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PROOF OF INSURANCE (2020) CLOSEDtro DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE I 06/18/2019 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(les) 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). CONTACT d PRODUCER .....,.,.., „, NAME: (866) 263-7122 ....("............. — Aon Risk Services Northeast, Inc. PHONEFAX 800) 363-0105 d New York NY Office IABC'. No, Ext): INC, NOAk One Liberty Plaza E-MAIL O 165 Broadway suite 3201 ADDRESS: = New York NY 10006 USA — OWNED "'" SCHEDULED INSURER(S) AFFORDING COVERAGE NAIC # INSURED _ AUTOS ONLY AUTOS INSURER A: National Union Fire Ins Co Of Pittsburgh 19445 Los Anqeles SMSA LP INSURER B: New Hampshire Insurance Company 23841 dba Verizon wireless 1095 Avenue of the Americas INSURER C: AIU Insurance Company . . mWWVWW....m 19399 New York NY 10036 USA INSURER D: American Home Assurance Co. 19380 UMBRELLA LIAB OCCUR INSURER E: Illinois National Insurance Co ........................... 23817 EXCESS LIAB I CLAIMS -MADE Ijl INSURER F: , (AGGREGATE COVERAGES CERTIFICATE NUMBER: 570076833798 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. Limits shown are as requestod'' I T TYPE OF INSURANCE MSd q POLICY NUMBER d, q�wy� yyyy gj,q./yyryy}I LIMITS 06/30/2019106/30/20201 """" ....""""' A X ' COMMERCIAL GENERAL LIABILITY GLb412251 U6/3U/LU1�U 6/3U/2uz61 EACH OCCURRENCE $1,000,000 CLAIMS -MADE II X II OCCUR V a If yes, describe under DESCRIPTION OF OPERATIONS below I DAMAGE TO REN f ED a P N:.._...._I..�...(iEa occurrcincel $1,000,0001 ���............JJJ X XCU Coverage is Included RE: n one person)$10,000: (Any MED EXP A 400 Lomita Street, E1 Segundo, CA 90245, .............................. PERSONAL &ADV INJURY $1,000,00 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $1,000,000' M POLICY PE F—] LOC PRODUCTS -COM,P/O,P,AGG $1,000,000,1 OTHER: A AUTOMOBILE LIABILITY CA 299-19-14 06/30/2019, $1,000,000 AOS 1 lEa a Aden (Ea 0 en ....G A X ANYAUTO CA 299-19-18 06/30/2019, 06/30/2020 Y Per pe.. person) CERTIFICATE HOLDER City of El Segundo 350 Main street E1 Segundo CA 90245 USA ACORD 25 (2016103) CANCELLATION $1,000,000 $1,000,000 $1,000,000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE CC) rn M CQ r 0 O Z r O V d U POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD — OWNED "'" SCHEDULED MA BODILY INJURY (Per accident) A _ AUTOS ONLY AUTOS CA 299-19-15 06/30/2019'06/30/2020 - PROPERTY DAMAGE HIREDAUTOS NON -OWNED [_- VA (Per accident) A ONLY AUTOS ONLY See Next Page 06/30/2019''06/30/2020 UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB I CLAIMS -MADE , (AGGREGATE !DED I IR'ET'ENTIION ,, B WORKERS COMPENSATION AND WC014649148 1 06/30/2019'1,06/30/20201 )((STATUTE �RH EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE I E.L. EACH ACCIDENT D OFFICERIMEMBER EXCLUDED? N NIA A Wo014649146 06/30/2019106/30/20201 """" ....""""' (Mandatory in NH) CA E L, DISEASE -EA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below I E L, DISEASE -POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Cell Site: Posa Park, Location Code: 160970, Address: 400 Lomita Street, E1 Segundo, CA 90245, CERTIFICATE HOLDER City of El Segundo 350 Main street E1 Segundo CA 90245 USA ACORD 25 (2016103) CANCELLATION $1,000,000 $1,000,000 $1,000,000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE CC) rn M CQ r 0 O Z r O V d U POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD C N/A AGENCY CUSTOMER ID: 570000027366 06/30/2019 LOC #: NY ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMED INSURED Aon Risk Services Northeast, Inc. Los Angeles SMSA LP POLICY NUMBER See Certificate Number: 570076833798 CARRIER B N/A NAIC CODE See Certificate Number: 570076833798 I EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER NJ,TX,VA INSURER INSURER (INSURER ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD mm certificate form for policy limits. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY POLICY INSD WVD POLICY NUMBER EFFECTIVE EXPIRATION LIMITS DATE DATE (MM/DD/YVVY) (MM/DD/YYVY) AUTOMOBILE LIABILITY A CA 299-19-16 06/30/2019 06/30/2020 NH - Primary A CA 299-19-17 06/30/2019 06/30/2020 NH - Excess P WORKERS COMPENSATION C N/A WC014649149 06/30/2019 06/30/2020 NY E N/A WC014649144 06/30/2019 06/30/2020 FL B N/A WC014649145 06/30/2019 06/30/2020 MA,ND,OH,WI,WY I B N/A WC014649147 06/30/2019 06/30/2020 NJ,TX,VA ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD