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PROOF OF INSURANCE (2021 - 2022) CLOSEDpage 2 of 9 Client#: 1252713 305STRADYOC ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE oa27/2127/2D/Y1 021 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: I the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be end orsed. dorsed. 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Kimberly Elfring McGriff Insurance Services PHoTrE — 714 941 2822 .._............. ....PAX ----..___ (a/c fL E Erin me .... c No) 877 297 9247 2400 E Katella Ave Suite 1100 DDR( SS g g p Anaheim, CA 92806 --- ---...........INSURER(S) AFFO._W--......COVERAGE...............____.....-....-....�....,......�,............_— NAIC # 714941-2800 INSURER g.lant..I.......W...._.r. __...__.....------�_ Vigilant Insurance Company 20397 INSURED ........... ......... ......... .................... ...,...__ INSURER B : Federal Insurance Company ---------- 20281......— StradlingYocca Carlson & Rauth APC iNSURER.C............ .......................W........_--.................................. _...... .-------------- r....................-..--.... — , ......._ 660 Newport Center Drive, Suite #1600 Newport Beach, CA 92660 INSURER D , — .............. INSURER E INSURER 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 CONTRACTOR 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. POLICY EFF LTR_ TYPE OF INSURANC NX 35327003 LICY NUMBER - (5 O1 /2021 05 LIC'IrEXP LIMITS _ LIABILITY �..,-- YYY) (M ., OD/YVYY _ ,. ...m COMMERCIAL EACH OCCURRENCE �$1.r000,000 A X /01/2022, � „- COMM �. IRAr$1 000 000 _„�...� CLAIMS -MADE � ...X1 g�FfdTED OCCUR MIISInS' (Ew occn�rn�nrvee� MED EXP (Anyone person) ,$,10, 0, 000 _ -PERSONAL &ADVINJURY $1.000.000 GEN'L AGGREGATE AGGR �ATE LIMIT APPLIES ,..PE R .: ....._...,. . �... .. T ,2t00..-0.. ,O._O_ O JECTPRO IPOLICY LOC PRODUCTS sINCLUDED OTHER $_ g AUTOMOBILE LIABILITY 74988851....___ 5/01/2021 05/. COMBiNEDSINGLELIMIT 01/202 �Ea accidenti $1,OOD,000 — ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY .�........ HIRED AUTOS WR& �.�., .. GE ..,_....... $. ...„ w......� ......................e AUTOS ONLY AUTOS ONLY V DAMA�( NON -OWNED ,cden4) ...— .. ......_.—w'..... $ _B .. �X . X OCCUR ......... 7972 ...0 . / CC R CE $ . M 0 000 6620 5/01 /2021 05. W....... r. -- UMBRELLA LIAR 01/202 EACH OCCURRENCE $27 OO , .. T _ _. .. _ ._—..— TE $27,000 EXCESS LIAB WORKERS COMPENSATIONO _ pEp RETENTION S, CLAIMS MADE X i 71700994 1/03/2020 11/03/2021(X AGGREGATE � $ .Ae„ STAT. .,... f �OTH- AND EMPLOYERS' LIABILITY Y / N N _ IJ,TE __.._ EEi ' "" " A ANY PRIETOFVPARTN EXCLUDED? NIA III E.L. EACH ACCIDENT $1 000 000 r/N EAEMPL e a a 0 0 (Mandatory In BER EXCLUDED? EXECUTIVE E.L. DISEASE - EA EMPLOYEE $1 OOO O If yes, describe under DESCRIPTION OF OPERATIONS below E.L DISEASE -POLICY LIMIT $1 t00000 _... DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space Is required) Certificate holder is included as Additional Insured including Primary/Noncontributory wording with respects to General Liability as required by written contract, per form attached. Waiver of Subrogation applies to Workers Compensation per form attached. 60 Day Notice of Cancel lation/Nonrenewal (20 Day in the event of non-payment) applies per form attached. (See Attached Descriptions) CEHTIFICAIIt HULL)''d»wH t �xfwa�ef~I.rcIIVIw City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Administrative Technical Specialist ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD 11 #S27830223/M27830217 KSELF SAG ITTA 25.3 (201 6J03) 2 of 2 #S27830223/M27830217 page 3 of 9 m page 4 of 9 Liability Insurance Endorsement Policy Period 05/01/2021 Effective Date Policy Number 35327003 Insured Stradling Yocca Carlson & RaLAh APC 05/01/2022 Name of Company VIGILANT INSURANCE COMPANY Date Issued 'Z; This Endorsement applies to the following forms: Under Who Is An Insured, the following provision is added. Who Is An Insured Additional Insured - Persons or organizations shown in the Schedule are insureds; but they are insureds only if you are Scheduled Person obligated pursuant to a contract or agreement to provide them with such insurance as is afforded by Or Organization this policy. However, the person or organization is an Insured only: • if and then only to the extent the person or organization is described in the Schedule; • to the extent such contract or agreement requires the person or organization to be afforded status as an insured; • for activities that did not occur, in whole or in part, before the execution of the contract or agreement; and • with respect to damages, loss, cost or expense for injury or damage to which this insurance applies. No person or organization is an insured under this provision: • that is more specifically identified under any other provision of the Who is An insured section (regardless of any limitation applicable thereto). 1-jaWity Insurance Additional Insured - Scheduled Parson Or Organization Form 80-02-2367 (Rev. 5-07) Endorsement continued Page I I M, page 5 of 9 Who Is An Insured Addilional Insured - with respectto any assumption of liability(of another person or organization)by them in a Scheduled Person contract or agreement. This limitation does not apply to the liability for damages, loss, cost or Or Organization expense for injury or damage, to which this insurance applies, that the person or organization (continued) would have in the absence of such contract or agreement. Under Conditions, the following provision is added to the condition titled Other Insurance. Conditions Other Insurance — If you are obligated, pursuant to a contract or agreement, to provide the person or organization Primary, Noncontributory shown in the Schedule with primary insurance such as is afforded by this policy, then in such case Insurance — Scheduled this insurance is primary and we will not seek contribution from insurance available to such person Person Or Organization or organization. Schedule Persons or organizations that you are obligated, pursuant to a contract or agreement, to provide with such insurance as is afforded by this policy. All other terms and conditions remain unchanged. Authorized Representative Liability Insurance Additional Insured -Scheduled Person Or Organization last page Form 80-02-2367 (Rev. 5-07) Endorsement Page 2 M, page 6 of 9 Stradling Yocca Carlson & Rauth APC 35327003 CHUSBe Conditions Audit Of Books And Records Common Policy Conditions Contract The following Conditions are included under each part of the policy, unless stated otherwise. We may audit your books and records as they relate to this insurance at any time during the term of this policy and up to three years afterwards. Cancellation The first named „insured may cancel this policy or an of i individual „ y p y y is individual coverages at any time by sending us a written request or by returning the policy and stating when thereafter cancellation is to take effect. We may cancel this policy or any of its individual coverages at any time by sending to the first named insured a notice 60 days (20 days in the event of non-payment of premium) in advance of the cancellation date. Our notice of cancellation will be mailed to the first named insured's last known address, and will indicate the date on which coverage is terminated If notice of cancellation is mailed, proof of mailing will be sufficient proof of notice. The earned premium will be computed on a pro rata basis. Any unearned premium will be returned as soon as practicable. �. .. , ., Changes This policy can only be changed by a written endorsement that becomes part of this policy. The endorsement must be signed by one of our authorized representatives. ., . ,. 1, ,; : ., . ��, . „ Compliance By Insureds We have no duty to provide coverage under this policy unless you and any other involved insured have fully complied with all of the terms and conditions of the policy. Compliance With This insurance does not apply 1 to the extent that trade or economic sanctions or other laws or Applicable Trade regulations prohibit us from providing insurance. Sanctions Conformance An terms of this insurance which are in conflict with the applicable statutes of the y app ' State in which this policy is issued are amended to conform to such statutes. First Named Insured The person or organization first named in the Declarations is primarily responsible for payment of all premiums. The first named insured will act on behalf of all other named insureds for the giving and receiving of notice of cancellation or nonrenewal and the receiving of any return premiums that become payable under this policy. Inspections And Surveys We may: make inspections and surveys at any time; give you reports on the conditions we find; and recommend changes. Common Policy Conditions Form 80-02-9090 (Rev. 6-05) Contract Page 1 of2 page 7 of 9 condft—lon-s— Inspections And Surveys Any inspections, surveys, reports or recommendations relate only to insurability and the premiums (continued) to be charged. We do not make safety inspections. We do not undertake to perform the duty of any person or organization to provide for the health or safety of workers or the public. And we do not warrant that conditions: are safe or healthful-, or comply with laws, regulations, codes or standards. This condition applies not only to us, but also to any rating, advisory, rate service or similar organization which makes insurance inspections, surveys, reports or recommendations for us. Titles Of Paragraphs The tides of the various paragraphs of this policy and endorsements, if any, attached to this policy are inserted solely for convenience or reference and are not to be deemed in any way to limit or affect the provisions to which they relate. Transfer Of Rights And Your rights and duties under this insurance may not be transferred without our written consent. Duties However, if you die, then your rights and duties will be transferred to Your legal representative, but only while acting within the scope of duties as your legal representative, or to anyone having temporary custody of your property until your legal representative has been appointed. of nonrenewal is mailed, proof of mailing will be sufficient proof of notice. Common Policy Conditions Form 80-02-9090 (Rev. 6-05) Contract Page 2 of 2 0 page 8 of 9 Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number Stradling Yocca Carlson & Rauth APC Policy Number Symbol: Number: 71700994 ... ._ _._. .�.._... _ ......................_.�...... �.... .._....... Policy Period Effective Date of Endorsement 11/ow2o20 TO 11/03/2021 __. _... _ .................... ._._.... __ w.. __ ......_...._ Issued By (Name of Insurance Company) V ilant Insurance Company insert the oalicy number, The remainderofwthe winformation is to be completed only when this endorsement is issued su�Ka�e�,M���t,.9aa tree pec�pax �k err of the policy. CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. 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, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Schedule 1. (❑) Specific Waiver Name of person or organization Any person or organization where you are required pursuant to a written contract or agreement to waive rights of subrogation against such person or organization. (N) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: 3. Premium: The premium charge for this endorsement shall be 1% percent of the premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Advance Premium: WC 90 03 75 (05/18) Authorized Representative 17 page 9 of 9 This page has been left blank intentionally. 18