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PROOF OF INSURANCE (2021 - 2021) CLOSED.. a'' � DATE IMMIDDIYYYY) �-, CERTIFICATE OF LIABILITY INSURANCE 9/16/2020 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(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). PRODUCER CONCT NAME: Christian Brothers Services Artex Risk Solutions, Inc. (CB) PHHOA Epp 800-807-0300 2850 Golf Road, 5th Floor E Ftp CArc plop: 630 378-2508 Rolling Meadows IL 60008-4050ss;,.,.,,, ............................... INSURER(S) AFFORDING COVERAGE NAIC # IN.au.B.E.a..Ivanla Manufacturers Assoc Ins Co 12262 .^....Penns.Y . INSURED CHRIBRO-14 INSURER B c Old Re UbIIC.II1SUrance Compan 24147 Brothers of the Christian Schools & Affiliates P....................................................................y........................... Loc #1177028 DOC POW ST VINCENT SENIOR CITIZEN NTR las,uR,eR.9.:.................................................................................................................................... 1205 Windham Parkway INSURER D: Romeoville IL 60446-1679 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 2024388489 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 IERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH 'OLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. .....................LIMITS...................... .. � � � .......... ...I-, ILTR GtN RSR..........•"' POLICY OF 06UdY�E%P TYPE OF INSURANCE WVD POLICY NUMBER IMMIDDNYh"Yp IM'MIDDIYYYYY A X COMMERCIAL GENERALLIABILITYY 8220000998922 6/15/2020 6/15/2021 EACH OCCURRENCE $4,000„000 �I CLAIMS -MADE X..J OCCUR Ph Mb$O ra� uggr,race)......m. m$mmincluded................................... MED EXP (Any one person)$...15u.0.0........................................ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Only the General Liability Coverage will apply on a Primary and Non -Contributory basis (per attached endorsement) if required by fully executed written contract. Certificate Holder is added as Additional Insured (per attached endorsement) for General Liability and Automobile liability coverages solely, strictly and specifically with regards to: C'onsuitant Services for the Community Development Block Grant Program for Home Delivered Meals. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of EI Segundo its Official and Employees Office of City ACCORDANCE WITH THE POLICY PROVISIONS. Clerk 350 Main Street AUTHORIZREPRESENTATIVE IIEI Segundo CA 90245 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD PERSONAL & ADV INJURY $ Included„ .............. GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ N/A POLICY D JPECO” 7 LOC .. ............................ ...P..R.OD.T.S.-...CO.M.P..P.AGG�.$.I.n...c....l.u....d....e...d OT'HEH. ' $ AUTOMOBILE LIABILITYCOMBINED Y MWTB 21543 Bk d;SINGLELuMIP 1 I 6/15/2020 6/15/2021 $ 1,000,000 iE....u,,,.... X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY ccident) '',, $ a _ AUTOS ONLY AUTOS X HIRED NON -OWNED PROPERTY DAMACE.................m.,...... $ AUTOS ONLY „XAUTOS ONLY VPer acedeual7 UMBRELLALIAB CCURAGREGATE RENCE $ ............. CLAIMS -MADE EXCESS LIAR A............... ..................._...................................................... DED( � RETENTION$....................................... $ �.... WORKERS COMPENSATION (PER �I � OTH- AND EMPLOYERS' LIABILITY YIN ,,,S.T,.A,,,TIJTE,LI,,,__ „F.R ........._..V ANYPROPRIETOR/PARTN ERIEXECUTIVE HA $ BE EXCLUDED? NIA OFFICER///MEM (Mandatory ) Ej� DISEASE E - EA EMPLOYEE' $ If yes, descnbe under DESCRIPTION OF OPERATIONS below E L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Only the General Liability Coverage will apply on a Primary and Non -Contributory basis (per attached endorsement) if required by fully executed written contract. Certificate Holder is added as Additional Insured (per attached endorsement) for General Liability and Automobile liability coverages solely, strictly and specifically with regards to: C'onsuitant Services for the Community Development Block Grant Program for Home Delivered Meals. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of EI Segundo its Official and Employees Office of City ACCORDANCE WITH THE POLICY PROVISIONS. Clerk 350 Main Street AUTHORIZREPRESENTATIVE IIEI Segundo CA 90245 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD PENNSYLVANIA MANUFACTURERS' ASSOCIATION INSURANCE COMPANY Attaching to and forming part of Policy No. 822000 0998922 Named Insured: THE RELIGIOUS AND CHARITABLE RISK POOLING TRUST OF THE BROTHERS OF THE CHRISTIAN SCHOOLS AND AFFILIATES Effective date of this endorsement is June 15, 2020 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under SECTION II INSURING AGREEMENT C, GENERAL LIABILITY COVERAGE defined within the Coverage Agreement SECTION 1: Schedule .................................. Name of Additional Insured Persons(s) or Designated Location(s) Of Covered Operations: Organization(s): ANY PERSON OR ORGANIZATION WHEN YOU HAVE AGREED IN A WRITTEN CONTRACT FOR THAT PERSON OR ORGANIZATION TO BE ADDED AS AN ADDITIONAL INSURED ON YOUR POLICY. If Ilii 11 11 v a l II:)CWe IIIIIi( I' I 11@010 II V� (;,I4.,IIV 1) ;xIi 11lll�1 fl 11 Is FilIIdcI IYlie! lll �o VII 11hP C l: 11:�III "r 1116 11, 1 e 11 ;r;:V" 11) ::1 Ile (III V ui a Vyi,,l !Ju! I I p l i c. a, 111 t1;. V 111 0 rn",'ti;:,o III k l" If Section II Insuring Agreement C -Name of Insured Amended Who Is Alyn insured defined In the (.:general Insurance Agreement is amended to include as an AddihonKal Insured [he person(s) or organi,rabon(s) shown in the ;schedule above but only with respect to liability in the performance of the Narned Insured's ongoing operations for thle Additional Insured(s) at the I....ocation(s) designated in the Schc:da..rle above for "bodily injury" or "property damage;", c,.aused In whole or in part, try the Narned insured's acts or ornissions which takes place after the execution of a written agreement With the