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PROOF OF INSURANCE (2021 - 2022) CLOSEDCERTIFICATE OF LIABILITY INSURANCE DATE (MMIDONYYY) 07/12/2021 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 andorsement(st. PRODUCER StateFarm SKALA INSURANCE AGENCY INC ( Ills GENE SKALA AGENT LIC.#0587032 4214 N SIERRA WAY SAN BERNARDINO, CA 92407 INSURED r NANCY K BOHL INC DBA THE COUNSELING TEAM INTERNATIONAL AND DBA THE ORGANIZATIONAL NETWORK CERTIFICATE NUMRFR- i±-13-8861 GENE@GENESKALA.COM Slate Farm General insurance Company State Farm Mutual Automobile Insurance Company 25151 25178 .. a THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED D 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. INTSR TYPE OF INSURANCE AeL.0 a �fPOLICY NUMBER M I LMS ILI COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE ®OCCUR DTI $ 2,000.000 CLAIMS -MADE CUR Rt MR a c urrLralcsl._ I" a 300,000 HIRED AUTO MED EXP (A one do S 5.000 A ENOL Y Y 92LB14261 & 92YD04220 07/12/2021 07/12/2022 .. _. PERSONAL li ADV INJURY S CENLAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 4.006,000 POLICY 1?'rECx .+C0- 1-1W-....m....�... LDC PRODUCTS -COMPIOPAGG S $ _. AUTOMOBILE LIABILITYL1 Y 4414167F2475 06/24/2021 12/24/2021 , INED N sINLE CiMiT S ANY AUTO „ BODILY INJURY (Per pown) S 1,000,000 B OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ 1,000,000 HIRED NON-CVVNED AUTOS ONLY _, AUTOS ONLY PERTY CkkJMAGE dsra s 1,000,000 $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S .. EXCESS LIAR .. CLAIMS -MADE. .... ''.. AGGREGATE $ OED RETENTIONS S WORKERS COMPENSATION RAND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ N/A E.L. EACH ACCIDENT -.- S IMandatory In NH) If es, dub;nt a under yy E.L. DISEASE - EA EMPLOYE S ID F SCRIPT O OPERATIONS 6olgw E.L. DISEASE -POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schad^ maybe attached If more space Is required) Business Office Policy Property Locations: 41750 Rancho Los Palmas Dr Ste D-2, Rancho Mirage, CA 92270 1881 Business Center Dr, San Bernardino, CA 92408 39755 Murrieta Hot Springs Rd, Ste D160, Murriete, CA 92563 1545 Anacapa Rd Ste 7C, Victorville, CA 92392 135 S State College Blvd Ste 200. Brea, CA 92821 444 Camino Del Rio Ste 2013, San Diego, CA 92108 701 Palomar Airport Rd, #300, Carlsbad, CA 92011 74075 El Paseo Ste A9 & All6, Palm Desert, CA 92260 232 Harrison Ave Ste D, Claremont, CA 91711 4160 Temescal Canyon Rd Ste 309. Corona, CA 9288 City of El Segundo, its officers, officials, employees, agents and volunteers. 350 Main St El Segundo, CA 90245 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. I ne A,—urcu name ana Togo are regisLerea marKS OT AGUKLI All rights reserved. 1001486 132849.12 03.16.2016 92-YG-0422-0 028378 CMP-4786.1 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY CMP-4786.1 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92-YD-0422-0 Named Insured: Name And Address Of Additional Insured Person Or Organization: CITY OF EL SEGUNDO ITS OFFICERS OFFICIALS EMPLOYEES AGENTS & VOLUNTEERS 50 MAIN ST EL, SEGUNDO CA 90245-3895 1. SECTION II — WHO IS AN INSURED of b. If coverage provided to the additional in - SECTION II — LIABILITY is amended to in- sured is required by a contract or agree- clude, as en additional insured, any person or ment, the insurance provided to the organization shown in the Schedule, but only additional insured will not be broader than with respect to liability for "bodily injury', that which you are required by the contract "property damage", or "personal and advertis- or agreement to provide for such addition- ing injury" caused, in whole or in part, by; al insured; and a. Ongoing Operations c. If the contract or agreement between you (1) Your acts or omissions; or and the additional insured is governed by (2) The acts or omissions of those acting California. Civil Code Section 2782 or 2782,05, the insurance provided to the on your behalf; additional insured is the lesser of that in the performance of your ongoing opera- which: tions for that additional insured; or (1) Is allowed for the satisfaction of a de- b. Products — Completed Operations fense or indemnity obligation by Cali - "Your work" performed for that additional fornia Civil Code Section 2782 or insured and included in the "products- 2782.05 for your sole liability; olr completed operations hazard". (2) You are required by contract or However, Paragraph 1. above is subject to the agreement to provide for such addi- following: tional insured. a. The insurance afforded to the additional We have no duty to defend or indenrinify the insured only applies to the extent permit- additional insured under this endorsement un- "suit" ted by law; til a claim or is tendered to us. Q, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CONTINUED - 2 -0 028378 M 28370 CMP-4786 1 Page 2 of 2 2. .any insurance or����.