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PROOF OF INSURANCE (2019 - 2019) CLOSED 'R...J'/"L0 � DATE(MMIDD ) r,,, L...dr CERTIFICATE OF LIABILITY INSURANCE 11/06/2018 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 Mary Pojar PHONE OO West lstSteSuiteB 'Ett,IL ma7.1@........ fX N r�E: ........ Y Dunlap Agency )AIC No,Ext): 838-3158 NoT: (714 922-6157 ADDRESS ry dunlapins com _._..... INSURERS)AFFORDING COVERAGE NAIC# Tustin CA 92780 INSURERA:: Sintlnel Insurance Cc 11000 ....._................... _W W Wv .................. ......................................... INSURED INSURER B: Preferred Employers Ins Co 10900 Matrix Imaging Products,Inc INSURER C: Lloyds of London AA1122000 20512 Crescent Bay, INSURER D ................... ............... Suite 100 INSURER E Lake Forest CA 92630 INSURER F COVERAGES CERTIFICATE NUMBER: 2018-2019 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 MAYBE 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 TYPE OF INSURANCE POLICY NUMBER _ rcEXF •••••••••• •• ILT R COMMERCIAL GENERAL LIABILITY D.DL S4.VtaMd POLICY EFF POLICY •� I• LIMITS .........•_...... .. . LTR •••••••••••••••••••••• NSD V+ND (MMIDDIYYYY) MMIDD/YYYY EACH OCCURRENCE _ 3 1,000,000 DAMAGE 1°0 REN 1"EIJ_ 1,000,000 CLAIMS-MADE ❑OCCUR PREMISES fEa occurrence) 5 . .�.�......_......................... MED EXP fA.ny one person) s 10,000 A 72SBABD3913 10/17/2018 10/1712019 � 1000000 PERSONAL&ADV INJURY S ' GEITLAGGREGATE I MM F Al 1"I IIS PI:R GENERALAGGREGATE s 2 000 000 R,r2,000,000 POLICY .YEOT CTC: PRODUCTS-COPrhPIOP AGG 3 OTHER: Employee Benefits S 1.000,000 1. A.11 UTOMOBILE LIABILITY COMB+NEID SINGLE LWIT g 1,000,000 _ fE saccidr)nti „ ANYAUTO BODILY INJURY(Per person) 5 A OWNEDOSONLY SCHEDULED 72SBABD3913 DX 10/17/2018 10/17/2019 BODILY INJURY(Per accident) S AUTAUTOS X��,,,,r++� HIRED +w,� NON-OWNED C'Ctt-?4.,G..Ii'tt't DAtr(IFtGI.:. 9i AUTOS ONLY ^''�!^ AUTOS ONLY F+.,i zrcco-dentV X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 4,000,000 A EXCESS LAB CLAIMS-MADE 72 SBABD3913 10/17/2018 10/17/2019 AGGREGATE S 4,000,000 WORKERS COMPENSATION XI RETi d�lDON S 10,000 s ......... _____....... ......._�. .. PER O'C'H- ... �. AND EMPLOYERS' PLOYS S'EIILIT X STATUTE ER ABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT S 1,000,000 B EXCLUDED NIA N157011-5 12/01/2018 12/01/2019 •-•—• ---- (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 S 1,000,000 Deductible:$1,000 $1,000,000 Professional Liaility C Network Security MPL-0000265-01 06/17/2018 06/17/2019 Deductible:$1,000 $250,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The City of EI Segundo,its officials,and employees are named as additonal insured Insurance on the Certificate Is Primary. Thirty(30)days notice of Cancellation required CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of EI Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main St AUTHORIZED REPRESENTATIVE r� EI Segundo CA 90245 )�(� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD MATRIX IMAGING PRODUCTS, INC POLICY NUMBER: 72SBABD3913 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED-OWNERS, LESSEES OR CONTRACTORS (Form B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: The City of EI Segundo, its officials and employees (If no entry appears above, information required to complete this endorsement will be shown in the Declaration as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the schedule, but only with respects to liability arising out of your work preformed for that insured. CG 20 10 07 04 Copyright, Insurance Services Office, Inc. 2004 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 The City El Segundo, Its officials and employees 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:, Policy No. WKN157011 Endorsement No.1 Insured:MATRIX IMAGING PRODUCTS,INC. Premium$0 Insurance Company:Employers Countersigned by Dean Dun4R_., WC 00 03 13 (Ed.4-84) Copyright 1983 National Council on Compensation Insurance,