Additional Insured(s) B. For the coverage provided by this endorsement the following paragraph is added to Section IV General Conditions, Section sill, Insuring Agreement C -General l lability l his insurance is primary insurance as respects to this coverage to the additional insured person or organization, where the written contract or written agreement requires that this insurance be primary and noncontributory In that event, we will not seek contribution from any other insurance policy available to the additional insured can which the additional insured person or organization is a Narned Insured C. Who is Aini Insured is also amended to include as an additional insured the person(s) or organization(s) shown In the Schedule, with respect to liability forr "bodily injury" err "propertydainaage" caused, in whole or in part by the, "Named Insureds work" at the location designated and described in thin•, schedule of this endor"sement: performed for that additional insured and Included in the "products completed operations hazard" the most we will pay is the arnount of insurance recti..lired by the written contract or the amount of applicable limits of insurance under this policy; whichever is less This lnsuirance, does not apply to any claims or suits seeking darrrages, Including defense, arising out of, directly or Indirectly, frorn any actual or alleged participation rn any act of sexual misconduct, ese,xual harassment, sexual molestation, sexual abuse or any claim sexual in nature., physical or meatal, of any person. Except as amended in thtis endoarsement this insurance is subject to all coverage terms. clauses and conditions in the policy to which this endorsernent is attached and only applies to tho extent permitted by law IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM SCHEDULE Name of Person(s) or Organization (s): All persons or organizations as required by contract or agreement With respect to COVERED AUTOS LIABILITY COVERAGE, Who Is An Insured is changed with the addition of the following: Each person or organization shown in the Schedule for whom you are doing work is an "insured". But only for "bodily injury" or "property damage" that results from the ownership, maintenance or use of a covered "auto" by: 1. You; 2. an "employee" of yours; or , 3. anyone who drives a covered "auto" with your permission or with the permission of one of your "employees". However, the insurance afforded to the person or organization shown in the Schedule shall not exceed the scope of coverage and/or limits of this policy. Not withstanding the foregoing sentence, in no event shall the insurance provided by this policy exceed the scope of coverage and/or limits required by the contract or agreement. PCA 001 10 13 MWTB 21543 Religious and Charitable Risk Pooling Trust 06/15/2020 - 06/15/2021 a "= �'�'`�"' CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) AR 12/2/2019 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). PRODUCER CONTACT Ap) ex Risk Solutions, Inc. CB P.-,.dN,,,C 180'an Brothers Services 2850 Golf Road, 5th Floor ( >� ^.... 00.807-0300 ,,NoiI 630.378-2508 Rolling Meadows IL 60008-4050 ADDRESS. NSURER(3) AFFORDING COVERAGE NAIC # INSURERA: Old Republic„Insurance ComP.anY... 24147 INSURED CHRIBRO-14 INSURER B: Brothersof the Christian Schools & Affiliates INSURER c................................................................................................................................................... 1Loc #1177028 205 Windham POI OW ST VINCENT SENIOR CITIZEN NTR arkway INSURER ,o.................................................................................................................. ................ .�...........,..,,............. INSURE Romeoville IL 60446-1679 II RE: p INSURER F : COVERAGES CERTIFICATE NUMBER: 15726475 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. INSPOLICYRR TYPE OF INSURANCE D )” .... , EFF r PoCfc y- IT ....................NSD �N.YP POLICY NUMBER � AM'MIIODNYYI(1'a IM'�M/DCd1Y, PA"1 LIM S COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE III OCCUR PREMISES ( a QWq enre,),,,,,,,,,,,,,,,,,,,,,,$ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO' LOC JECT OTHER: AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AT HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLALIAB Y OCCUR EXCESS LIAB fl CLAIMS -MADE �,-DED L..RETENTION.$....-�..................., A WORKERS COMPENSATION Y MWC 305311 05 AND EMPLOYERS' LIABILITY Y f N ANYPROPRIETOR/PARTNERIEXECUTIVE P, NJ N/A OFFICERIMEMBEREXCLUDED? �I (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below 1/1/2020 MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ COMBINED SINGLE LIMIT $ BODILY INJURY (Per person) $ BODILaccident) .. $ 046�� 64446E $ ENC. .. ,........ AGGREGATE GG RE GATE ........................................... $ 1/112021 XI ( STATUTE ERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE -EA EMPLOYEE, $1,000,000 E L. DISEASE- POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Wavier of Subrogation, per the attached endorsement, (where allowed by law) is provided under the Worker's Compensation coverage when required by fully executed written contract. Evidence of Coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of EI Segundo, its officials and employees ACCORDANCE WITH THE POLICY PROVISIONS. Office of the City Clerk ............ 350 Main St A'UTHORI,BREPRESENTATIVE EI Segundo CA 90245 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 0484) POLICY NUMBER: MWC 305311 05 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA 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 0 % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE PERSON OR ORGANIZATION ALL PERSONS OR ORGANIZATIONS WHERE REQUIRED BY WRITTEN CONTRACT DATE OF ISSUE: 11-01-19 JOB DESCRIPTION ©1998 by tha Workers' Compensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB's California Workers' Compensation Insurance Forms Manual © 1999. INSURED COPY