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PROOF OF INSURANCE (2021 - 2021) CLOSEDDATE(MMIDDIYYYY) AC0kRL> CERTIFICATE OF LIABILITY INSURANCE 02r20/2020 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). PRODUCER CONTACT Deb Groff Community Insurance - NHPHONE FAX S ExtT. 717-354-4551 yAJNe): (717)355 2154 d rtltf Jim m 684 W Main 5t. E,MAIL: g-- munitysure,co P.O. Box 367 INSURER(§) AFFORDING COVERAGE NAIC New HollandPA 17557 INSURERA : Erie Insurance Exchange 26271 INSURED INSURERS: Ragnasoft, Inc JNSURERC: 117 S. West End Ave, Ste 12 INSURERD INSURER E : Lancaster PA 1 .... .. 7603........ L SURER F .. ..... .. .. COVERAGES CERTIFICATE NUMBER: 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. TYPE OF JR .. INSURANCE MI) SWVn POLICY NUMBER (MMIDIR .YI=N �" CICY E7CP fYYYY) IMM 'IDD,IYYYYB .. LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1000000 CLAIMS -MADE �('i-IIX FZrMISr6„��, 0-a occurrence ..J.W,._._._......................._.,. $ 100_0000 MED EXP (Any one person) $5000 A Q37-0156703 01/01/2020 01/01/2021 PERSONAL $ADV INJURY $ 1000000 LIMIT APPLIES PER: GENERAL AGGREGATE $ 2000000 > aRT', 7 POLICY I_(C, n,Fa _- ........................._r „TS COMP/OPAGG PRODI.IC'„ „ $ 22000000 .$:pmf r AUTOMOBILE LIABILITY ...� .. 1.0M:'k:TlNEL,'9 NG1_E LIMI1 $ 2-112 2—rq ANY AUTO BODILY INJURY(Per person) ............ OWNED A,UTOSONLY HIRED SCHEDULED AUTOS NON -OWNED BODILY INJURY (Per acridenl) iF F R(t PB=R'T ` 'AMAGE $ „�. AUTOS ONLY AUTOS ONLY fD:+a.�r �u�u;r:.iUeril').................. $ UMBRELLA LIABEACH OCCUR OCCURRENCE $ EXCESS LIAB .^.mmDED F7 CLAIMS.MADE ......................... ........................................ AGGREGATE $ -,,,,,,,,......... ................................ ...................... ,.,........ ... II V I RETENTION $$ WORKERS COMPENSATION p X PF1'ui.l p'E' V ORH AND EMPLOYERS' LIABILITY "'""'...... ............................................. DENT $ 500000 lPARTNERIEXECUTIVE NIA A OFFICER/MEMBER EXCLUDED? Q85-0106925 01/01/2020 01/01/2021 ' CIEAEMPLOYEE........................................................ (MandetoryinNH)ANY .... EL. DISEASE _ $ 500000 If yes, describe under DESCRIPTION OF OPERATIONS below EL DISEASE POLICY LIMIT $ 500000 Limit - each claim $1,000,000 B Professional Liability MPL152586320 01/09/2020 01/09/2021 Limit -Aggregate $1,000,00 Retention $2,500 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Cyber Liability inlcuded under the Professional Liability policy with same limits. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN RagnaSoft, Inc ACCORDANCE WITH THE POLICY PROVISIONS. 117 S, West End Ave, Ste 12 AUTHORIZED REPRESENTATIVE I Lancaster PA 17603-3396 Fax: Email: O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ERIE INSURANCE COMMERCIAL GENERAL LIABILITY CG 20 10 (Ed. 4113) UF -9665 POLICY NUMBER: 037-0156703 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. k I M ki ril 0 10 - , 101 .1 1=4446411 -:111111111:4 NJ :15 F701 0 1*1 ;401 acyl 0 1 Ful g to] ON This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Name Of Additional Insured Person(s) Or Organization(s) City of El Segundo 350 Main St El Segundo, CA 90245 SCHEDULE Location(s) Of Covered Onerations 350 Main St El Segundo, CA � Information required to comolete this Schedule, if not shown above, Nvill be shown in the Declarations, A. Section I] Who Is An Insured is amended to include as an additional insured the person(s) or orpanization(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 pare. by: 1. Your acts or emissions: 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: I. 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: I. 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 ofthe 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. With respect to the insurance afforded to these additional insureds, the following is added to Section [if — Limits or 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; This insurance does not apply to "bodily injury" or whichever is less, '.property damage" occurring after: This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. 