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PROOF OF INSURANCE (2019 - 2020) CLOSED Client#:294228 IXPCOR ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 2/07/2019 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT .. NAME'. USI Insurance Services LLC PHONEFAX AFC,.,44.E'iy:484 351-4600 ..Irc ); 610 537-4974 1787 Sentry Pkwy W.,Veva 16 LMA L ADDRESS; Suite 300 _ INSURER(S)AFFORDING COVERAGE NAIC# Blue Bell, PA 19422 INSURER A: Aaaocialadindustries ins CoInc 2.3.1.40....................... INSURED INSURER B:SlarStone National Insurance Company 25496 IXP Corporation Travelers Commercial Insurance Company 36137 INSURER C: P Y Princeton Forrestal Village, INSURER D'Liberty I Union Fire Ins Pittsburgh,PA 19445 103 Main Street Suite 100 INSURER E: Y 19917 National insurance Underwriters,Inc Princeton, NJ 08540 INSURER F: COVERAGES CERTIFICATE NUMBER: 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 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. LTRR TYPE OF INSURANCE ADOL SUSR POLICY EFF POLICY'EXP LIMITS IN$R WVD POLICY NUMBER (MMIDD/YYYY),(MMIDD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $,1,t00Q 000 _--- CLAIMS-MADE X,I OCCUR 'aYWAfyi i 1,RENTED -� ...... A X AES103569104 08131/2018 08/31/2019 MA,NI I(Any one peE_Hi LE21LQqEL1 rson) $100,000 ED PERSONAL&ADV INJURY $1,000,000 GEN LIYG ....... GENERAL AGGREGATE $2,000,000 PRO- POLICY XI JECT LOC PRODUCTS-COMP/OPAGG $2,000,000 OTHER: ,$ A AUTOMOBILE LIABILITY AES103569104 08/31/2018 SINGLE LIMIT $1,000,000$ 08131/2019(Eaa dni) NE ( ANY AUTO f INJURY(Per person) OWNED SCHEDULED 11 HIRED IX NON-OWNED AUTOS ONLY AUTOS BO 11 Y11 11 e $ AUTOS ONLY I�frerJoc IAS to /hJAG�k X AUTOS ONLY accidanl)...$............................... B UMBRELLA LIAB OCCUR 59184D183ALI 08/31/2018 08/31/2019 EACH OCCURRENCE $5,000,000,,, X EXCESS LAB X CLAIMS-MADE AGGREGATE $5x000,000 DED IX;RETENTION SQ $ C WORKERS COMPENSATION UB003K766849 01/01/2019'01/01/2020 X /PERN I UTE OTH_' AND EMPLOYERS'LIABILITYER ANY PROPRIETOR/PARTNER/EXECUTIVE' '/ EL EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N NIA (Mandatory in NH) E DISEASE-EA EMPLOYEE,$1,000/00.0_ If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $1,000,000 D Professional 18336672 08/31/2018 08131/2019 $5,000,000 E Excess Liab- E04NAAS4JW007 08/31/2018 08/31/2019 $5,000,000 Excess DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Liability policies will be endorsed to name CITY,its officials,and employees as additional insureds under said insurance coverage and to state that such insurance will be deemed primary such that any other insurance that may be carried by CITY will be excess thereto.Such endorsement must be reflected on ISO Form No.CG 20 10 11 85 or 88,or equivalent. For purposes of this Agreement,equivalent insurance includes Form CG 20 10 04 13 and CG 20 37 04 13. (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION I EI Se undo Police De artment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE g p THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attention: Jaime Bermudez, Lieutenant ACCORDANCE WITH THE POLICY PROVISIONS. 348 Main St. EI Segundo,CA 90245 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD #S24900855/M24603288 SACCR DESCRIPTIONS (Continued from Page 1) The Workers Compensation policy includes a Waiver of Subrogation in favor of Certificate holder when required by written contract. i SAGITTA 25.3(2016/03) 2 Of 2 #S24900855/M24603288 POLICY NUMBER:AES1035691 04 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED ESSO O 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 All persons or organizations where required by written contract with the Named Insured 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 additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" property damage"occurring after: caused, in whole or in part, by: 1. All work, including materials, parts or 1. Your acts or omissions;or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed;or However: 2. That portion of "your work" out of which the 1. The insurance afforded to such additional injury or damage arises has been put to its intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. 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 10 04 13 ©Insurance Services Office, Inc., 2012 Page 1 of 2 This page has been left blank intentionally, TRAVELERSJWORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 00 03 13(00)- 001 POLICY NUMBER: UB-3K766849-18-43-G 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 any one not named in the Schedule. SCHEDULE DESIGNATED PERSON: DESIGNATED ORGANIZATION: ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. DATE OF ISSUE: 12-15-17 ST ASSIGN: PAGE 1 OF