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PROOF OF INSURANCE (2021 - 2021) CLOSEDACCOR" ® CERTIFICATE OF LIABILITY INSURANCE I DAT/(15/202pYY) 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 CONTACT Lizette Orozco Bowermaster & Associates PHONE FAX 10805 Holder St I (A/C. No. ExtC 714-733-6200 (A/C, No): E-MAIL Ste 350 ADDRESS: lorozco@bowermaster.com Cypress CA 90630 I INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: American Automobile Insurance Company 21873 INSURED Donovan Bros Golf, LLC 1800 Carbon Canyon Road Chino Hills CA 91709 DONOGOL-01 I INSURER B: I INSURER C: I INSURER D: I INSURER E: I INSURER F: COVERAGES CERTIFICATE NUMBER: 1236363945 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYYI (MM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY Y Y USCO17102200 7/1/2020 7/1/2021 EACH OCCURRENCE $ 1 000 000 CLAIMS -MADE � OCCUR Ded:$1,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑PRO � LOC OTHER: JECT A AUTOMOBILE LIABILITY X ANY AUTO Y Y SCV0072432001 OWNEDSCHEDULED AUTOS ONLY AUTOS X HIRED I X I NON -OWNED AUTOS ONLY AUTOS ONLY A UMBRELLALIAB VI OCCUR Y USCO127462OU X EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRI ETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? [--]N/A (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 7/1/2020 7/1/2021 COMBINED SINGLE LIMIT $ 1,000,000 fEa accident) BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ f Per accident) 7/1/2020 7/1/2021 EACH OCCURRENCE $5,000,000 AGGREGATE $ 5,000,000 PER STATUTE EERH E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: The Lakes at EI Segundo Certificate Holder is Additional Insured as respects to General Liability per attached endorsement form CERTIFICATE HOLDER City of EI Segundo Attn: Recreations and Parks 350 Main Street EI Segundo CA 902453895 USA 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. AU HOR ZED REPRESENTATIVE @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD THIS CERTIFICATE SUPERSEDES PREVIOUSLY ISSUED CERTIFICATE MultiCoveiC - Without Non Employment Discrimination Liability CG 71 94 01 14 Policy Amendment(s) Commercial General Liability Coverage Form Your Commercial General Liability Coverage Form is occurred before you acquired or revised as follows: formed the organization; and 1. Broadened Named Insured (3) Coverage B does not apply to per- sonal and advertising injury arising A. SECTION II - WHO IS AN INSURED, out of an offense committed before item 3., is deleted and replaced by the follow- you acquired or formed the organ- ing: ization. 3. Any organization that you own at the inception of this policy, or newly acquire or form during the policy period, and over which you maintain during the pol- icy period majority ownership or major- ity interest, will qualify as a Named Insured if- a. £a. There is no other similar insurance available to that organization; and b. The first Named Insured shown in the Declarations has the responsi- bility of placing insurance for that organization; and c. That organization is incorporated or organized under the laws of the United States of America. However: (1) Coverage under this provision 3 is afforded only until the next occur- ring annual anniversary of the be- ginning of the policy period shown in the Declarations, or the end of the policy period, whichever is earlier; and (2) Coverage A does not apply to bodily injury or property damage that B. SECTION II - WHO IS AN INSURED, the last paragraph, is deleted and replaced by the following: No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture, or limited liability company that is not shown as a Named In- sured in the Declarations. However, this does not apply to a limited liability company that meets all of the conditions in Section II - Who Is An Insured, item 3., above. 2. Additional Insured If an Additional Insured endorsement is attached to this policy that specifically names a person or organization as an additional insured, then this Section 2. Additional Insured does not apply to such person or organization. SECTION II - WHO IS AN INSURED, sub- section 2.e., is added as follows: e. Any person or organization is included as an additional insured, but only to the extent such person or organization is legally obligated to pay for bodily injury, property damage or personal and advertising injury caused by your acts or omissions. With respect to the insur- ance afforded to such additional insured, all of the following additional provisions apply: This Form must be attached to Change Endorsement when issued after the policy is written. One of the Fireman's Fund Insurance Companies® as named in the policy Secretary President CG7194 1-14 Copyright 2013, Fireman's Fund Insurance Company, Novato, CA. All rights reserved. Includes copyrighted material of Insurance services Office, Inc., with its ncrmission. Page I of 6 (1) You have agreed in a written insured (f) Their liability as grantor of a fran- contract that such person or organization chise to you. be added as an additional insured under this policy; (6) This insurance does not apply to bodily injury, property damage, personal and (2) The bodily injury, property damage or advertising injury, occurrence or offense: personal and advertising injury for which said person or organization is legally ob- (a) Which takes place at a particular