�ed to l:ho additiom� l in- (3) The nature and locatki n of any injury sured shall only apply with respect to a claim or damage arising out of the "occur - made or a "suit" brought for damages for rence" or offense; which you are provided coverage. b. Tender the defense and indemnity of any 3. VMfth respect to the insurance afforded to the claim or "suit" to us and to all other insur- additional insured, the following is added to ers who may have insurance potentially SECTION II — LIMITS OF INSURANCE, available to the additional insured-, and If coverage provided to the additional insured c. Agree to make available any other insur- is required by contract or agreement, the most ante the additional insured has for de - we will ay on behalf of the additional insured the insurance: fense or damages for which we would coverage under SECTION II — will be t�e lesser of amount of a. Required by the contract or agreement; or provide LIABILITY, b. Available under the applicable Limits Of 5. With respect to the insurance afforded the ad - ditional insured, the following replaces SEC- Insurance shown in the Declarations. TION II —LIABILITY of Paragraph 7. Other This endorsement shall not increase the ap- Insurance of SECTION I AND SECTION Il - plicable Limits Of Insurance shown in the COMMON POLICY CONDITIONS: Declarations. a This insurance: is primary to arrd will not:. 4. With respect to the insurance afforded to the seek contribution from any other Insurance the-follo-wing is added to available to the additional insured, provided _additional_inaure.d, Paragraph 3. Duties In The Event Of Occur- that the additional insured is a earned in- rence, Offense, Claim Or Suit of SECTION sured under such other insurance, II — GENERAL CONDITIONS: b. Regardless of any agreement between The additional insured must: you and the additional Insured, this insur- ance is excess over any other insurance a. See to it that we are notified as soon as whether primary, excess, contingent or on practicable of an "occurrence" or an of- any other basis for which the additional in- fense which may result in a claim. To the sured has been added as an additional in extent possible, notice should include: sured on other policies. (1) How, when and where the "occur- There will be no refund of premium in the event rence" or offense took place; this endorsement is cancelled. (2) The names and addresses of any in- jured persons and witnesses; and All other policy provisions apply. CMP-4786.1 ©, Copyright, StateFarm Mutual Automobile InSUrarloe Company, 2013 Includes copyrighted material of Insurance Svwices Ofte, Inc., with its permission. "' 92-YD-0422-0 028379 CMP-4786.1 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY CMP-4786.1 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92-YD-0422-0 Named Insured: NANC"Y K BOHL INC DBA THE COUNSELING TEAM INTERNATIONAL AND DBA THE ORGANIZATIONAL NETWORK PO BOX 10427 SN BERNRDNO CA 92423-0427 Name And Address Of Additional Insured Person Or Organization: 1. SECTION II — WHO IS AN INSURED of b. If coverage provided to the additional in - SECTION II — LIABILITY is amended to in- sured is required by a contract or agree- clude, as an additional insured, any person or ment, the insurance provided to the organization shown in the Schedule, but only additional insured will not be broader than with respect to liability for "bodily injury"', that which you are required by the contract "°propely damage". or "'personal and ad�vertis or agreement to provide for such addition- ing injury", Caused in whole or in part by: al insured; and a. Ongoing Operations c. If the contract or agreement between you (1) Your acts or omissions; or and the additional