PROOF OF INSURANCE (2020) CLOSEDACCOR" ® CERTIFICATE OF LIABILITY INSURANCE I DATE/(19/201gYY)
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
NAME:
Arthur J. Gallagher Risk Management Services, Inc. PHONE FAx
2850 Golf Road I (A/C. No. ExtC 630-595-5300 (A/C, No): 630-694-4401
Rolling Meadows IL 60008 I E-MAIL a'
ADDREss: certrequests@ajg.com
INSURER(S) AFFORDING COVERAGE NAIC #
INSURERA: Valley Forge Insurance Company 20508
INSURED CLEOCOM-01 INSURER B: Continental Insurance Company 35289
Cleo Communications Holding, LLC
4949 Harrison Avenue, Ste 200 I INSURER C:
Rockford, IL 61108-7947 I INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 1453653836 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR INSD WVD POLICY NUMBER (MM/DD/YYYYI (MM/DD/YYYYI
A X COMMERCIAL GENERAL LIABILITY 6057103335 6/1/2019 6/1/2020 EACH OCCURRENCE $ 1 000 000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is 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 Street,
EI Segundo CA 90245 AUTHORIZED REPRESENTATIVE
USA
@ 19088-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
DAMAGE TO RENTED
CLAIMS -MADE � OCCUR
PREMISES (Ea occurrence)
$ 100,000
MED EXP (Any one person)
$ 15,000
PERSONAL &ADV INJURY
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
X PRO -
POLICY ❑JECTPRO ❑LOC
PRODUCTS - COMP/OP AGG
$ 2,000,000
OTHER:
$
A AUTOMOBILE LIABILITY 6057103366
6/1/2019 6/1/2020 COMBINED SINGLE LIMIT
fEa accident)
$ 1,000,000
X ANY AUTO
BODILY INJURY (Per person)
$
OWNEDSCHEDULED
BODILY INJURY
$
AUTOS ONLY AUTOS
(Per accident)
HIRED NON -OWNED
PROPERTYDAMAGE
$
AUTOS ONLY AUTOS ONLY
fPer accident)
B X UMBRELLALIAB OCCUR 6057103383
6/1/2019 6/1/2020 EACH OCCURRENCE
$10,000,000
EXCESS LIAB CLAIMS -MADE
H
AGGREGATE
$ 10,000,000
DED I X I RETENTION $ in nnn
$
A WORKERS COMPENSATION 6057103349
6/1/2019 6/1/2020 X I SPER TATUTE EORH
AND EMPLOYERS' LIABILITY
ANYPROPRIETOR/PARTNER/EXECUTIVE Y / N
E.L. EACH ACCIDENT
$ 1,000,000
OFFICER/MEMBER EXCLUDED? [--]N/A
(Mandatory in NH)
E.L. 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 / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is 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 Street,
EI Segundo CA 90245 AUTHORIZED REPRESENTATIVE
USA
@ 19088-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD