Press Alt + R to read the document text or Alt + P to download or print.
This document contains no pages.
PROOF OF INSURANCE (2022 - 2022) CLOSEDClient#: 444977 KNNPUBLI
ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
8/18/2021
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: Ifthecertificate 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 any rights to the certificate holder in lieu of such endorsement(s).
PRODUCER NEE: Felicia McAroy
Marsh & McLennan Agency LLC PHONE 925 482 9337 `X 925-482-9390
-LLC naP, E G .,. _
Marsh &McLennan Ins Agency LLC ADDRESS, Felicia.Mc:Aroy@MarshM!MA.com
1340 Treat Blvd #250
INSUR_ER(S) AFFORDING COVERAGE NAIC #
Walnut Creek, CA 94597 "
Hanover Insurance Com an �22292
INSURED
KNN Public Finance LLC
2054 University Avenue #300
Berkeley, CA 94704
P Y
INSURER B : Gemini Insurance Company 10833
_ _ .....................u..,
INSURER C _.._...............................��
INSURER D :
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,
6NSR ADDLSUBR POLICYEFF POLICYEXP".
Fi. TYPE OF INSURANCE INR gJarVD POLICY NUMBER (MMrDDrYYYY) MM/DD/YYYY)_ LIMITS
A )( COMCLAIMS CMERCIAL LAIMS-MADE AL LIABILITY
T X OHFD50198804 8/19/2021 01/19/202 DAMAGE OC � RENTED CE $,1 000,000
I I � _
$1 A000'000 _
MED EXP (Any one person)_ $10 000
PERSONAL & ADV INJURY $1 .000.000
GEN'LAGGREGATE LIMIT APPLIESPER:
X� POLICY � PRO-
JECT � � LOC
.. .... I
GENERALAGGREGATE $2
... _... OP AGG s
PRODUCTS COMP/ �2
OTHER:
$
A
AUTOMOBILE LIABILITY -
AU
I OHFD50198804
8/19/2021
08/19/202:r,den
l a 1
ANY AUTO
BODILY INJURY (Per person) $
JI OWNED SCHEDULED
AUTOS ONLY AUTOS
XHIRED �, NON -OWNED
f AUTOS ONLY 1 X AUTOS ONLY
BODILY INJURY (Per accident) I $
'PROPER"��'Y DR1IuGA4)(~:
„,Pmr kScrstl,&s't�, $
$
I
A
UMBRELLA LIAB
Xf X_, OCCUR
OHFD50198804
8/19/2021
/19/202
08- 9/2
EACH OCCURRENCE
$2
1, EXCESS LIAB CLAIMS -MADE
AGGREGATE
$2
WORKERS
PER OTH_
Y/N
A
ANNDEMPLOYERSELPABILTY X
NY R9ETORJPARTRVLRPE ECUTIVE$
0.' fFIC.ERJMEMBER EXCLUDED? �
N / A_
E.L. EACH
ACCIDENT
[$
(MarWalory In NH)
E.L. DISEASE - EA EMPLOYEE
yes, describe under
if _
- POLICY LIMIT
B
Errors & Omission
........
VCPL066959
_ .-------
8/19/2021
. .............. ....w,..,,E,.L..DISEASE
I08/19/202
,..
$2,000,000 Per Claim
$2,000,000 Aggregate
$50,000 Deductible
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached.. more space is required)
City of El Segundo, its officials and employees are included as Additional Insured (General Liability), per
the attached.
City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
y g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Attn: Joseph Lillio ACCORDANCE WITH THE POLICY PROVISIONS.
350 Main Street
El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE
©1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S8601657/M8601522 WBFZM
INSURED: KNN Public Finance LLC
POLICY#: OHFD50198804 POLICY PERIOD- 08119/2021TO: 08/19i2022-
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BUSINESSOWNERS LIABILITY SPECIAL BROADENING ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS COVERAGE FORM
..............
SUMMARY OF COVERAGES
m _........
Limits
. -�-----------
Page
1.
Additional Insured by Contract, Agreement or Permit
Included
1
2.
-,o ................ . �.._,,,,,.w„ ............ _.��._
Additional Insured - Broad Form Vendors
Included
_
w � ........
3.
m. _ ... _ __ - . ..........
Alienated Premises
_._ ... ......
Included
J_..��
3
4.
_...,,._, ..,._. ............. _
Broad Form Property Damage - Borrowed Equipment,�Custmomers
Included
3
Goods and Use of Elevators
5.
Incidental Malpractice- (Employed Nurses; EMT�s arrd-P
Paramedics)
_..
Included
_
3
6.
Personal and Advertising Injury - Broad Form
Included
4
7.
��.......� ................ ____m.........................................�.�.�.........�
Product Recall Expense
Included
__
4
.,.........Product
....
...Expense EOccurrencem.n.�.�.................................................................
...Recall Each Limit
. � �....-u�renc....-.,.,.
Occurrence
e
Product Recall Expense .................. .imi
Aggregate Limit
$50,000
5
Aggregate
to
Product Recall Deductible
$500
5
�.._.
8.
,..._...... .�w-._-_ ......... ..�....
Unintentional Failure to Disclose Hazards
_._w....._
Included
__,m-..................._
....�
6
9..�.�_
__-_ _ .., .�� .....-..w...._.. __.._.,,,..__ .._
Unintentional Failure to Notify
�.......
Included
6
This
endorsement amends coverages provided under the Businessowners Coverage Form through new
coverages
and broader coverage grants. This coverage is subject to
the provisions
applicable to the
Businessowners Coverage Form, except as provided below.