Insured is governed by (2) The acts or omissions of those acting California Civil Code Section 2782 or 2782,05, the insurance provided to the an your behalf; additional insured is the lesser of that in the performance of your on oing opera- tions for that additional insure„ or which: (1) Is allowed for the satisfaction of a de- b. Products — Completed Operations fense or indemnity obligation by Cali - "Your work" performed for that additional fornia Civil Code Section 2782 or insured and included in the "products- 2782.05 for your sole liability; or completed operations hazard". (2) You are required by contract or However, Paragraph 1. above is subject to the agreement to provide for such addi- following: tional insured. a. The insurance afforded to the additional We have no duty to defend or indernnify the insured only applies to the extent permit_ additional insured under this endorsement un- "suit" ted by law; til a claim or is tendered to us. ©, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CONTINUED 92-YD-0422-0 028379 M 28370 CMP-47861 Page 2 of 2 2. Any insuanco pr,,,­ided '�a fl-,C, additior, I in- (3) The nature and loci,�,I`an of any injury sured shall only apply with respect to a claim or damage arising Out of the "occur - made or a "suit" bl'OUght for damages for rence" or offense; which you are provided coverage. b. Tender the defense and indemnity of any 3. With respect to the insurance afforded to the claim or "suit" to us and to all other insur- additional insured, the following is added to ers who may have insurance potentially SECTION Il ­ LIMITS OF INSURANCE., available to the additional insured, and If coverage provided to the additional insured c. Agree to male available any other insur- is required by contract or agreement, the most ance the additional insured has for de - we will pay on behalf of the additional insured fense or damages for which we would will be the lesser of the amount of insurance, provide coverage under SECTION 11 a. Required by the contract or agreement; or LIABILITY. b. Available under the applicable Limits Of 5. With respect to the insurance afforded the ad - ditional insured, the following replaces SEC- Insurance shown in the Declarations. TION 11 —LIABILITY of Paragraph 7. Other This endorsement shall not increase the ap- Insurance of SECTION 11 AND SECTION 11 Iicable Limits Of Insurance shown in the COMMON POLICY CONDITIONS: Declarations. a. - This insurance is priri,ia, ry to and will not 4. With respect to the insurance afforded to the seek contribution frorn any other insurance additional insured,- the following- is added to ---available to the additional, insured, provided - Paragraph 3. Duties In The Event Of Occur- that the additional insured is a narned in- rence, Offense, Claim Or Suit of SECTION sured under such other insurance, 11 — GENERAL CONDITIONS: b. Regardless of any agreement between The additional insured must: you and the additional insured, this insur- ance is excess over any other insurance a. See to it that we are notified as soon as whether primary, excess, contingent or on practicable of an "occurrence" or an of- any other basis for which the additional in- fense which may result in a claim, To the sured has been added as, an additional in- eytent possible, notice should include: sured on other policies. (1) How, when and where the "occur- There will be no refund of premium in the event rence" or offense took place; this endorsement is cancelled. (2) The names and addresses of any in- jured persons and witnesses', and All other policy provisions apply. CMP-4786.1 @, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. J11 I`�' 92-YD-0422-0 028380 CMP-4787 F, Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CMP-4787 WAIVER OF TRANSFER OF RIGHTS OF RECOVERYAGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92-YD-0422-0 Named Insured: NANCY K BOHL INC DBA THE COUNSELING TEAM INTERNATIONAL AND DBA THE ORGANIZATIONAL NETWORK PO BOX 10427 SN BERNRDNO CA 92423-0427 Name And Address Of Person Or Organization: CITY OF EL SEGUNDO ITS OFFICERS OFFICIALS EMPLOYE=ES AGENTS & VOLUNTEERS $50 MAIN ST EL SEGUNDO CA 90245-3895 The following is added to Paragraph 10.b. of SECTION I AND SECTION II — COMMON POLICY CONDITIONS: We waive any right of