ligated to pay occurs subsequent to the premises after you cease to be a execution of such insured contract; tenant of that premises; (3) The most we will pay is the lesser of (b) Which takes place after all work, in - either the amount of insurance available cluding materials, parts or equip - under the applicable Limits of Insurance ment furnished in connection with shown in the Declarations or the limits such work to be performed by or on of insurance required by the insured behalf of the additional insured at contract; the site of the covered operations, has been completed; (4) The insurance afforded to such additional insured only applies to the extent per- (c) Which takes place after that portion mitted by law; of your work out of which the injury or damage arises has been put to its (5) Such person or organization is an addi- intended use by any other person or tional insured only with respect to: organization other than another contractor or subcontractor engaged (a) Their ownership, maintenance, or in performing operations for a prin- use of that part of the premises, or cipal as part of the same project; or land, owned by, rented to, or leased to you, except such person or or- (d) Which takes place after the expira- ganization is not an insured with re- tion of any equipment lease to spect to structural alterations, new which (4)(d) above applies; construction or demolition oper- ations performed by or on behalf of (7) With respect to architects, engineers or such person or organization; surveyors, coverage does not apply to bodily injury, property damage or per - (b) Your ongoing operations performed sonal and advertising injury arising out for that insured; of the rendering or failure to render any professional services by or for you, in - (c) Their financial control of you, ex- cluding: cept such person or organization is not an insured with respect to struc- (a) The preparing, approving, or failing tural alterations, new construction to prepare or approve, snaps, shop or demolition operations performed drawings, opinions, reports, surveys, by or on behalf of such person or field orders, change orders, or draw - organization; ings and specifications; or (d) The maintenance, operation or use (b) Supervisory, inspection, architec- by you of equipment leased to you tural, or engineering services. by such person or organization; These exclusions apply even if the claims against (e) Operations performed by you or on any insured allege negligence or other wrongdoing your behalf and for which a state or in the supervision, hiring, employment, training political subdivision has issued a or monitoring of others by that insured, if the permit, provided such operations are occurrence which caused the bodily injury or not performed for such state or pol- property damage, or the offense which caused the itical subdivision, and are not personal or advertising injury, involved the render - included within the products-com- ing of or the failure to render any professional pleted operations hazard; or services by or for you. CG7194 1-14 Copyright 2013, Fireman's Fund Insurance Company, Novato, CA. All rights reserved. Includes copyrighted material of Insurance services Office, Inc., with its permission. Page 2 of 6 3. Additional Insured - Vendors If an Additional Insured Vendors endorsement is attached to this policy that specifically names a person or organization as an additional insured, then this Section 3. Additional Insured - Vendors does not apply to that person or organization. Unless the products -completed operations hazard is excluded from this policy, SECTION II - WHO IS AN INSURED, item 2.f. is added as follows: f. Any vendor of yours is included as an addi- tional insured, but only with respect to bodily injury or property damage caused by your products which are distributed or sold in the regular course of the vendor's business, sub- ject to the following additional exclusions: (1) The insurance afforded such vendor does not apply to: (a) Bodily injury or property damage for which the vendor is obligated to pay damages by reason of the assump- tion of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the ab- sence of the contract or agreement; (b) Any express warranty unauthorized by you; (c) Any physical or chemical change in the product made intentionally by the vendor; (d) Repackaging, unless unpacked solely for the purpose of inspection, dem- onstration, testing, or the substi- tution of parts under instructions from the manufacturer, and then re- packaged in the original container; (e) Any failure to make such in- spections, adjustments, tests or ser- vicing as the vendor has agreed to make or normally undertakes to make in the usual course of busi- ness, in connection with the distrib- ution or sale of the products; (f) Demonstration, installation, servic- ing or repair operations, except such operations performed by the vendor in full compliance with the man- ufacturer's written instructions at the vendor's premises in connection with the sale of the product; (g) Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or (h) Bodily injury or property damage arising out of the liability of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. (2) This insurance does not apply to any in- sured person or organization from whom you have acquired such products or any ingredient, part or container, entering into, accompanying or containing such products; (3) The most we will pay is the lesser of ei- ther the amount of insurance available under the applicable Limits of Insurance shown in the Declarations or the limit of insurance required by the contract or agreement; and (4) The insurance afforded to such vendor only applies to the extent permitted by law. Additional Insured - Limited Primary and Non- contributory Provision The following is added as a second paragraph tc Section IV Conditions, Condition 4. Other Insur- ance, following paragraph b.