PROOF OF INSURANCE (2020) CLOSEDPage 1 of 1
t DATE (MMIDDIYYYY)
CERTIFICATE OF LIABILITY INSURANCE 07/18/2019
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).
PRODUCE" CONTACT
R Y. C"N FA
1-877-945-7378 1-888-467-2378
AALWillis of New Jersey, Inc. PHONE'
c/o 26 Century Blvd . E.I.• ,d±.0 @1oY.
E-MAIL
certificates@Willis.com
P.O. Box 305191 -ADDRESS,.,,, ............. .....,___.................,... __
Nashville, TN 372305191 USASUl ONG COVERAGE NAICY
INSURER A : Mitsui SumitomoInsurance Company of Ameri 20362
Mitsui...^...�_r__.
INSURED INSURER B; Inc 22551
Sumitomo Insurance USA
Berlitz corporation
7 Roszel Road (INSURER C
Princeton, NJ 08540 INSURER D:
INSURER E.:
INSURER F:
COVERAGES CERTIFICATE NUMBER: W12080204 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.
ADOL SUBW POLicY EFF POLICY EXP
ILTR' LIMITS
LTR TYPE OF INSURANCE WvrY POLICY NUMBER IMM'DOrYYYYI dMIAM00;Y'YYY'F
X COMMERCIAL GENERA�L; "LIABILITY EACH OCCURRENCE 3PGt- 1,000,000
CLAIMS -MADE X OCCUR i FIEtuC E,S(gr a c�aglurbarrmq; 1,000,000
�
A I� MED'-FE
(Any one lmrr*111w _ 10,000
I '
_. Y PKG3000272 08/01/2019 08/01/2020' PERSONAL & ADV INJURY 5 _ 1,000,000
GEN'L AGGREGATE LIMIT APP'LI'ES PER:
POLICY JECT X LOC
EC'"r I
OTHEP:
AUTOMOBILE LIABILITY
ANY AUTO
A OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
X AUTOS ONLY AUTOS ONLY
-
B X UMBRELLA LIAB X OCCUR
EXCESS LIAB �'' CI,.AIfS R 1AG:itE:,
DED X riE'fLNTI'ON$ 10,000
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y P N
A i AN'YNIROP'RIETrn,,PANTT'NetE kiLXE(,LI'I IV'E No N I A
s„ FFICER�MEMBEREXCLUDED?
Mandatory In NH)
MI yoa, deiw'Nae ulrrdor
DESCRIPTION OF OPERATIONS ho'vwa'
�I 1
GENERAL n+.a" CREGATE
S'„
2,000,000
PRODUCTS - COMP/OPAGG
j$
1,000,000
$
COMBINED SINGLE LIMIT
$
1,000,000
gEw,;:agp'dendr „
BODILY INJURY (Per person)
$
Y INJ RY (Per accident)
BVR8302170 08/01/2019 08/01/2020 BODILY
L
$
11 PRO �AI1AGC
I
_
L:w1t}P
I
I j...E.A.C.H 0„C„CU.R„BEIGE
!...'� .........
_....10,000,000
....................----
UMB5500107 08/O1/20191108/O1/2020,AGGAKIATE
r
10,000,000
I
�5
PER I OTH
X
$'i:J'a`rU I l- I �,�,, .: LR,
—
„ ..-
IL D H Ef-EAST
S
1,000,000
wCP9001200 08/01/2019 08/01/2020Y'
0, 000
DISEASE EA N,If LOYFE� ..1,
E.L. DISEASE i'CYLVC'Y LItAl'f
I.:t'
1, 00 0, D00
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
It is agreed that City of EL Segundo, the officers, officials, employees and volunteers are included as Additional
Insureds as respects to General Liability policy. It is further agreed that such insurance as is afforded shall be
primary and non-contributory with any other insurance in force for or which may be purchased by Additional Insureds.
�I
CERTIFICATE HOLDER CANCELLATION
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
City of EL Segundo
350 Main Street 9
E1 Segundo, CA 90245
®1988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
sR %D: 18276776 aATcR: 1289323
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