recovery we may have against the person or organization shown in the Schedule because of payments we make for injury or damage arising out of: a. Your ongoing operations; or b. "Your work" done under contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule. All other policy provisions apply. CMP-4787 ©, Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 92-YD-0422-0 028381 CNIP-4787 < Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY CMP-4787 WAIVER OF TRANSFER OF RIGHTS OF RECOVERYAGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92-YD-0422-0 Named Insured: NANCY K BOI- L INC DBA THE COUNSELING TEAM INTERNATIONAL AND DBA THE ORGANIZATIONAL NETWORK PO BOX 10427 SN BERNRDNO CA 92423-0427 Name And Address Of Person Or Organization: CITY OF EL SEGUNDO ITS OFFICERS OFFICIALS EMPLOYEES AGENTS & VOLUNTEERS 350 MAIN ST EL SEGUNDO CA 90245-3895 The following is added to Paragraph 90.b. of SECTION I AND SECTION II — COMMON POLICY CONDITIONS: We waive any right of recovery we may have against the person or organization shown in the Schedule because of payments we crake for injury or damage arising out of: a. Your ongoing operations; or b. "Your work" done under contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule. All other policy provisions apply. CMP-4787 ©, Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 92-.LB-1426-1 028456 CMP 4786.1 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY. CMP-4786.1 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92-LB-1426.1 Named Insured: NANCY K BOHL INC DBA THE. COUNSELING TEAM INTERNATIONAL AND DBA THE ORGANIZATIONAL NETWORK PO BOAC 10427 SN BERNRDNO CA 92423.0427 Name And Address Of Additional Insured Person Or Organization: 0 MAIN ry EL.. 90245-3895 1. SECTION II — WHO IS AN INSURED of b. If coverage provided to the additional in - SECTION II — LIABILITY is amended to in- sured is required by a contract or agree- clude„ as an additional insured, any person or meat, the Insurance provided to the organization shown in the Schedule, but only additional insured will not be broader than with respect to liability for "bodily in ury" , that which you are required by the contract Opr p rfiy damageN, or "personal and advertis- or agreement to provide for such addition- ing injury" caused, in whole or in part, y: al insured; and a. Ongoing Operations c. if the contract or agreement between you (1) Your acts or omissions; or and the additional insured is governed by (2) The acts or omissions of those acting California Civil Code Section 2782 or 2782.05, the insurance provided to the on your behalf; additional insured is the lesser of that in the performance of your ongoing opera- which: tions for that additional insured; or (1) Is allowed' for the satisfaction of a de- b. Products —Completed Operations b. or indemnity obIigation by Cali - "Your work" performed for that additional fornia Civil Code Section 2782 or insured and included in the "products- 2782.05 for your sole liability; or completed operations hazard". (2) You are required by contract or However, Paragraph 1. above is subject to the agreement to provide for such addi- following: tional insured. a. The insurance afforded to the additional We have no duty to defend or indemnify the insured only applies to the extent permit- additional insured under this endorsement un- "suit" ted by law; til a claim or is tendered to us. d, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CONTINUED 9 -i ,,.1426,,,,1 028456 M 28448 CMP-4786 1 Page 2 of 2 2. Any insurancc: ploOded t,n thr ach:!�Vilcnal in- (3) The nature and location of any injury sured shall only apply with respect to a claim or damage arising out, of the "occur- rnade or a "suit" brought for darnages for rence" or offense; which you are provided coverage, b. Tender the defense and indemnity of any 3. With respect to the insurance afforded to the clairn or "suit" to us and to all other insur- additional insured, the following is added to ers who may have insurance potentially SECTION li — LIMITS OF INSURANCE., available to the additional insured; and If coverage provided to the additional insured c. Agree to make available any other insur- is required by contract or agreement, the most ance the additional insured has for de - we will ay on