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PROOF OF INSURANCE (2019 - 2019) CLOSEDARISINC-02 DELETOURNEAU ACORO� CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY)6/26/2019 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 g this certificate does not confer ri hts to the certificate holder in lieu of such endorsement(s). PRODUCER CppNTACT Denise Letourneau m NA ONE, Erti:..r sY Ste 05 W82601Wyoming Financial nsurance 1011 dletourrl2eau83weres.—cOm.....................................01 (ac_.No,......... 400 E 1 ... _..._........................................................ INSURED Arista Tek, Inc. 710 Garfield Street, #220 Laramie, WY 82070 INSURE N! AFFORDING COVERAGE ......................... NAIC 9 ... ....................._. ........... „I,Ns,U.RER,A.;Admiral Insurance Company 24856 ., J NA!M E.R.A I: ............................ INSURER C INSURER D: INSURER E 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 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, INW l• mXmmITITCOMMERC ADDL SU OLIC XP TYPE OF INSURANCE POLICY NUMBER I IN6a y�la _ eXl(YXa...[00 LIMITS IAL GENERAL LIABILITY; EACH OCGURREN E G S 1,000,000 CLAIMS -MADE X OCCUR FEIECC1648505 7/13/2018 7 ❑. 3.. � ....� DAMAGE TO RENTED PREMISES dE .SacG,4M[ ff i............ _....................................._. . , 50,000 .._...._.................� 5,000 MED ExP (Any ane rsonl...S PERSONAL &ADV, INJURY „S_,,,„,,,,,,,,,,,,,,,....... ,000,000 2,000,000 SEN LA�GGREGA'TELIMITAPPLIESPER: GENERAI,AGGR,E, A,,,,TE.................. — — n .. POLICY ❑I JE LQT LOC $ PRODUCTS - GOMPIOP.AG,G ............................... 2,000,000 I OTHER $ A COMBINED SINGLE LIMIT 1,000,0001 AUTOMOBILE LIABILITY _/F,.e_GF!Q,II,R1 $ ANY AUTO FEIECC1648505 7/13/2018 7/13/2019 „Bc DILY.) JU,RYIT,(,Per„parsan) m, S AUTOSONLY _.. AUTOOSyUyL�EED BODILY INJURY (Per accident,),,,, S„ X.. AUTOS ONLY X... ATOS ONLY PROPERTY OeCEpide t AMAGE ................ .._. $ $ LIA& OCCUR $ EA�......X......... 1,060—,000 EXCESS AB `.�.`.. ..... CLAIMS -MADE FEIEXS2310102 7/13/2018 7/13/2019 O RQCCURRENCS ....._.......� .�...���. �� AGG GATE $ ...... .........__...........__.._... 1,000,000 DED �a RETENTION $ $ _.... _-......... KERS COMPENSATION AND PER OTH- ATU �R ... ... S.u ..............................� ANY PROPREMPLOIET R/PAR NLERIEXECUTIVE Y..L.N.0 I „E_,L�EACHACCIDENT ”"' (TY OFFICER/MEMBEREXCLUDED9 NIA (Mandatory in NH) DISEASE - EA,E,MPLOYEE, .___ If yes, describe under DESCRIPTION OF OPERATIONS belowE L DISEASE - POLICY LIMIT $ A Professional Liabili _.. FEIECC1648505 7/13/2018 7/13/2019 Claim Expense Limit 1,000,000 A Professional Liabili FEIECC1648505 7/13/2018 7/13/2019 Claims Expense Aggr 2,000,000 When required OPERATIONS Ewrittenscot LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mom space is required q y tract or agreement additional insured applies under the General Liability per forms E�C-379-0712. Primary 8 Non contributory additional insured per form ECC -548-0317. Thirty (30) days notice of cancellation applies. Ten (10) days for non payment of premium. Forms attached. CERTIFICATE HOLDER City of EI Segundo Fire Department 314 Main St EI Segundo, CA 90245 P ACORD 25 (2016/03) ►+ . e SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE � �Zlilli(�LLr d�i)t�1J .................... ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AristaTek, Inc.; Albany County Research Corp. Endorsement Number: 16 ima184i �'"rre�vraw Automatic Primary and Non -Contributory Insurance Endorsement Designated Work Or Project(s) This endorsement, effective 7/13/2018 attaches to and forms a part of Policy Number FEI-ECC-16485-05. This endorsement changes the Policy. Please read it carefully. This endorsement modifies insurance provided under the Coverage Part(s) indicated below: COMMERCIAL GENERAL LIABILITY COVERAGE CONTRACTORS POLLUTION LIABILITY COVERAGE SCHEDULE Name of Person or Organization: Any person(s) or organization(s) whom the Named Insured agrees, in a written contract, to provide Primary and/or Non-contributory status of this insurance. However, this status exists only for the project specified in that contract. In consideration of an additional premium of SAvvlied and notwithstanding anything contained in this policy to the contrary, it is hereby agreed that this policy shall be considered primary to any similar insurance held by third parties in respect to work performed by you under any written contractual agreement with such third party. It is further agreed that any other insurance which the person(s) or organization(s) named in the schedule may have is excess and non- contributory to this insurance. ECC -548-0317 AristaTek, Inc.; Albany County Research Corp. Endorsement Number: 5 Automatic Additional Insured - Owners, Lessees or Contractors This endorsement, effective 7/13/2018 attaches to and forms a part of Policy Number FEI-ECC-16485-05. This endorsement changes the Policy. Please read it carefully. In consideration of an additional premium of $Annlied. this endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Any person(s) or organization(s) whom the Named Insured agrees, in a written contract, to name as an additional insured. However, this status exists only for the project specified in that contract. The person or organization shown in this Schedule is included as an insured, but only with respect to that person's or organization's vicarious liability arising out of your ongoing operations performed for that insured. ECC -319-0712 A�' DATE (MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 1 06/25/2019 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 CONbiBERK -P.OTACT NAME: cc A Is.) salessupport@biberk.com pport@biberk.com -FAX c 2 Stamford, 113247 E 06911 ?"'�m� F� ('03) 654-3613 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Berkshire Hathaway Direct Insurance Company 10391 INSURED AristaTek Inc 710 E Garfield St Ste 220 Laramie, WY 82070 INSURER B INSURER C • - INSURER D: ' INSURERE ° I INSURER F: ...........................................................................�� � ���..........,•...................................,.....___ i 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 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, U EXCLUSIONSDODIT10 SUCHPLIMITSSHLCHAVEREDUCED BOF LTR ADDSU POLICYPOLICY � POIYNUMBPMOYYYY� VAT .........................................0 ..... ...LIMIT$c0MMERCI GENERAL ILITY EACH OCCURRENCE ' ................................... CSA(vlA,'iti..(�ENr�D "�E 1. CLAIMS -MADE OCCUR $ 0 PREMISES,(Ea occurrence) 0 MED EXP (Any one person) $ 0 PERSONAL & ADV INJURY $ 0 APPLIES PER: GEN' _ GENERAL ---- _ POLICY LO C POLICY ::] ECT �....... ........................... PRODUCTS COMPAOPAGG $ ........... ..........................________0 OT14E.R�. $ �- AUTOMOBILE LIABILITY f~C�Mt�ur� �� I'ED'SINGLE HPAIT $ ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY HIRED AUTOS NON -OWNED �aP PR "��a;TY DAf»nA�E AUTOS ONLY „ AUTOS ONLY .( LA'f"'c'�dr"r'�I'I $ ................................... IFS' LLA LIAB EL EX OCCUR EACH EACH OCCURRENCE ( LIAB SI Ip� AGGREGATE ,$ DS DIERETENTION$ WORKERS COMPENSATION PER OTH- ILITY STATUTE I X ERANYPROPRIETOR/, YIN„ EMPLOYERS &UDED? C A CIDE H C $1,,,000,000 A OFFFIIC RIMEMBEREXCC N NfA N9WC958374 )9/14/2018 ')9/14/2019 NM (Mandatory in NH)PARTNER/EXECUTIVE E L. DISEASE ETPLOYEE - EA - _$.uQ_Q<QQQ ........ If yes, describe under DESCRIPTION OF OPERATIONS below EL DISEASE- POLICY LIMIT $1,000,000 Professional Liability (Errors & Per Occurrence/ Omissions): Claims -Made Aggregate DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attachetl 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 EI Segundo Fire Department ACCORDANCE WITH THE POLICY PROVISIONS. 314 Main St EI Segundo, CA 90245 AUTHORIZED REPRESENTATIVE. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 26 (2016/03) The ACORD name and logo are registered marks of ACORD