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PROOF OF INSURANCE (2019) CLOSED DATE(Mmn)DffYYY) CERTIFICATE OF LIABILITY INSURANCE 10130/2018 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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSt#tED,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 Marsh USA InaNAM?j -- 1166 Avenue of the Americas _lAdONE .t..fAuC•Not. New York,NY 10036 EMAIL Attn:NewYork.Certs@marsh.corn Fax:212-948-0500 ' yy MSURERISI AFFORDING COVERAGE I, NAIC iI INSURER A: mpo Toanny „........._mINrINSURER B: kb MAmerica Insurance Company 10945Caron$duhOn$America,Ina V 425 N.Martingale Rem,Suite 1700 i�(,su�E�c,;Snm, Amenca Flee 8 Monne Inspran�C.omPany r „38997 Schaumburg,IL 60173 INSURER D: INSURER E: ry INSURER F: q COVERAGES CERTIFICATE NUMBER: NYG009352820-24 RE'VISI'ON 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. �OiSdyLTR A� POLICY NUMBER ....lMMIDDY EFF �'ymriam EXF TYPE OF INSURANCE srz dYYYY) (NAMBrIDrf"'y'A"'y1 LIMITS B X COMMERCIAL GENERAL LIABILITY CLL6404741-08 11/0112018 1110112019 EACH OCCURRENCE $ 1,000,000 UAhSACe YCRa"ICU -, a $ 1, 0,000 CLAIMS-MADE X OCCUR PRS,M,,�tl�SE'^�,.�FFrd�c�'�wrrrfr:rp.,.., .,. MED EXP(Any one person) $ 5,000 _ PERSONAL B ADV INJURY S —1'�'� GEN'L AGGREGATE LIM.................,,,,,,,, `.,,,,,,,,� ....,.,.,..........�....�...._..... ......,..,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,................,.,.,...... IT APPLNES PER: GENERAL AGGREGATE $ 2,000,000 ^ ,POLICY❑JECT PRO-- L_:.:.!I LOC PRODUCTS-COMPIOPAGG $ 1,OD0,000 ...�.�.......�.......,,m.__...,-., OTHER d $ A uroMOBILEUAB1uTr FrA40003D0(AOS) 111011°2018 11/01/2019o arc N?l............... $ 1,000,000 A XANY AUTO ACV40995RD(MA) 1110112018 1110112019 BLDILIYS UR(Per person') $ �.A ..... NED ("".._ ..,!.ODIC PROPERTY E _$.......,m,m,.......... ............ AUTOS ONLY AUTOS IRED 6 OS ONLY A6 0 o LD COMP/C'49OLLIDED Graccdent $ ___............ 11 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR IMS-MADE AGGREGATE $ ....,_......_._..,_. ...._._ .....,.. DEC) RETENTIONS $ C WORKERS COMPENSATION JCD4001%RO 11)0112018 1110112079PER I OTH- AND EMPLOYERS'IJABILITY X (STATUTEP'""""""'"........_...._._..._ 1,000,000 YINANYPROPRIE7ORIPARTNERIEXECUTIVE �� qE L EACH ACCIDENT $ OFFICER)MEMBER EXCLUDED? I P NIA (Mandatory in NH) ""'ryE,L,DISEASE-EA EMPLOYEE $ ........ ............ ......................... ............................... ................................._ If yes,dinzAbo under 1 Q00 0GO DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I 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'compensalion)where required by written contract This insurance is primary and non-conlributory over any exisling insurance and limited to liability arising out of the operations of the named insured and where required by written contract. Waiver of subrogation is applicable where required by wriden contract. CERTIFICATE HOLDER CANCELLATION City of EI Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 350 Main Sheet THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN EI Segundo,CA 90245 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. I William Mollica ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: CLL6404741-08 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY., PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON O 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 0 Insurance Services Office, Inc., 2012 Pagel 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 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 0 Insurance Services Office, Inc., 2012 CG 20 10 0413 POLICY NUMBER: CLL6404741-08 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 ollowing:COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional 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 COMMERCIAL GENERAL LIABILITY CG 20 01 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABfLITY 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 CG 20 0104 13 ©Insurance Services Office, Inc., 2012 Page 1 of 1 Company Copy 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: 11/1/2018 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: 11/01/18 Policy No JCD40017RO Endorsement No Insured: CANON U.S A, INC Premium: INCL Insurance Company: Sompo America Fire&Marine Insurance Companv Countersigned by WC 00 03 13 (Ed. 4-84) ©1983 National Council on Compensation Insurance.