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PROOF OF INSURANCE (2020 - 2020) CLOSED0 DATE (MMIDD/YYYY) C" R" CERTIFICATE OF LIABILITY INSURANCE 11 /1 V2019 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). CONTACT PRODUCER SullivanCurtisMonroe Insurance Services (IRV) NAME 1920 Main Street Suite 600 PHONE-ME No. Ext)', 949.2507172 FAX No) ° 949.852.9762 Irvine, CA 92614 ADDRESS www. SullivanCurtisMonroe com License # OE83670 INSURED H'osputal Association Of Southern California 515 S., Figueroa Street, Suite 1300 Los Angepes CA 90071 INSURER(S) AFFORDING COVERAGE NAIC # (NSURER,A,: Admiral Insurance CompanyAM Best: A+ XV 24856 INSURER B: Federal Insurance Company AM Best: A++ XV 20281 INSURER C " INSURER D INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 52286514 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 "TR TYPE OF INSURANCE AN DL SW D POLICY NUMBER IMPOi IDMYYYYd POLICY CXP LIMITS .... C'Y'EFF „ PMMPG1DdYYYYI A COMMERCIAL GENERAL LIABILITY E000000977911 11/8/2019 11/8/2020 EACH OCCURRENCE s5„000,000 DAMAGE "Gn k tj'4"LO f CLAIMS -MADE OCCUR I.'IREMI;SES (En rxxunor cey s300,000 # $7,500 Each Claim Deductible, MED EXP (Any one person) s5,000 PERSONAL &ADV INJURY 55,000„000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 57,000,000 PRO, V. -Cl C' .+� h�C:}LVt'.;Y ( PRODUCTS - COMPIOP AGG s7000,000 OTHER s B AUTOMOBILE LIABILITY 74992589 11/8/2019 11/8/2020 GOI��IRIINE1�SINGLE '�LId47 d,Ea aC,.:,dant,V, $1.000.000 ANY AUTO BODILY INJURY (Per person) S OWNED SCHEDULED BODILY INJURY (Per accident) S AUTOS ONLY AUTOS HIRED NON -OWNED PRf�l9r"k.I'}I TY r}i1'BuSIaGI: s +?� AUTOS ONLY ? AUTOS ONLY IPei nc6derr6,1„ J Comp Ded $500 Coll Ded S500 Liabilitv Deductible $0 UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS -MADE AGGREGATE S { DED RETENTION $ s WORKERS COMPENSATION PER STATI„ITF ERH_ AND EMPLOYERS' LIABILITY Y/'N ANYPROPRIETOR/PARTNER/EXECUTIVE E EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) ”""'"""' E L DISEASE - EA EMPLOYEE S II, yes, describe under DESCRIPTION OF OPERATIONS below E DISEASE - POLICY LIMIT S A Professional Liability, Claims Made E000000977912 11/8/2019 11/8/2020 $5,000,000 per claim $7,000,000 Aggregate $7,500 Deductible A Sexual Abuse & Molestation -PL Only E000000977912 11/8/2019 11/8/2020 $2,000,000 per claim $2,000,000 Aggregate $7,500 Deductible DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) • Iw EI Segundo Fire Department 314 Main Street EI Segudo CA 90245 ACORD 25 (2016/03) 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 Chrystal Rott ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 52206519 1 HOSPIASS 119-20 GPL ,CAU I Patricia Ayala 111/11/2019 1:2E:03 PN (PST) I Page 1 of 2 Hospital Association Of Southern California POLICY NUMBER: E000000977911 Effective Date: 11/8/2019 11/11/2019 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Name Of Additional Insured Person(s) Or Organization(s) Any person or 01, nization that is an owner of real property or persona' 13ropes4y on which you are performing ongoing op 'on,, or a coritractor on whose behalf you are performing ongoing operations, but only if rwoverac�e as an additional imsured is required by a written contrao or written agreement that is an "'insured contract' and provided the "bodily injury" or "property damage" first occurs, or the persona and advertising rnprrr " offense is first committed, subsequent to the execu ion o the contract or agreement. SCHEDULE Location(s) Of Covered Operations IAII locations at which the Named Insured is performing (ongoing operations. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 — 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: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. 