0 Insurance Services Office, Inc., 2012 iW ACCWO CERTIFICATE Off" LIABILITY INSURANCE DAT 051115//zoyYY, 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). PRODUCER CONTACT Aon Risk Services, Inc of Florida I NAME: Aon Risk Services„ Inc of Florida 1001 Brickell33 Bay Drive. Suite #1100 IAJ No. Ext): 800-743-8130 C, Nol: 800-52'2-7514 FAX Miami, FL 33131-4937 EMAIL ADDRESS: ADP.COI,Cen(enAAon corn INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: American Home Assurance Co. 19380 INSURED INSURER B: ADP TotalSource FL XVI, Inc. 10200 Sunset Drive I INSURER C Miami, FL 33173 WITH RESPECT TO WHICH THIS L/C/F INSURER D: Plan -It Interactive Inc INSURER E: 150 W. Industrial Way, Benicia, CA 94510 I INSURER F: ... COVERAGES CERTIFICATE NUMBER: 2787602 REVISION N UMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSU11 ED 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. I.PAIT`', SHCA04N ARE AS FEQY,YESTFD. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LTR INSR WVD (MMIDD/YYYY) (MM/DDIYYYY) I LIMITS COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE $ CLAIMS -MADE OCCUR DAMAGE TO RENTED I PREMISES (Ea occurrence) $ MED EXP (Any one person) $ I PERSONAL & ADV INJURY $ GEN"L AGGREGATE' LIMIT APPLIES PER: I GENERAL AGGREGATE $ POLICY 0 PROJECT F� LOC I PRODUCTS - COMP/OP AGG $ OTHER $ COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accident) $ ANY AUTO I BODILY INJURY (Per person) $ . OWNED SCHEDULED AUTOS ONLY _ AUTOS I BODILY INJURY (Per accident) $ HIRED NON -OWNED PROPERTY DAMAGE I AUTOS ONLY AUTOS ONLY (Per accident) $ I UMBRELLA LIAB OCCUR EACH OCCURRENCE $ _ I EXCESS LIAB CLAIMS -MADE AGGREGATE $ DEC I I RETENTION $ WORKERS COMPENSATION STATUTE 6RH AND EMPLOYERS' LIABILITY Y) N A ANY PROPRIETOR/PARTNER/EXECUTIVE WC 027118173 CA 7/1/2020 7/1/2021 E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N / A X (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, descdbe under p g DESCRIPTION OF OPERATIONS below II E L DISEASE - POLICY LIMIT I $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) All worksle, employees working for PLAN -IT INTERACTIVE INC, paid under ADP TOTALSOURCE, INC's payroll, are covered under the above stated policy WAIVER OF SUBROGATION IN FAVOR OF CERTIFICATE HOLDER AS RESPECTS OF JOB PERFORMED BY PLAN -IT INTERACTIVE INC AS REQUIRED BY WRITTEN CONTRACT Event 07/14/14 CERTIFICATE HOLDER City of EI Segundo -Recreation and Parks Department 401 Sheldon St EI Segundo, CA 90245 CANCELLATION 2,000,000 2,000,000 2,000,000 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 oillon OR,16.4 (Jatviae.6, 42me o (flotilla ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD �,?•. i?r, In; rn•,, 11V 1)I; !„ Inn ;f i1„ N' I, 1'I11!U iI p Ii,i " 1027450 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA This endorsement changes the policy to which it is attached effective on inception date of the policy unless a different date is indicated below. (The following" attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement. Effective on 07/01/2020 at 12:01 AM, forms a part of Policy No. WC 027118173 Issued to: ADP TotalSource FL XVI, Inc. 10200 Sunset Drive Miami, FL 33173 L/C/F Plan -It Interactive Inc 150 W. Industrial Way Benicia, CA 94510 Premium: N/A By: American Home Assurance Co. 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. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us). You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be Additional Premium Percent% of the California workers' compensation premium otherwise due on such remuneration. Person or Organization City of EI Segundo -Recreation and Parks Department 401 Sheldon St EI Segundo, CA 90245 WC 04 03 06 (Ed. 4-84) Schedule Countersigned by Job Description Authorized Representative .w�• ��y�,,,.. iYi', r.; rSfi �s �airgi'�[�iP26;, ,i;ri) {1 i�;9 li,:} it ti t'f r7 t1 4'i iY��ii �k 1027450