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PROOF OF INSURANCE (2019) CLOSED
u1 DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 9121/2018 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 ' OW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED RESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. .,ORTANT: It the certificate holder is an ADDITIONAL INSURED, the policy(fes) must 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 C0 ACT NAME. Palmer&Cay, LLC PHONE FAX 22 Barnard Street �,n * �tl ...... . .....�'.com.. to P'.NPf Suite 200 -APP � f�i��01nr:r�`1z . .... ......... ..___ w _._....ww.... ........ Savannah GA 31401 INSURER(S)AFFORDING COVERAGE NAIL k P. _y 1991 �NSu13ER,A,:_National C,asua��yITCom an _....m.,........,.__. . �................__,_...._ INSURED 153 INSURER B:Scottsdale Insurance Company 15580 Girl Scouts of Greater Los Angeles 801 S. Grand Avenue Suite 300 INSURER D Los Angeles CA 90017-4621 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:811490505 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BEI.OW 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 ADDL SUBR' POLICY EFF POLICY EXP TYPE OF INSURANCE PM,M'DD1yYyI LIMITS LTR INSo i WyD POLICY NUMB lMM/DD/YYYY1 A X COMMERCIAL GENERAL LIABILITY Y Y KK122370700 10/1/2018 10/1/2019 EACH OCCURRENCE $1.000.000 CLAIMS-MADE X OCCUR DAMAGE TO RENTEDPREMISES_(Ea nccuuence)_,„- 1,000,000_____ _ MED EXP(Any one person) $10.000 PERSONAL R ADV INJURY $1 000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $5.000.000 X POLICY�_1 ,JE T LOC PRODUCTS-COMPIOP AGG $5,000,000 X TOMOBILE LIABILITY KK122370800 10/112018 10/112019 UI�1BINtC1 SINGLE LIMIT Ee✓mr:r•rc,onru�_- _.w_.-------,_ 1 000000_ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident $ x NON-OWNED PROPERTY DAMAGE HIRED AUTOS X,,,,,,; AUTOS (Per acrident) $75.000 $ UMBRELLA LIAB i OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEC) .,...... „I RETENTION$ $ A WORKERS COMPENSATION WCC330962B 10/1/2018 10/1/2019 X PER'q.tl b F OTnH. AND EMPLOYERS'LIABILITY ANY PROPRIETORrPARTNER%EXECUTIVE Y 1 C.L.EACH,U,' $1.000,000 OFFICERWEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYLL S 1,000,000 If yes,describe under .rw.._N, .. .....m......:........ ...-...D,1s.ASE POLICY..L.IMIT. ....1.000.000 DESCRIPTION OF OPERATIONS below E.L.DISEASE i DESCRIPTION OF OPERATIONS 1 LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) The City of EI Sogaundo,its offic(as.officials,employees,agents and volunteers are named additional insured on the general liability policy with respect to the use of its pve:rl kes for Girl Scout activities of the insured Girl Scout Council.Should any of the above described policies be cancelled before the expiration date thereof,the issuintt company will rnwl 30 days written notice to the certificate holder named below. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of EI Segundo, its Officers, employees, agents ACCORDANCE WITH THE POLICY PROVISIONS. and volunteers 339 Sheldon Street AUTHORIZED REPRESENTATIVE EI Segundo CA 90245 ©1986-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: KK122370700 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. A A 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 of EI Segundo, its officers, employees, agents and volunteers 339 Sheldon Street EI Segundo CA 90245 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to in- clude as an additional insured the person(s) or organi- zations) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omis- sions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 © ISO Properties, Inc., 2004 Page 1 of 1