behalf of true additional insured fense or damages for which we would will be t�e lesser of the amount of insurance: provide coverage under SECTION II — a. Required by the contract or agreement, or LIABILITY. b. Available under the applicable Limits Of 5. With respect to the insurance afforded the ad - ditional Insured, the following replacesSEC- Insurance shown in the Declarations. TION II —LIABILITY of Paragraph 7. Other This endorsement shall not increase the ap- Insurance of SECTION I AND SECTION II — plicable Limits Of Insurance shown in the COMMON POLICY CONDITIONS: Declarations. a. This --insurance is primary to and- will-not- 4. With respect to the insurance afforded to the seek contribution from any other insurance additional insured, the following is added to _ _ _ ;avalable to the additional Insured) provide! Paragraph 3. Duties In The Event Of Occur- il-ia the additiopial insured is a narned in- rence, Offense, Claim Or Suit of SECTION cured under such other insurance, II — GENERAL CONDITIONS: b. Regardless of any agreement between The additional insured must: you and the additional insured, this insur- ance is excess over any other insurance a. See to it that we are notified as soon as whether primary, excess, contingent or on practicable of an "OCCUrrence" or an of- any other basis for which the additional in- fense which may result in a claim. To the sured has been added as an additional in - extent possible, notice should include: sured on other policies. (1) I -low„ when and where the "occur- There will be no refund of premium in the event rence° or offense took place; this endorsement is cancelled. (2) The names and addresses of any in- jured persons and witnesses; and All other policy provisions apply. CM P-4786.1 ©, Ccpayoght, State Farm Mutual Automobile Insurance Company„ 2013 Includes copyrighted mat nal of Insurance SerOoes office, Inc., with its permission. 92-LB-1426.1 028457 C iNP 4786.1 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY CMP-4786.1 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92-LB-1426-1 Named Insured: Name And Address Of Additional Insured Person Or Organization: CITY OF EL SEGUNDO ITS OFFICERS OFFICIALS EMPLOYEES AGENTS & VOLUNTEERS 350 MAIN ST EL SEG'UNDO CA 90245-3895 1. SECTION II — WHO IS AN INSURED of b. If coverage provided to the additional in - SECTION II — LIABILITY is amended to in- sured is required by a contract or agree- clrude, as an additional insured, any person or ment, the insurance provided to the organization shown in the Schedule„ but only additional insured will not be broader than with respect to liability for `bodily injury'' that which you are required by the contract "property damage", or "personal and advertis- or agreement to provide for such addition- Ing injury" caused, in whole or to park, by: al insured; and a. Ongoing Operations c. If the contract or agreement between you (1) Your acts or omissions; or and the additional insured is governed by (2) The acts or omissions of those acting California Civil Code Section 2782 or 2782.05, the insurance provided to the on your behalf; additional insured is the lesser of that in the performance of your ongoing opera- which: tions for that additional insured.„ or (1) Is allowed for the satisfaction of a de- b. Products — Completed Operations fense or indemnity obligation by Cali - "Your work" performed for that additional "products- fornia Civil Code Section 2782 or 2782.05 for your sole liability; or insured and included in the completed operations hazard". (2) You are required by contract or However, Paragraph 1. above is subject to the agreement to provide for such addi- following: tional insured, a. The insurance afforded to the additional We have no duty to defend or indemnify the insured only applies to the extent permit- additional insured under this endorsement un- "suit" ted by law; til a claim or is tendered to us. m, Copyright, State Farris Mutual ALtornobile, insurance Company, 2013 Includes copyrighted matefol or Insurance Services Office, Inc., with its permission. M 28448 CA4P-4786 1 Page 2 of 2 2. Any insurainc provided to the ad "Itlonal in- sured shall or�ly apply with respect to a claim made or a "suit" brought for damages for which you are provided coverage. 