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PROOF OF INSURANCE (2019) CLOSED Page 1 of 2 PIG" DATE(MMIDD/YYYY) C" CERTIFICATE OF LIABILITY INSURANCE 09/2,/2018 11i I 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 NAME; Willis of Massachusetts, Inc. PHONEFAX (A]C,No,Ext): 1-877-995-7378 (A/C,No): 1-888-967-2378 c/o 26 Century Blvd EMAIL P.O. Box 305191 ADDRESScertificates@willis.com Nashville, TN 372305191 USA INSURERS)AFFORDING COVERAGE NAIC# INSURERA: ACE American Insurance Company 22667 INSURED INSURER B: Indemnity Insurance Company of North Ameri 43575 UniFirst Corporation and its Subsidiaries 68 Jonspin Road INSURER C: ACE Fire Underwriters Insurance Company 2,0702 Wilmington, MA 018871086 INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER:W8216781 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, IN R TYPE OF INSURANCE ADOL'SUSR' POLICY EFF POLICY EXP INSD WVD POLICY NUMBER (MM/DD/YYYY) YMMOWYYYY'1 LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000 DAMAGE TO REN'T'ED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) S 1,000,000 A MEI}EAP PAny one person) S 5,000', y y HDOG7120909A 10/01/2018 10/01/2019' PERSONAL BADV INJURY S 1,000,0001 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POIJCY ' dJl RO•C,T X LOC PRODUCTS-COMP/OP AGO S 2,000,00011 I OT FNEV? $ AUTOMOBILE LIABILITY C)41NN'ED SINGLE LIMIT S 2,000,000 (En,,jot,dw,t). X ANY AUTO BODILY INJURY(Per person) S A OWNED SCHEDULED y y ISAH25271750 10/01/2018 10/01/2019 BODILY INJURY(Per accidenq S AUTOS ONLY AUTOS . HIRED NON-OWNED PROPERTY DAMAGE ATOS ONLY ATO NLY (pxer mt,dtV) S $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ S WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y?N B OF ICER/MEM� REXCLLU RIE7 ECUTIVE '"',;""� N/A y WLRC65434507 (AOS) 10/01/2018 10/01/2019 EL EACH AICCIDENT TE ER ., ,� 1,000,0001 (Mandatory in NH) E .DISEASE-EA EMPLOYEE S If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ A Workers Compensation and y WLRC65434465 (AZ, CA) 10/01/2018 10/01/2019 EL Each Accident $1,000,000 Employers Liability EL Disease - Limit $1,000,000 Per Statute EL Disease - Each Emp$1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Division/Location: 324 Certificate Holder is an Additional Insured for General Liability and Auto Liability as their interest may appear if required by written contract but only with respect to liability arising out of operations of the Named Insured. SEE ATTACHED CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of El Segundo AUTHORIZED REPRESENTATIVE Attn: City Clerk City Clerk's Office, 350'Main Street Room 5 El Segundo, CA 90245-3813 ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SR Io: 16800246 aATcR: 885500 AGENCY CUSTOMER ID: LOC#: ADDITIONAL REMARKS SCHEDULE Page 2 Of 2 .............. AGENCY NAMED INSURED Willis of Massachusetts, Inc, UniFirst Corporation and its Subsidiaries .......... 68 Jonspin Road POLICY NUMBER Wilmington, MA 018871086 See Page 1 CARRIER NAIC CODE ...................... ........... See Page 1 See Page 1 EFFECTIVE DATE: See Page 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE, S2r��ficate of Liability Insurance It is understood and agreed that the Company waives its right of subrogation against the Additional Insured which may arise by reason of a payment of claim under all the policies, if required by written contract and as permitted by law. Additional Insureds: City of El Segundo, its officials, and employees, General Liability policy shall be Primary and Non-contributory with any other insurance in force for or which may be purchased by Additional Insured's. INSURER AFFORDING COVERAGE: ACE American Insurance Company NAIC#: 22667 POLICY NUMBER: WCUC65434581 (MA, ME, OH) EFF DATE: 10/01/2018 EXP DATE: 10/01/2019 SUBROGATION WAIVED: Y TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Workers Compensation and EL Each Accident $1,000,000 Employers Liability EL Disease - Limit $1,000,000 Per Statute EL Disease - Each Emp $1,000,000 INSURER AFFORDING COVERAGE: ACE Fire Underwriters Insurance Company NAIC#: 20702 POLICY NUMBER: SCFC65434544 (WI) EFF DATE: 10/01/2018 EXP DATE: 10/01/2019 SUBROGATION WAIVED: Y TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Workers Compensation and EL Each Accident $1,000,000 Employers Liability EL Disease - Limit $lf000f000 Per Statute EL Disease - Each Emp $1400f000 ACORD 101 (2008/01) 2008 ACORD CORPORATION. All rights reserved, The ACORD name and logo are registered marks of ACORD SR ID: 16800246 BATCH: 885500 CERT: W8216781 POLICY NUMBER: HDO G7120909A COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL I SU - DESIGNATED 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): Any person or organization whom you have agreed to include as an additional insured under a written contract, provided such contract was executed prior to the date of 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", "property If coverage provided to the additional insured is damage or personal and advertising injuryrequired by a contract or agreement, the most we caused, in whole or in part, by your acts or will pay on behalf of the additional insured is the omissions or the acts or omissions of those acting amount of insurance: on your behalf: 1. In the performance of your ongoing operations; 1. Required by the contract or agreement; or or 2. Available under the applicable Limits of 2. In connection with your premises owned by or Insurance shown in the Declarations; rented to you. whichever is less. However: This endorsement shall not increase the 1. The insurance afforded to such additional applicable Limits of Insurance shown in the Declarations. insured only applies to the extent permitted by law; and 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 26 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1 Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number .,_,_ Un'if'irst Cororation 68 Jon pin d, Policy Number Wilmington, IU'IA,01887 Srmbol:WLR Number:C65434465 Policy Period Effective Date of Endorsement 10/01/2018 TO 10/01/2019 110/01/2018 Issued By(Name of Insurance Company) ACE AMERICAN INSURANCE COMPANY Insert the policy number.The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. We have the right to recover our payments from anyone liable for an injury covered by this policy. We wil not enforce our right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Schedule 1. ( ) Specific Waiver Name of person or organization: (X) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: ALL OPERATIONS CONDUCTED BY AN INSURED PURSUANT TO SUCH WRITTEN CONTRACT 3. Premium: The premium charge for this endorsement shall be 2.0 percent of the California premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Minimum Premium:INCLUDED WC 99 03 22