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PROOF OF INSURANCE (2021) CLOSEDSOUTBAY-03 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 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 PHO E _w....................... _� .... Arroyo InsuranceServices- LAl o E,a)mm(323) 550 7900 ITIT ^ ...mac No).(323)WW256 0800 2900yW Broadway vc, N Los Angeles, CA 90041 6 INsuRERA.NanproftsmInsurance Alliance -of California INSURED INS 1RER B nt & Indemnity 22357ITITITITITIT_ : IiartforClmA,CClde mmmm, eOe, South Bay Children's Health Center Association, Inc. _,INSURERmc . ...........................m... ........................... _. 410 S. Camino Real INSURER,o?.. _. ........ — Redondo Beach, CA 90277 INSURER E : ...._.�._.. ...._................._ .. .... INSURER F : r �rGcrtlr f1I=rJ''rIr_If1AT MIIMRI=Rr REVISION NUMBER. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE _ NS IURANCCEE 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 INSURANCE .. POLICY NUMBER LIMITS,_. INSR 'ADDL SUBR POLICY EFF POLICY EXP LTR A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 uu CLAIMS -MADE X occuR X 2020-15361 3/31/2021 1211/2021 DAMAGE TO RENTED 500,000 S 20,000 MED„ p_ Any one arson S .._ 1,000,000 PERSONAL & ADV INJURY _ ...................... �������.�������.. .. 3,000,000 GENE. LIMIT PER: L AGGREGATE�. L RALAGGREGATE -._n ....._..P...A— $ X POLICY P El LOC J T PRODU CTS -COMP/OP AGG $ 3000'000 OTHER. A COMBINED SINGLE LIMIT 1,000,000 AUTOMOBILE LIABILITY I ,._ _............_._._. $ ...................„. ANY AUTO 2020-15361 3/31 /2021 12/1 /2021 _ BODILY NNJU9?M IPsepeoca)_.. AUTOS ONLY _.. AUTOSED BODILY BODILY INJURY (Per acciden0„ 1 .......... X AUTOS X._ ARMO PilarO� uR nl AMAGE �.... ONLY ....._._ ._................ A X UMBRELLA LIAB X OCCUR OCCURRENCE $ mm_ 000 1, ,000 EXCESS LIAB CLAIMS -MADE .................. 2020-15361-UMB 3/31/2021 12/1/2021 ,EACH AGGREGATE 1,000........... .... m ,000 DED RETENTION$ B WORKERS COMPENSATION X PER OTH- T AND EMPLOYERS' LIABILITY X 72WECAC4JWJ 12/1/2020 12/1/2021 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE/ EXCLUDED? N /A E A EACH ACCIDENT w$_......_ _._., (FICER/MEMBER artdatory in NH) E.L DISEASE - EA EMPLOYEE 1,000,000 $, If yes, describe under DESCRIPTION OF OPERATIONS below E L, DISEASE - POLICY LIMIT 1,000,000 $ DESCRIPTION OF OPERATIONS l LOCATIONS / VEHICLES (ACORD 101, Additlonal Remarks Schedule, may be attached if more space is required) "Medical Expense" coverage is EXCLUDED for inmates, PATIENTS or prisoners, Improper Sexual Conduct Liability $1,000,000 Each Occurence $3,000,000 Aggregate Liquor Liability SEE ATTACHED ACORD 101 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Segundo, CDBG Grant THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN tY El 9 ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Tina Gall PLanning and Building Safety Department 350 Main Street AUTHORIZED REPRESENTATIVE El Segundo, CA 90245— ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserves. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LISH SOUTBAY-03........��� .��..���.�m.�......�....._. �. LENG.........__ �rly "C 11 LOC Page 1 of 1 ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED Soulth. Bay Children's Health Center Association, Inc. krroyo Services - LA 410 S. Camino Real POLICY NUMBER ance Servl w _�... m - Redondo Beach, CA 90277 SEE PAGE 1 ............. SEP.� CARRIER NAIC CODE SEE PAGE 1 ISE 1 EFFECTIVE DATE: ,SEE PAGE 1 ACORD 101 (2008101) v LUUa w%.Vnu %oVRrvrv+1 w1N. rut ny11w 1Wac1 The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 2020-15361 COMMERCIAL GENERAL LIABILITY Named Insured: South Bay Children's Health Center Association, Inc. CG 20 26 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Any person or organization that you are required to add as an additional insured on this policy, under a written contract or agreement currently in effect, or becoming effective during the terra of this policy. The additional insured status will not be afforded with respect to liability arising out of or related to your activities as a real estate manager for that person or organization. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II —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 pad, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. in the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. 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 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. CG 20 26 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number: ZZ22 WWEEC AC4JWJ Endorsement Number: Effective Date: 12T1120 Effective hour is the same as stated on the Information Page of the policy, Named Insured and Address: South Bay Children's Health Center Association Inc 410 CAMINO REAL REDONDO BEACH CA 90277 We have the right to recover our payments from anyone liable for an unjury 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 2 % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description Any person or organization from whom you are required by written contract or agreement to obtain this waiver of rights from us Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date: 10/22/19 Policy Expiration Date: 12/1/21