3. With respect to the insurance afforded to the additional insured, the following is added to SECTION II — LIMITS OF INSURANCE: If coverage provided to the additional insured is required by contract or agreement„ the most we will ay on behalf of the. additional insured will be t�te lesser of the arnount of insurance. a. Required by the contract or agreement; or b. Available under the applicable Limits Of Insurance shown in the Declarations. This endorsement shall not increase the ap- plicable Limits Of Insurance shown in the Declarations. 4. With respect to the insurance afforded to the _w additional --insured, the following is added to Paragraph 3. Duties In The Event Of Occur- rence, Offense, Claim Or Suit of SECTION II — GENERAL CONDITIONS: The additional insured must: a. See to it that we are notified as soon as practicable of an "occurrence" or an of- fense which may result in a claim, To the extent possible notice should include: (1) l-low„ when and where the "occur- rence" or offense took place; (3) The nature and location of any injulrj or damage arising out of the "occur- rence" or offense; b. Tender the defense and indemnity of any claim or "suit" to us and to all other insur- ers who may have insurance potentially available to the additional insured; and c. Agree to mal: e available any other insur- ance the additional insured has for de- fense or damages for which we would provide coverage under SECTION II — LIABILITY. 5. With respect to the insurance afforded the ad- ditional insured, the following replaces SEC- TIONy, II —LIABILITY of paragraph 7. Other Insurance of SECTION I AND SECTION it — COMMON POLICY CONDITIONS: - a. This insurance is prlwary to and -will not seek contribution from any other insurance available —to the additional insured, provided - that the additional insured is a named in- sured under such other insurance, b. Regardless of any agreement between YOU and the additional Insured' this insur- ance is excess over, any other insurance whether primary„ excess„ contingent or on any other basis for which the additional in- sured has been added as an additional in,- sured on other policies. There will be no refund of premium in the event this endorsement is cancelled. (2) The names and addresses of any in- jured persons and witnesses; and All other policy provisions apply. CMP-4786.1 ©, Cq,.)yroght, state Farm Mutual Automobile In urame CoMpany, 2013 Includes copyrighted mateplal of Insurance services Offk;e. Inc., with its permssion. 92-LB-1426-1 028458 CMP 4787 t,,. w Page 1 of I THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CMP-4787 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92-LB-1426-1 Named Insured: NANCY K BOHL INC DBA THE COUNSELING TEAM INTERNATIONAL AND DBA THE ORGAN IZATIIONAL NETWORK PO BOX 10427 SN BERNRDNO CA 92423-0427 Name And Address Of Person Or Organization: CITY OF EL SEGUNDO ITS OFFICERS OFFICIALS EMPLOYEES AGENTS III VOLUNTEERS 350 MAINS T EL SEGUNDO CA 90245-3895 The following is added to Paragraph 10.b. of SECTION I AND SECTION II — COMMON POLICY CONDITIONS: We waive any right of recovery we may have against the person or organization shown in the Schedule because of payments we make for injury or damage arising out of: a. Your ongoing operations; or b. "Your work" done under contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule. All other policy provisions apply. CM P-4787 ©, Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc„ with its permission. S2-LB-1426-1 028459 CMP-4787 -gym Pane 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY CMP4787 WAIVER OF TRANSFER OF RIGHTS OF RECOVERYAGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92-LB-1426-1 Named Insured: NANCY" IBOHL INC DBA THE COUNSELING TEAM' INTERNATIONAL AND DBA THE ORGANIZATIONAL NETWORK PO BOX 10427 SN BERNRDNO CA 92423-0427 Name And Address Of Person Or Organization: CITY OF EL SEGUNDO ITS OFFICERS OFFICIALS EMPLOYEES AGENTS & VOLUNTEERS 30 MAIN ST EL SEGU'NDO CA 90245-3895 The following is added to Paragraph 10.115. of SECTION I AND SECTION II — COMMON POLICY CONDITIONS: We waive any, right of recovery we may have against the person or organization shown in the Schedule because of payments we male for injury or damage arising out of: a. Your ongoing operations; or