ULLJRETENTIONS $ A WORKERS COMPENSATION AOS:406-03-68-99-0007 2/17/2018 2/17/2019 �/ STATUrF ERH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE WY. E L EACH ACCIDENT s500,000 OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) E L DISEASE-EA EMPLOYEE,$5OQ Ono If yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT I.S 500.000 B Technology&Internet E&O D5280971A 001 2/17/2018 2/17/2019 $3M/claim,$3M aggregate,$10K retention C Fidelity/Crime SAA E217959 00 00 2/17/2018 2/17/2019 $500,000 limit DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) II City of EI Segundo,its officials,and employees are additional insureds,and coverage is primary and noncontributory as required by written contract,per policy terms and conditions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CIty of I Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. EI Segundo CA 90245 0 / AUTHORIZED REPRESENTATIVE Matt Rush ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 40e7e210 1 1a-19 GL AU U+s WC-, Cyber r Crime 1 saran Mathew:; 1 �/19/201e 4:29:01 em (MUT) I Page 1 or 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. @VA TAGE FOR GENERAL LIABILITY TECHNOLOGY COMPANIES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM The following schedule lists the coverage extensions provided by this endorsement. Refer to the individual provisions to determine the extent of your coverage. �I SCHEDULE OF COVERAGE EXTENSIONS 1. Additional Insured - Broad Form Vendors 8. Coverage Territory—Worldwide 2. Additional Insured—by Contract, Agreement or 9. Duties in Event of Occurrence, Claim or Suit Permit relating to: 10. Expected or Intended Injury (PD) o Work performed by you 11. Incidental Medical Malpractice o Premises you own, rent, lease or occupy 12. Medical Payments o Equipment you lease 13. Mobile Equipment Redefined 3. Aggregate Limit Per Location 14. Newly Acquired or Formed Organizations 4. Blanket Waiver of Subrogation 15. Non-Owned Aircraft 5. Bodily Injury Redefined- Mental Anguish 16. Non-Owned Watercraft 6. Broadened Named Insured 17. Personal and Advertising Injury 7. Broadened Property Damage 18. Product Recall Expense o Borrowed Equipment 19. Supplementary Payments Increased Limits o Customers' Goods o Use of Elevators 1. ADDITIONAL INSURED-BROAD FORM VENDORS Section II-Who Is An Insured is amended to include as an additional insured any person(s)or organization(s) (referred to below as vendor)with whom you agreed in a written contract or agreement to provide insurance, but only with respect to"bodily injury"or"property damage"arising out of"your products"which are distributed or sold in the regular course of the vendor's business, subject to the following additional exclusions: a. This provision 1 .does not apply to: (1) "Bodily injury"or"property damage"for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement.This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; (2) Any express warranty not authorized by you; (3) Any physical or chemical change in the product made intentionally by the vendor; (4) Repackaging, except when unpacked solely for the purpose of inspection, demonstration,testing or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; (5) Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; (6) Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; (7) Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or VCG 207 11 13 Includes copyrighted material of Insurance Services Office,Inc. Page 1 of 8 Copyright,OneBeacon Insurance Group LLC E-INSURED (8) "Bodily injury'or"property damage"arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However,this exclusion does not apply to: (a) The exceptions contained in Subparagraphs 4.or 6.; or (b) Such inspections,adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. (9) Any vendor, person or organization if the"products-completed operations hazard" is excluded either by the provisions of the Coverage Form or by endorsement. b. This insurance does not apply to any insured person or organization,from whom you have acquired such products,or any ingredient, part or container, entering into, accompanying or containing such products. 2. ADDITIONAL INSURED—CONTRACT,AGREEMENT OR PERMIT a. Section II-Who Is An Insured is amended to include as an additional insured any person(s)or organization(s)with whom you agreed in a written contract,written agreement or permit to provide insurance such as is afforded under this Coverage Part: 1. with respect to liability for"bodily injury", "property damage"or"personal and advertising injury"caused, in whole or in part,by your acts or omissions or the acts or omissions of those acting on your behalf: (a) In the performance of"your work"for the additional insured(s)at the location designated in the contract, agreement or permit; or (b) In the maintenance, operation or use of equipment leased to you by such person(s)or organization(s), or (c) In connection with premises you own, rent, lease or occupy. 2. with respect to liability for"bodily injury"or"property damage"caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf and occurring after: (a) All work on the project(other than service, maintenance or repairs)to be performed by or on behalf of the additional insured at the site of the covered operations has been completed; or (b) That portion of"your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as part of the same project. This insurance applies on a primary or primary and non-contributory basis if that is required in writing by the contract, agreement or permit. b. The insurance provided to the additional insured herein is limited.This insurance does not apply: 1. Unless (a) the written contract, agreement or permit is currently in effect or becomes effective during the term of this policy; and (b) the contract or agreement was executed or permit issued prior to the"bodily injury","property damage",or"personal and advertising injury"; 2. To any person or organization included as an insured under the Additional Insured-Broad Form Vendors provision of this endorsement; 3. To any person or organization included as an insured by an endorsement issued by us and made part of this Coverage Part; 4. To any person or organization if the"bodily injury", "property damage", or"personal and advertising injury"arises out of the rendering of or failure to render any professional architectural,engineering or surveying services by or for you including: (a) The preparing, approving, or failing to prepare or approve, maps, shop drawings,opinions, reports, surveys,field orders,change orders or drawings and specifications; or (b) Supervisory, inspection,architectural or engineering activities. VCG 20711 13 Includes copyrighted material of Insurance Services Office,Inc. Page 2 of 8 Copyright,OneBeacon Insurance Group LLC