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PROOF OF INSURANCE (2020) CLOSEDCERTIFICATE OF LIABILITY INSURANCE 'DATE(MM/DD/YYYY) 08/12/2019 V Iy 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). c PRODUCER CONTACT � Aon Risk Services South, Inc. GA Office "FR�U iv°iEFAXAtlanta INC, iNo, Exiry; (866) 283-7122 ( IAIC. . ................................................._ ...................._ ...., a 3550 LenoX Road NE E-MAIL p Suite 1700 ADDRESS: _ Atlanta GA 30326 USA INSURERIS) AFFORDING COVERAGE NAIC H INSURED INSURER A: Trans Pacific Ins Co 41238 ZOLL Medical Corporation ..._._._...._.._...,.._.... INSURER B: Tokio Marine America insurance Company .................. 10945 and subsidiaries 269 Mill Rodd ".INSURERmCo........... Mitsui, Ts ui Sumitomo Ins........ a .............._ _ ­ ...............ur nce USA Inc. ......_._.................. 22551 Chelmsford Chelmsford MA 01824-4105 USA (Per accident) INSURER D: The Travelers Indemnity Co. 25658 $25,000,000, AGGREGATE ............................$,25..,..000.,..000' INSURER E: The Charter oak Fire Insurance Company 25615 .......................................................................... INSURER F: Federal Insurance Company 202$1 COVERAGES CERTIFICATE NUMBER: 570077835291 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 requested Ntiii II TYPE OF INSURANCEADOL UBIR POLICY NUMBER y INSD SWVO �/21f'WY') LIMITS AR X COMMERCIAL GENERAL LIABILITY CLL640976002 UJ�1U.L/ 0i, 67/ 7 026 EACH OCCURRENCE 51,000,000 CLAIMS -MADE Y X 0 OCCUR 'YJFAi{.9l t iU i'7'E"N1 tU PREMISES (Ea occurrence) $1,000,0 0 0 MED EXP (Any one person)$10, 000 ,— ...................................... PERSONAL@ ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE 52,000,000 X PRO- POLICY LOC ...... ... ........................._...........__.. PRODUCTS-COMP/CP AGG Excluded JECT OTHER B AUTOMOBILE LIABILITY X ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS -... HIRED AUTOS NON -OWNED ........... w ONLY pµpµ AUTOS ONLY II� C X UMBRELLA LIAB X I OCCUR W . EXCESS LIAB J CLAIMS -MADE DED l 1F E7ENTIC I`,, )' D WORKERS COMPENSATION AND E EMPLOYERS' LIABILITY Y i N ANY PROPRIETOR / PARTNER / EXECUTIVE ^Cr N I A OFFICER/MEMBER EXCLUDED &.. (Mandatory in NH) X d, If yes, describe under DESCRIPTION OF OPERATIONS below F Products Liab CA6409761-02 07/01/201907/0112020 COMBINED SINGLE LIMIT 51,000,000 ZEa accident) 07/01/2019 07/01/2020 BODILY INJURY ( Per person) EL EACH ACCIDENT BODILY INJURY (Per accident) EL DISEASE -EA EMPLOYEE PROPERTY DAMAGE .............�. (Per accident) 08/15/2019 07/15/2020 Prod/Comp ops/Agg EXS5200217 07/01/2019 07/01/2020 EACH OCCURRENCE $25,000,000, AGGREGATE ............................$,25..,..000.,..000' Deductible U6 5 7 3194 7 3 07/U1/2019 U'%/O1/2U2d;i, X PTArurE I IORTH..-w UB8N278805 07/01/2019 07/01/2020 EL EACH ACCIDENT EL DISEASE -EA EMPLOYEE E L DISEASE -POLICY LIMIT 36019266 08/15/2019 07/15/2020 Prod/Comp ops/Agg Retro Date 10/1/2004 Prod/Comp Ops/Occ Deductible DESCRIPTION OF OPERATIONS I LOCATION'S 0 VEHICLES IACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Products Liability - claims made coverage,. CERTIFICATE HOLDER E1 Segundo Fire Department Attn: Capt. Mark Lees 314 Main St. El Segundo CA 90245 USA ACORD 25 (2016103) CANCELLATION O Z 2 M U w d U 51,000,000 51,000,000 $1, 000 , 000 _ 55,000,000 $5,000,000 in 5200,000 a� 4a - 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 ti✓ -K072 c��Y.�i/G cJ6C2SA,r'rd r�al.�i�eJ77A ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000057723 LOC #: ADDITIONAL REMARKS SCHEDULE Page of AGCNICY �)oAFr R[r, Aon Risk services south, Inc, YZOLL medical corporation 1 '111'" "HAVIU1 R see certificate Number: 570077835291 C'� 1-1 Fir 1-' NAW CO1 See Certificate Number: 570077835291 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 # F 79882432 08/15/2019 07/15/2020 n,cpqreijar(- s5'000,000 EX Products Liab Each s5'000,000 occurrence ACORD 101 (2008/01) (D 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD INSURER r"I S 1l j R F I'll �rahlrVJ R ADDITIONAL POLICIES 117a policy below does not include limit infionnaLion, refer to the corresponding polis}' on the ACORD certificate florin fbr policN IfiniLs 11011101 POLIc% INSR TYPE OF INSURANCE ADDL SUBR EFFECTWE POLICYNUMBER EXPIRMION LIMITS U1 R INSD MAI) DATE DATE EXCESS LIABILITY F 79882432 08/15/2019 07/15/2020 n,cpqreijar(- s5'000,000 EX Products Liab Each s5'000,000 occurrence ACORD 101 (2008/01) (D 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: CLL64097 60-02 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, ADDITIONAL INSURED -- DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurancerovided under the followin p 9 ., COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured e Person(s) Or Organization(s): ANY PERSON OR ORGAN=ZATION PdHEN YOU AND SUCH PEIRSON(S)OR ORGAN=ZATION(S) HAVE AGREED IN WRITING IN A CONTRACT OR AGREEMENT THAT SJCH PERSON OR ORGANIZATION BE NAMED AS AN ADDITIONAL INSURED CN THIS POLICY PROVIDED THE CONTRACT OR AGREEMENT KAS EXECUTED PRIOR TO THE "BODILY INJURY" "PROPERTY DAMAGE" OR "PERSONAL ANTD ADVERT 7SINC_ INJURY". 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 include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is 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. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 26 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 "AR WORKERS COMPENSATION TRAVELER „ AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 99 03 76 ( A) - 001 POLICY NUMBER: UB -5J319473 -19 -I2 -G WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA x (BLANKET WAIVER) 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. The additional premium for this endorsement shall be 2.00 % of the California workers' compensation pre- mium. Schedule Person or Organization ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. Job Description ELECTROMEDICAL AND ELECTROTHER This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Insured Insurance Company Policy No. Countersigned by Endorsement No. Premium DATE OF ISSUE: 07-23-19 ST ASSIGN: Page 1 of 1