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 additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C) ISO F:1roirwit-Lies, 9ric- 20-12 . 22GGIGt I iun;� IA�j,` I 19 co GA, ,ra,u I 11aI1-1,, A-y,a la I ci/11,'-•m.s L.21: :of :-K m T) 7 of r, Page 1 of 2 O C. 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. Page f 2 @ IISO IF:Iirolpeir ies, Inc., 2012 CG 20 10 04 13 5.:.:;OE,RV kIi p GaG3,YT; 2ASS � 1::? 20 tit+%, ,CAU ( raltrir.ia hy+a a 11 1'1/1, 1 ('.:Q7.5 t.:,.'0: 0.3 ?N( (PSTN) 1 1 or (, AGENCY CUSTOMER ID: HOSPIASS LOC ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED SullivanCurtisMonroe Insurance Services (IPV Ilospital Association Of Southern California ............. 11111-1111 ......................... 515 S Fiquerca Sireet, Suite 1300 POLICY NUMBER Los Ange es CA 9007 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability (03/16) ......................................... HOLDER: El Segundo Fire Department ADDRESS: 314 Main Street El Segudo CA 90245 .... .. ......... .......... ............. Named Insured: Hospital Association of Southern California dba: Reddinet AllHealth, Inc. AllHealth, Inc. dba: Checkpoint Modern Health Services, Inc. National Health Foundation Inactive LLC fka: Professional Data Services, Inc. Institute for Performance Excellence, AKA: IPE California Hospital Share, LLC HBWP, LLC Communities Lifting Communities, LLC PLEASE NOTE: WE DO NOT WRITE THE WORKERS' COMPENSATION FOR THIS INSURED AND CANNOT PROVIDE PROOF OF COVERAGE. ACORD 101 (2008/01) 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ATTACHMENT BOSPIASS 118-20 GPL CAU I PaZYici. Ayala 1 11/11/2019 1:28:03 ?M (PET) I Page 2 of 2 DATE (MMIDD/YYYY) C CERTIFICATE OF LIABILITY INSURANCE 8i26i2019 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). Alliant Insurance Services, Inc. PH Joan rross'Ie CONTACT 2180 Harvard Street, Suite 460 INC, No, g"I)' 916-543,27Ota, (1VC No)' 91FAX 0 643 50 Sacramento CA 95815 ADDDRESS: jcrossleyCa),alliant.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Everest Premier Insurance Company 16045 INSURED CALIASS-02 INSURER B: California Association of Hospitals & Health Systems INSURER C: 1215 K Street, Suite 800 INSURER D: Sacramento CA 95814 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: 931744079 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 INSIR ANDD SUBR' POLICY EFF POLICY EXP LIMITS LTIR TYPE OF INSURANCE WVD POLICY NUMBER IMM/DWYYYYI IMMIDDIYYYYI COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: "'. DAMAGE TO RENTED POLICY Jl.CT E �, �i I 1, !n'.. OTHER: MED EXP (Any one person) AUTOMOBILE LIABILITY PERSONAL &ADV INJURY ANY AUTO GENERAL AGGREGATE OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EXCESS LAB CLAIMS -MADE DED RETENTION S WORKERS COMPENSATION CA10000888191 AND EMPLOYERS' LIABILITY Y l N' ANYPROPRIETOR/PARTNER/EXECUTIVE 1 N I A OFFICER/MEMBEREXCLUDED? I (Mandatoryin NH) If yes, describe under DESCRIPTION OF OPERATIONS below EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence), $ MED EXP (Any one person) S PERSONAL &ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMPIOPAGG S 5 I:Cr^'JEiV'R�dEG'S'IITGLE LIMIT ('xT.V7 acoidi,,nl, ' BODILY INJURY (Per person) 'IS BODILY INJURY (Per accident) :P: 'r56" OPERlY DAMAGE {leer di ,:rdbnt,8, S EACH OCCURRENCE S AGGREGATE 'l S OTH,• 9/1!2019 9/1/2020 X STATUTE. "TATUTE. ER E . EACH ACCIDENT S1,000,000 E DISEASE - EAEMPLO'YEE S1,000,000 E L DdSEASE , POLICY LIMIT $ 1.000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached 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 ACCORDANCE WITH THE POLICY PROVISIONS. HASC 515 S. FIGUEROA ST, SUITE 1300 AUTHORIZED REPRESENTATIVE LOS ANGELES CA 90071 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD