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ICY ICI <br />RT TURNER <br />SPECIALTY <br />500 West Monroe, 30th Floor <br />Chicago, IL 60661 <br />Ph: 312-651-6000 <br />www.rtspecialty.com <br />CONFIRMATION OF INSURANCE ver#2 <br />We are pleased to confirm that coverage has been bound with the carrier shown below in accordance with terms, <br />conditions, and limitations provided by the carrier for you and your insured to review. As the broker with the direct <br />relationship with the Insured, it is your responsibility to carefully review with the Insured all of the terms, conditions, <br />and limitations of this Confirmation of Insurance, and to specifically reconcile with the Insured any differences <br />between those quoted and those you requested. RT Specialty expressly disclaims any responsibility for any failure <br />on your part to review or reconcile any such differences with the Insured. This coverage may not be bound without <br />a fully executed brokerage agreement. <br />Any amendments to coverage must be specifically requested in writing or by submitting a policy change request <br />form and then approved by the Insurance Company Underwriters. Coverage cannot be affected, amended, <br />extended or altered through the issuance of certificates of insurance. <br />DATE ISSUED: <br />PRODUCER: <br />FROM: <br />INSURED: <br />INSURER: <br />POLICY NO: <br />COVERAGE: <br />POLICY FORM: <br />POLICY PERIOD: <br />LIMITS OF LIABILITY: <br />.111►11]ACWdIki101ll,7ilIII &S <br />RATE: <br />PREMIUM: <br />TRIA/TERRORISM: <br />TAXES: (CA - RT to file) <br />Surplus Lines Tax <br />Stamping Office Fee <br />TOTAL: <br />AGENT COMMISSION: <br />July 30, 2021 <br />Marsh & McLennan Agency, LLC - Aliso Viejo <br />R-T Specialty, LLC / Terry McCann/Paul Jackson <br />All City Management Services, Inc. <br />10440 Pioneer Blvd. Suite 5 <br />Santa Fe Springs, CA 90670 <br />Westchester Surplus Lines Insurance Co. - Non -Admitted (AM Best: A++ XV) <br />G72535522001 <br />Excess Liability <br />XSC-27266 (05/09) <br />8/1/2021 to 8/1/2022 <br />$5,000,000 Occurence <br />$5,000,000 Aggregate <br />UMB: $3M/$3M - Mercer Ins Co, Primary GL - Landmark, Auto - State Farm <br />XS: $1 M/$1 M xs $3M - Lexington Ins Co <br />Flat Except Acquisitions <br />REJECTED <br />�ortaN <br />Ii:AMmaganen DMsian <br />REVIEWED & APPROVED BY. - <br />Risk Management Analyst <br />