(2): However, if you have added any person, organiza- tion or vendor of yours as an additional insured to this policy by way of this MultiCover ® endorse- ment and have agreed in a written insured contract that this insurance is primary and non-contribu- tory with other insurance available to that addi- tional insured, this insurance is primary and we will not seek contribution from such additional insured's other insurance, provided that the addi- tional insured is a Named Insured under such other insurance. 5. Waiver of Subrogation CG7194 1-14 Copyright 2013, Fireman's Fund Insurance Company, Novato, CA. All rights reserved. Includes copyrighted material of Insurance services Office, Inc., with its ncrmission. SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, item 8., is deleted and replaced by the following: Page 3 of 6 8. Transfer of Rights of Recovery Against Oth- ers to Us and Blanket Waiver of Subrogation a. If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after the loss to impair those rights. At our request, the insured will bring suit or transfer those rights to us and help us enforce them. b. If required by a written insured contract executed prior to the occurrence or of- fense, we waive any right of recovery we may have against any person or organ- ization named in such insured contract, because of payments we make for injury or damage arising out of your operations or your work for that person or organ- ization. 6. Cancellation - 90 Days Common Policy Conditions endorsement IL0017, A. Cancellation, item 2.b. is deleted and replaced by the following: b. 90 days before the effective date of cancella- tion if we cancel for any other reason. 7. Liberalization SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS , the following is ad- ded as an additional Condition: Liberalization If we adopt a change in our forms or rules which would broaden the coverage provided by any form that is a part of this policy without an extra pre- mium charge, the broader coverage will apply to this policy. This extension is effective upon the approval of such broader coverage in your state. 8. Fire, Explosion, Sprinkler Leakage, or Lightning Legal Liability Coverage A. SECTION I - COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclusions, the last paragraph, is deleted and replaced by the following: Exclusions c. through n. do not apply to damage by fire, explosion, sprinkler leakage, or lightning to premises while: 1. Rented to you; CG7194 1-14 Copyright 2013, Fireman's Fund Insurance Company, Novato, CA. All rights reserved. Includes copyrighted material of Insurance services Office, Inc., with its ncrmission. 2. Temporarily occupied by you with the permission of the owner; or 3. Managed by you under a written agree- ment with the owner. A separate limit of insurance applies to this coverage as described in Section III - LIMITS OF INSURANCE. B. SECTION III - LIMITS OF INSURANCE, item 6., is deleted and replaced by the follow- ing: 6. Subject to 5. above, the Damage to Premises Rented To You Limit shown in the Declarations, for property damage to any one premises while rented to you, or in the case of damage by fire, explo- sion, sprinkler leakage, or lightning while rented to you, temporarily occupied by you with the permission of the owner, or managed by you under a written agreement with the owner, is the greater of: a. $1,000,00OAny One Premises; or b. The Damage To Premises Rented To You Limit shown in the Decla- rations. C. SECTION IV - COMMERCIAL GEN- ERAL LIABILITY CONDITIONS, 4. Other Insurance, b. Excess Insurance, (1)(a), items (i) and (iii), are deleted and replaced by the following: (i) That is Fire, Explosion, Sprinkler Leak- age, or Lightning insurance for premises while rented to you, temporarily occu- pied by you with permission of the owner, or managed by you under a writ- ten agreement with the owner; (iii) That is insurance purchased by you to cover your liability as a tenant for property damage to premises rented to you, temporarily occupied by you with the permission of the owner, or managed by you under a written agreement with the owner; or D. SECTION V - DEFINITIONS, 9. Insured Contract, item a., is deleted and replaced by the following: (a) A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any Page 4 of 6 person or organization for damage by fire, explosion, sprinkler leakage, or lightning to premises while rented to you, temporarily occupied by you with per- mission of the owner, or managed by you under a written agreement with the owner, is not an insured contract; 9. Damage to Invitees' Automobiles from Falling Trees or Tree Limbs - Limited Coverage This coverage applies to direct physical damage to automobiles