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PROOF OF INSURANCE (2019 - 2020) CLOSED CERTIFICATE OF LIABILITY INSURANCE ""' 1101/1.111/V ' crx „, 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 holderis 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 VA' 'ACTInc. FAX Aon Risk services Northeast, 866-2B3-7122 Aon Risk Services Northeast, Inc. HJxtl Ni .0800} 363-0105.... f_,NY NY office ILO One Liberty PlazaRESS: 2 165 Broadway, Suite 3201 INSURER(S)AFFORDING COVERAGE NAIL# New York NY 10006 USA INSURED INSURERA: Hartford Fire insurance co. 19682 EMG (INSURER B: Allianz Global Risks US Insurance CO, 35300 10461 Mill Run circle, Suite 1100 Owings Mills MD 21117 USA _INSURER C: INSURER D: I ............................m. ....._ .. INSURER E, INSURER F: COVERAGES CERTIFICATE NUMBER: 570074699459 REVISION NUMBER: THIS 113 TO CERTIFY THAT THE P'O'LICIES OF INSURANCE'LIST'ED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHE POLICY PERIOD INDICATED NOT'WITHST"ANDING ANY REQUIRE'ME;N'T,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT'WITH RESPECT'TO'WHICH THIS CERTIFICATE: MAY BE ISSUED OR MAY PERTAIN, THE. INSURANCE AFF'O'RDED BY THE:. POI'..ICIES DESCRIBED HEREIN PS SI.MJECT TO AI..L,"l'HE,TERM'S, EXCLUSIONS AND CONDITIONS,OF SUCH POI..ICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED'BY PAID CLAIMS, Limits shown.are as requested IINSR ADDL SUHH POLICY NUMBER POLICY L1°h POLfCY'EMP LIMITS TYPE OF INSURANCE LTR IN'50 M''D . EACH OCCURRENCE $2,000,O00 � X COMCEAIMS-MADEGENERAL X LIQ USLb0159319((CUR Ol/IU lO/201„) 5110112020”"r!�itU ENi EO '...m � PREMISES(Ea ocrun �........ encel S1,000,000 ..... MED EXP(Any one person) $10,000 - PERSONAL&ADV INJURY S2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER GENERAL AGGREGATE _ $2,000,000' p�-X����PRO- � POLICY L FI JECT X LOC PRODUCTS-COMP/OP AGO $2,000,0001 0 OTHER. A 10 AB 541202 01/01/2019 01/01/2020 COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY $2$2,000,000 A05 6„Ea accidenli ,.,.,. .. A X ANYAUTO 10 AB 541203 01/01/2019 01/01/2020 BODILY INJURY(Per person) O Z OWNED SCHEDULED HI BODILY INJURY(Per accident) r — AUTOS ONLYAUTOS PROPERTY DAMAG"""""E HIRED AUTOS _ NON-OWNED v .......... 0 I4LY AUTOS ONLY (Per accident) ,w ;:- t_ X UMBRELLA IAB _ O B usL00163319 01/01/2019 01/01/2020 O X OCCUR EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 EXCESS�C7F ERS CO ABl11ltl:;NIJ CLAIMS-MADE . WORK X RI?:' $10,000 ,...-_ E.L,IEACH ACCIDENT .., ... .....,....... „ PENSATION AND LOTH. EMPLOYERS'LIABILITY ER,,,,, ANY PROPRIETOR/PARTNER I EXECUTIVE N aFFICERIMEMBER EXCLUDED? NIA "'"�""- (Mandatory in NH) �' E,L DISEASE-EA EMPLOYEE If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT B Archit&Eng Prof USF00248019 01/01/2019 01/01/2020 Each claim $1,000,000 SIR applies per policy teras & condi/,ions Aggregate $1,000,000 DESCRIPTION OF OPERATIONS I LOCATION',I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) � The Architects & Engineers policy includes coverage for Professional Liability and contractors Pollution Liability. city of E1 Segundo, its officials and employees are included as Additional insured in accordance with the policy provisions of the General Liability policy, 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. cityof El Segundo AUTHORIZED REPRESENTATIVE Ken Berkman r 350 Main Street ' Al; E1 Segundo CA 90245 USA (� M14 4��c/rf�J�Ia c�oss ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: USL00159319 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 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) Location(s) Of Covered Operations Any owner, lessee or contractor for whom Locations that are listed in the written you are performing operations when you contracts or agreements stated on the left and such owner, lessee or contractor have side of this SCHEDULE. agreed in writing in a contract or agreement that such owner, lessee or contractor should be added as an additional insured on your policy. 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 2. If coverage provided to the additional insured is include as an additional insured the person(s) or required by a contract or agreement, the organization(s) shown in the Schedule, but only insurance afforded to such additional insured with respect to liability for "bodily injury", "property will not be broader than that which you are damage" or "personal and advertising injury" required by the contract or agreement to caused, in whole or in part, by: provide for such additional insured. 