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PROOF OF INSURANCE (2019 - 2019) CLOSED ,AC"REX CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DD/YYYY) `� 6/19/2019 1 12/4/2018 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). PRODUCERCO TALI Loddon Ir1SUrarloe Brokers,LLC fVE 725 SflE21,35th R. FAX (A/C,Np,Ext): I WC,NoY; CALL MF15767 EMAIL LOS higeles CASIM17 ADDRESS. (213)689-0065 INSURER(§JJ�EEORDING COVERAGE MAIC x INSURER A: Atlantic Specialty Insurance Company 27154 INSURED R-CsuM Irlc. I INSURER B: IIiScox Insurance Companv,Inc. 10200 1302737 2201 Park R.,Ste.102 I INSURER c; Federal Insurance Comnanv 20281 El SegurxJo CA 90245 ��NSURER INSURER O ENSURER F COVERAGES PROS11()I CERTIFICATE NUMBER. 29 11)78 REVISION NUMBER; XXXXXXX 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. I ASR ADDL .0/BR POLICY EFF POLICY EXP TYPE OF INSURANCE dN POLICY NUMBER IMMMDIYYYYI./AgMq,IDO,ryryYYa LIMITS COMMERCIAL GENERAL LIABILITY Y N 7110082470012 6/19/2018 6/19/2019 EACH OCCURRENCE S 1,000,000 I CLAIMS-MADEFIX OCCUR IPIREMFaES(Enoc Impnool $ 1,000,000 (MED EXP(Any one person) $ 10,000 Er (PERSONAL 8 ADV INJURY $ 1,006.000 GEN'L AGGREGATE LIMIT APPLIES PER: (GENERAL AGGREGATE $ 2.600,000 u - I 9POLICYF—]JPROECT LOC (PRODUCTS-COMP/pP AGG $ 2,000,000 OTHER: $ I - �, AuromoBlLE LIABILITY N N 7110082470012 6/19/2018 6/19/2019 [Ce,tJcr aN p sN'GL n(MIT $ 1,000,000 ANY AUTO IBODILY INJURY(Per person) $ XXXXXXX OWNED SCHEDULED AUTOS ONLY AUTOS IBODILYINJURY(Per accidenl $ XXXXXXX HIRED NON-OWNED PROPERTY DAMAGE, ' AUTOS ONLY AUTOS ONLY P'Pr nf,identl, $ XXXXXXX Comp/Coll Ded $ 1.000 A X UMBRELLALIAB NCLAIMS•NAADE OCCUR N N 7110082470012 6/19/2018 6/19/2019 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB (AGGREGATE $ 5,000,000 DED I_ I RETENTION$ $ XXXXXXX WORKERS COMPENSATION PER OTH- '`� AND EMPLOYERS'LIABILITY Y I N Y 4060321310009 12/31/2018 12/31/2019 X STATUTE ISR ANY PROPRIETOR/PARTNER/EXECUTIVE N/A ( !E,L,EACH ACCIDENT $ 1.000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E,L,DISEASE-EA EMPLOYEE s 1.000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L-DISEASE-POLICY LIMIT 2 1.000,000 B Cyber N N 227318518 6/19/2018 6/19/2019 $5,000,000 Each%Vrol �ful Act Teclwology Prof Liab $5,000,000 Lim 52W I'et. C 3rd Party Crime 8242-9026 6/19/2018 6/19/2019 $3,000,000LiniiSddlKPet. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The City,its officers,officials,employees,agents,and volunlcel.s are an Additional Insured to the extent provided by the policy Ian+LHIgO,or endorsement issucd or approved by the insurance carrier.Waiver of Subrogation applies to the worker's compensation. 30 Day Notice of CameVldtlion applies per attached endorsement. CERTIFICATE HOLDER CANCE'L'LATION See Attacllrimits SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 2911.178 AUTHORIZED REPRESENTATIVE Oty Of CI Seguncb Oty Oer°k Altn: Actrnristrative Swkes 350 PMn St at 1;bm 5 EI SegurYJO CA 9LY24,5 ACORD 25(2016/03) ©17 ll rights reserved The ACORD name and logo are registered marks of ACORD Attachment Code :D498109 Certificate ID :2911178 POLICY NUMBER: 7110082470012 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -DESIGNATED 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): The City, its officers, officials, employees, agents, and volunteers, 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 Section III - organization(s)shown in the Schedule, but only with Limits Of Insurance: respect to liability for"bodily injury", "property damage" or"personal and advertising injury"caused, in whole or If coverage provided to the additional insured is required in part, by your acts or omissions or the acts or by a contract or agreement,the most we will pay on omissions of those acting on your behalf: behalf of the additional insured is the amount of insurance: 1. In the performance of your ongoing operations; or = 1. Required by the contract or agreement;or 2. In connection with your premises owned by or rented to you. 2.Available under the applicable Limits of Insurance shown in the Declarations; However: whichever is less. 1.The insurance afforded to such additional insured only applies to the extent permitted by law;and This endorsement shall not increase the applicable 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 26 04 13 ©Insurance Services Office, Inc.,2012 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be % of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization job Description WHERE REQUIRED BY WRITTEN CONTRACT All Operations WC 04 03 06 (Ed.4-84) 9MM Attachment Code:D492298 Certificate ID : 2911178 Attachment Code:D463006 Certificate ID:2911178 June 20, 2018 City of EI Segundo City Clerk Attn: Administrative Services 350 Main Street, Room 5 EI Segundo, CA 90245 Re: Notice of Cancellation Clause To Whom It May Concern: As a service to our valued client, Lockton will provide at least thirty (30) days notice of cancellation to the certificate holder listed on the attached Acord 25 certificate of insurance should any of the policies described on the attached certificate be 1) cancelled by the insurer, other than for non-payment of premium (10 day notice for non-payment/non-reporting), and 2) cancelled more than 30 days prior to the expiration date of the policy (if such cancellation occurs less than 30 days prior to expiration, Lockton will provide as much prior notice as practicable). If notice is mailed, proof of mailing notice to the certificate holder to the postal mailing address as shown in the schedule will be sufficient proof of notice. Thank you and please contact our office if you have any questions. Regards, David Burgos Assistant Vice President Lockton Insurance Brokers