owned by invitees subject to all of the following: 1. Provided such damage originates from trees on premises owned, managed, leased or rented by an insured; 2. Coverage applies only to invitees of an in- sured or an insured's tenant; 3. Such damage is directly caused by wind -dri- ven falling trees or tree limbs; 4. The most we will pay for any one loss is the lowest of: a. the actual cash value of the damaged au- tomobile as of the time of the loss; or b. the cost of repairing the damaged auto- mobile; or c. the cost of replacing the damaged auto- mobile with another automobile of like kind and quality. Regardless of the number of occurrences, losses or claims, this coverage is subject to a limit of $25,000 in any one policy period; 5. This coverage is not subject to the General Liability General Aggregate Limit; and 6. We will make payments under this coverage without regard to fault. 10. Non -Owned or Chartered Watercraft SECTION I - COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAM- AGE LIABILITY, 2. Exclusions, item g. Aircraft, Auto, or Watercraft, item (2), is deleted and re- placed by the following: (2) A watercraft you do not own that is: (a) Less than 51 feet long; and (b) Not being used for public transportation or as a common carrier; 11. Chartered Aircraft SECTION I - COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAM- AGE LIABILITY, 2. Exclusions, g. Aircraft, Auto Or Watercraft, item (6), is added as follows: (6) An aircraft in which you have no ownership interest and that you have chartered with crew. 12. Coverage Territory - Broadened SECTION V - DEFINITIONS, item 4.a., is de- leted and replaced by the following: a. The United States of America (including its territories and possessions), Puerto Rico, Canada, Bermuda, the Bahamas, The Cayman Islands, and the British Virgin Islands; 13. Personal and Advertising Injury - Contractual Unless personal and advertising injury is excluded from this policy the following applies: SECTION I - COVERAGES, COVERAGE B, 2. Exclusions, item e., is deleted. 14. Fellow Employee Coverage SECTION II - WHO IS AN INSURED, 2.a., item (1) is deleted and replaced by the following: (1) Personal and advertising injury: However, subsections (a), (b), (c) and (d) of item (1) remain unchanged. 15. Bodily Injury Definition - Broadened SECTION V - DEFINITIONS, 3. Bodily Injury is deleted and replaced by the following: Bodily injury means bodily injury, sickness or dis- ease sustained by a person including death or mental anguish resulting from any of these at any time. Mental anguish means any type of mental or emotional illness or disease. 16. Expected or Intended Injury - Amendment to Ex- clusion CG7194 1-14 Copyright 2013, Fireman's Fund Insurance Company, Novato, CA. All rights reserved. Includes copyrighted material of Insurance services Office, Inc., with its permission. SECTION I. Coverage A Bodily Injury and Pro- perty Damage Liability, 2. EXCLUSIONS, a. Ex- pected or Intended Injury, is deleted and replaced by the following: Page 5 of 6 a. Expected or Intended Injury Bodily injury or property damage expected or intended from the standpoint of the insured. This exclusion does not apply to bodily injury or property damage resulting from the use of reasonable force to protect persons or prop- erty. 17. Unintentional Failure to Disclose Hazards SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, item 6. Representa- tions, the following is added: d. If you unintentionally fail to disclose any ha- zards existing at the inception date of this policy, we will not deny coverage under this Coverage Form because of such failure. However, this provision does not affect our right to collect additional premium or exercise our right of cancellation or non -renewal. 18. Supplementary Payments - Increased Limits SECTION I - COVERAGES, SUPPLEMEN- TARY PAYMENTS - COVERAGES A AND B, items l.b. and l.d., are deleted and replaced by the following: b. The cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or suit, including substantiated loss of earnings up to $500 a day because of time off from work. 19. Duties in the Event of an Occurrence, Offense, Claim or Suit - Amended SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, item 2.a. is deleted and replaced by the following: (1) You must see to it that we or any licensed agent of ours are notified of a General Liabil- ity occurrence or offense which may result in a claim as soon as practicable after it becomes known to: (a) You, if you are an individual; (c) Your member, if you are a limited liabil- ity company; (d) Your executive officer if you are an or- ganization other than a partnership, joint venture or limited liability company; or (e) Your authorized representative or insur- ance manager. Knowledge of an occurrence or offense by persons other than those listed above does not imply that those listed above also have such knowledge. (2) To the extent possible, notice should include: (a) How, when and where the occurrence or offense took place; (b) The names and addresses of any injured persons and witnesses; and (c) The nature and location of any injury or damage arising out of the occurrence or offense. 