1. Your acts or omissions; or 2. The acts or omissions of those acting on your B. With respect to the insurance afforded to these behalf; additional insureds, the following additional in the performance of your ongoing operations for exclusions apply: the additional insured(s) at the location(s) This insurance does not apply to "bodily injury" or designated above. "property damage"occurring after: However: 1. All work, including materials, parts or 1. The insurance afforded to such additional equipment furnished in connection with such insured only applies to the extent permitted by work, on the project (other than service, law; and maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or CG 20 10 04 13 ©Insurance Services Office, Inc., 2012 Page 1 of 2 2. That portion of "your work" out of which the 2. Available under the applicable Limits of injury or damage arises has been put to its Insurance shown in the Declarations; intended use by any person or organization other than another contractor or subcontractor whichever is less. engaged in performing operations for a This endorsement shall not increase the principal as a part of the same project. applicable Limits of Insurance shown in the Declarations. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III—Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or Page 2 of 2 ©Insurance Services Office, Inc., 2012 CG 20 10 0413 POLICY NUMBER: USL00159319 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 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 GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Any owner, lessee or contractor for whom you are Locations that are listed in the written contracts or performing operations when you and such owner, agreements stated on the left side of this SCHEDULE. lessee or contractor have agreed in writing in a contract or agreement that such owner, lessee or contractor should be added as an additional insured on your policy. 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 2. If coverage provided to the additional insured is include as an additional insured the person(s) or required by a contract or agreement, the organization(s) shown in the Schedule, but only insurance afforded to such additional insured will with respect to liability for "bodily injury" or not be broader than that which you are required "property damage" caused, in whole or in part, by by the contract or agreement to provide for such "your work" at the location designated and additional insured. described in the Schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Pagel of 2 B. With respect to the insurance afforded to these additional insureds, the following is added to Section III—Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 ©ISO Properties, Inc., 2004 CG 20 37 07 04 ❑ 1`� 0 DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE a 01/04/2019 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 1-617-391-0245 CONTACT NAME Green Insurance Exchange, LLC PHONE o Etrt) FAX,Nop C-MAIL 15 Broad Street AD,PRFSS:, Suite 200 INSURER(S)AFFORDING COVERAGE NAIC# Boston , MA 02109 INSURER A: NAUTILUS INS CO 17370 INSURED INSURER B: GREAT DIVIDE INS CO 25224 Clampett Industries, LLC dba INSURER EMG : 10461 Mill Run Circle, Suite 1100 INSURER D, INSURER E: Owings Mills, MD 21117 INSURER F: COVERAGES CERTIFICATE NUMBER: 55062943 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. INSR AODL SUSR POLICY EFF POLICY EXP TYPE OF INSURANCE LTR INSD WVn POLICY NUMBER (MMI00/YYYY1 (MMIDDNYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO rqr N'f Eb CLAIMS-MADE OCCUR PREMISES i;Ea mc'ur;renu q,) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 'RO" PRODUCTS-COMP/OP AGG $ I't'JI.IICY JECT I � I�,tL „ PD'T'IMf2A AUTOMOBILE LIABILITY (:(?I!MWNFC)SINQLE LIBI"I'T' YT Ira arvdent) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PRCPEk°CY DAMAGE $ „AUTOS ONLY AUTOS ONLY (PEP acu:,duwlt) $ UMBRELLA LIAROCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A AND EMPLOYERS'LIABILITY WORKERS COMPENSATION WCA2012615-15 (AZ) 09/03/18 09/03/19 X ,PER H- TIJ7F EOR H ANYPROPRIETORIPARTNER/EXECUTIVE 'YIN WCA2012614-15 (AOS) 09/03/18 09/03/19 E EACH ACCIDENT $ 1,000,000 OFFICERIMEMBEREXCLUDED7 N NIA (Mandatoryin NH) E DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Waiver of subrogation as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street AUTHORIZED REPRESENTATIVE E1 Segundo, CA 90245 AG— //�� USA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD MWing 55062943 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 04 84 WAIVERF 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 Any Principal wherein such waiver has been included before loss as part of a contractual undertaking by the Named Insured. Any person or organization for which the employer has agreed by written contract, executed prior to loss, may execute a waiver of subrogation. However, for purposes of work performed by the employer in Missouri, this waiver of subrogation does not apply to any construction group of classifications as designated by the waiver of right to recover from others (subrogation) rule in our manual. WC 00 03 13 04 84 © 1983 National Council on Compensation Insurance Page 1 of 7