b. "Your work" done under contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule. All other policy provisions apply. CMP-4787 m, Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc-, with its permission. G t-11, IL �I�El I, I' 1111 A,. iI Certificate of Liability Insurance Date Issued: 09/07/2021 Underwritten by: Philadelphia Indemnity Insurance Company • One Bala Plaza, Suite 100 • Bala Cynwyd, PA 19004 • NAIC #: 18058 Administered by: CPH & Associates • 711 S. Dearborn St. Ste 205 • Chicago, IL 60605 • P 800.875.1911 • F 312.987.0902 • info@cphins.com DISCLAIMER: This certificate is issued as a matter of information only and confers no rights upon the certificate holder. The Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend, or alter the coverage afforded by the policies listed thereon. Insured: Nancy K. BON Inc. dba The Counseling Policy Number: 025826 Team International Nancy Bohl Policy Term: 08/31/2021 to 08/31/2022 1881 Business Center Drive #11 San Bernardino, CA 92408 Covered Locations Professional Liability: Portable coverage, not location specific Coverage Type Per Incident Aggregate (Occurrence Form) (Per individual claim) (Total amount per year) Professional Liability $ 1,000,000 $ 5,000,000 Supplemental Liability $ 1'000,000 $ 5,000,000 Licensing Board Defense $ 35,000 $ 35,000 Commercial General N/A NIA Liability N/A NIA Fire/Water Legal Liability Business Personal Property N/A NIA Certificate Holster El Segundo Police Department 348 Main Street El Segundo, CA 90245 ® Certificate Holder has been added as an additional insured If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). Notice of Cancellation will only be provided to the first named insured in accordance with policy provisions, who shall act on behalf of all additional insureds with respect to giving notice of cancellation. Authorized Representative C. Philip Hodson l::-1 F)ll iCP_05 (03/01) Additional Insured Endorsement This endorsement modifies insurance provided under the following: ALLIED HEALTHCARE PROVIDER PRO SIONAL AN919ERLEMENIALUAMUMMURANCE POLICY In consideration of the premium paid, this policy is amended as follows: El Se uund Police De meat, is hereby added as an Additional Insured, solely for Damages arising out of a Professional Incident covered under this policy. The Professional Incident must arise out of services provided by the Insured, under contract with El Step do Police Dte artment. Additional Insured Name and Mailing Address: El Segundo Police Department 348 Main Street El Segundo, CA, 90245 All other terms and conditions of this policy remain unchanged. Policy #: 025826 Effective on or after: 08/31/2021 Issued to: Nancy K. Bohl Inc. dba The Counseling Team International Expiration date: 08/31/2022 POLICYHOLDER COPY SIP P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 08-12-2021 EL SEGUNDO POLICE DEPARTMENT SIP 348 MAIN ST EL SEGUNDO CA 90245-3813 GROUP: POLICY NUMBER: 0702751-2021 CERTIFICATE ID: 94 CERTIFICATE EXPIRES: 08-12-2022 08-12-2021/08-12-2022 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2019-08-12 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: EL SEGUNDO POLICE DEPARTMENT ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 08-12-2011 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2021-08-12 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: EL SEGUNDO POLICE DEPARTMENT ENDORSEMENT #1651 - NANCY K BOHL, P,S,T - EXCLUDED. EMPLOYER NANCY K BOHL INC SP 1881 BUS CTR DR STE 11 SAN BERNADINO CA 92408 M0410 PRINTED : 07-15-2021 (REV.7-2014) ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION 702761-21 RENEWAL SP 2-47-86-99 PAGE 1 HOME OFFICE SAN FRANCISCO EFFECTIVE AUGUST 12, 2021 AT 12.01 A.M. AND EXPIRING AUGUST 12, 2022 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME NANCY K BOHL INC 1881 BUS CTR DR STE 11 SAN BERNADINO, CA 92408 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, EL SEGUNDO POLICE DEPARTMENT WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, NANCY K BOHL INC IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER. IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH EMPLOYEES SHALL BE INCREASED BY 03%. NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: 2570 AUTHORIZED REPRESENT IVE AUGUST 25, 2021 PRESIDENT AND CEO