20. Medical Payments Unless COVERAGE C MEDICAL PAY- MENTS, or the products -completed operations hazard has been excluded from this policy the fol- lowing applies: A. SECTION I - COVERAGES, COVERAGE C MEDICAL PAYMENTS, 2. Exclusions, item £, is deleted and replaced by the follow- ing: f. Products -Completed Operations Hazard Included within the products -completed operations hazard. However, this exclu- sion does not apply to expenses for den- tal services. B. Section I - COVERAGES, COVERAGE C MEDICAL PAYMENTS, is amended to in- clude item 3. as follows: 3. Limit of Insurance The Medical Expense Limit of Insurance shall be the greater of- a. £ a. $20,000 Any One Person; or b. The amount shown in the Declara- tions. (b) Your partner or member, if you are a partnership or joint venture; All other terms and conditions of the policy apply. CG7194 1-14 Copyright 2013, Fireman's Fund Insurance Company, Novato, CA. All rights reserved. Includes copyrighted material of Insurance services Office, Inc., with its permission. Page 6 of 6 I DATE (MM/DD/YYYY) AC'OR" CERTIFICATE OF LIABILITY INSURANCE 01/17/2020 `11.i 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 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 NAME: Self Insured Solutions PHONE (A/C, No, Ext): (800) 592 0047 (A/C, No, Ext): FAX (800) 592-2541 E-MAIL Administrator, California Restaurant Mutual Benefit Corp. ADDRESS: service @breCkpOInt.COm 430 N Vineyard Ave.. #102 INSURER(S) AFFORDING COVERAGE NAIC# Ontario, CA 91764 INSURER A: California Restaurant Mutual Benefit Corp.* INSURED INSURER B: Star Insurance Company 12831 Donovan Golf Courses Management, Inc. INSURER C: Affiliate of California Restaurant Mutual Benefit Corp. INSURER D: c/o Bowermaster & Associates P. O. Box 6026 INSURER E: Cypress, CA 90630 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY EQUIREMENT, TERM, OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO 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. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I (OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED $ PREMISES (Ea occurrence) MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) $ EACH OCCURRENCE $ AGGREGATE $ X WC STATU- OTH- TORY LIMITS ER 01/01/2020 01/01/2021 E.L. EACH ACCIDENT $1,000,000.00 E.L. DISEASE - EA EMPLOYEE $1,000,000.00 E.L. DISEASE -POLICY LIMIT $1,000,000.00 01/01/2020 01/01/2021 Applicable to WC Statutory Limits and Employers Liability Limits. DESCRIPTION OF OPERATIONS / LOCATION / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: Golf Course: The Lakes at EI Segundo — 400 S. Sepulveda Blvd ** Waiver of Subrogation applies - see attached ** *Complies with the requirements of the Director of Industrial Relations under the provisions of Sections 3700 to 3705, inclusive, of the Labor Code of the State of California, holder of Master Certificate of Consent to Self -Insure No. 4517 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of EI Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Recreations and Parks ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street, Segundo,, CA 90245-3895 AUTHORIZED REPRESENTATIVE E) Se ; g D. Haas © 1988-2010 ACORD CORPORATION. All rights reserved ACORD 25 (2014/01) The ACCORD name and logo are registered marks of ACORD [I GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PROJECT (LOC OTHER AUTOMOBILE LIABILITY ANY AUTO ANYOWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTO UMBRELLA LIAB OCCUR EXCESS LIAB CLAIMS -MADE [I DED I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE A N N/A y X 4517-1682 OFFICE/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below B EXCESS WORKERS COMPENSATION 71 WCE-0937481-19 AND EMPLOYERS LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED $ PREMISES (Ea occurrence) MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) $ EACH OCCURRENCE $ AGGREGATE $ X WC STATU- OTH- TORY LIMITS ER 01/01/2020 01/01/2021 E.L. EACH ACCIDENT $1,000,000.00 E.L. DISEASE - EA EMPLOYEE $1,000,000.00 E.L. DISEASE -POLICY LIMIT $1,000,000.00 01/01/2020 01/01/2021 Applicable to WC Statutory Limits and Employers Liability Limits. DESCRIPTION OF OPERATIONS / LOCATION / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: Golf Course: The Lakes at EI Segundo — 400 S. Sepulveda Blvd ** Waiver of Subrogation applies - see attached ** *Complies with the requirements of the Director of Industrial Relations under the provisions of Sections 3700 to 3705, inclusive, of the Labor Code of the State of California, holder of Master Certificate of Consent to Self -Insure No. 4517 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of EI Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Recreations and Parks ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street, Segundo,, CA 90245-3895 AUTHORIZED REPRESENTATIVE E) Se ; g D. Haas © 1988-2010 ACORD CORPORATION. All rights reserved ACORD 25 (2014/01) The ACCORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY California Restaurant Mutual Benefit Corp. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS We have the right to recover our payments from anyone liable for a covered injury. We will not enforce our right against th 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.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Name of Person or Organization: City of EI Segundo Attn: Recreations and Parks 350 Main Street EI Segundo, CA 90245-3895 Insured: Donovan Golf Courses Management, Inc. Policy No.: 4517-1682