The following changes are made to SECTION II -
LIABILITY:
1. Additional Insured by Contract, Agreement or
Permit
The following is added to SECTION II -
LIABILITY, C. Who Is An Insured:
Additional Insured by Contract, Agreement or
Permit
a. Any person or organization with whom you
agreed in a written contract, written
agreement or permit to add such person or
organization as an additional insured on
your policy is an additional insured only with
respect to liability for "bodily injury",
""property damage", or "personal and
advertising injury" caused, in whole or in
part, by your acts or omissions, or the acts
or omissions of those acting on your behalf,
but only with respect to:
(1) "Your work" for the additional insured(s)
designated in the contract, agreement or
permit;
(2) Premises you own, rent, lease or
occupy; or
(3) Your maintenance, operation or use of
equipment leased to you.
b. The insurance afforded to such additional
insured described above:
(1) Only applies to the extent permitted by
law; and
(2) Will not be broader than the insurance
which you are required by the contract,
agreement or permit to provide for such
additional insured.
(3) Applies on a primary basis if that is
required by the written contract, written
agreement or permit.
(4) Will not be broader than coverage
provided to any other insured.
(5) Does not apply if the "bodily injury"
"Yproperty damage" or "personal and
advertising injury°is otherwise excluded
from coverage under this Coverage Part,
including any endorsements thereto.
391-1006 08 16 Includes copyrighted materials of Insurance Services Offices, Inc., with its permission. Page 1 of 6
INSURED: KNN Public Finance LLC
POLICY#: O H F D 50198804
POLICY PERIOD: 08/19/2021 TO: 08/19/2022
c. This provision does not apply:
(1) Unless the written contract or written
agreement was executed or permit was
issued prior to the "bodily injury"
""property damage", or ""personal injury
and advertising Injury".
(2) To any person or organization included
as an insured by another endorsement
issued by us and made part of this
Coverage Part.
(3) To any lessor of equipment:
(a) After the equipment lease expires; or
(b) If the "bodily injury", "property
damage",." "personal and advertising
injury"' apses out of sole negligence
of the lessor,
(4) To any:
(a) Owners or other interests from whom a.
land has been leased if the
.'occurrence" takes place or the
offense is committed after the lease
for the land expires; or
(b) Managers or lessors of premises if:
(1) The "occurrence" takes place or
the offense is committed after
you cease to be a tenant in that
premises; or
(ii) The "bodily injury", "property
damage"" "personal Injury" or
"advertising Injury" arises out of
structural alterations, new
construction or demolition
operations performed by or on
behalf of the manager or lessor.
(5) To "bodily in "property damage"" or
personal and advertising injury arising
out of the rendering of or the failure to
render any professional services.
This exclusion applies even if the claims
against any insured allege negligence or
other wrongdoing in the supervision,
hiring„ employment, training or
monitoring of others by that insured, if
the "occurrence" which caused the
"bodily injury" or "property damage" or
the offense which causedthe ""personal
and advertising injury" involved the
rendering of or fai�ure to render any
professional services by or for you.
d. With respect to the insurance afforded to
these additional insureds, the following is
added to SECTION II - LIABILITY, D. Liability
and Medical Expense Limits of Insurance:
The most we will pay on behalf of the
additional insured for a covered claim is the
lesser of the amount of insurance:
1. Required by the contract, agreement or
permit described in Paragraph a.; or
2. Available under the applicable Limits of
Insurance shown in the Declarations.
This endorsement shall not increase the
applicable Limits of Insurance shown in the
Declarations
e. All other insuring agreements,, exclusions,
and conditions of the policy apply.
2. Additional Insured - Broad Form Vendors
The following is added to SECTION II -
LIABILITY, C. Who Is An Insured:
Additional Insured - Broad Form Vendors
Any person or organization that is a vendor
with whom you agreed in a written contract
or written agreement to include as an
additional insured udder this Coverage Part
is an insured„ but only with respect to liability
for "bodily injury" or "property damage"
arising out of "your products" which are
distributed or sold In the regular course of
the vendor's business.
b. The insurance afforded to such vendor
described above:
(1) Only applies to the extent permitted by
I aw;
(2) Will not be broader than the insurance
which you are required by the contract or
agreement to provide for such vendor;
(3) Will not be broader than coverage
provided to any other insured; and
(4) Does not apply if the "bodily injury",
"property damage" or ""personal and
advertising injury" is otherwise excluded
from coverage under this Coverage Part,
I
ncluding any endorsements thereto
C. With respect to insurance afforded to such
vendors, the following additional exclusions
apply„
The insurance afforded to the vendor does
not apply to:
(1) "Bodily injury" or "property damage" for
which the vendor Is obligated to pay
damages by reasons of the assumption of
Viability in a contract or agreement. This
exclusion does not apply to liability for
darnages that the Insured would have in
the absence of the contract or
agreement;
(2) Any express warranty unauthorized by
you;
391-1006 08 16 Includes copyrighted materials of Insurance Services Offices, Inc., with its permission. Page 2 of 6
INSURED: KNN Public Finance LLC
POLICY#: OHFD50198804
(3) Any physical or chemical change in the
product made intentionally by the
vendor;.
(4) Repackaging, unless unpacked solely for
the purpose of Inspection„
demonstration, testing, or the
substitution of parts under instruction
frown the manufacturer, and then
repackaged in the original container;
(5) Any failure to make such inspection,
adjustments, tests or servicing as the
vendor has agreed to make or normally
undertakes to make in the usual course
of business in connection with the sale
of the product;
(6) Demonstration, installation, servicing or
repair operations, except such
operations performed at the vendor's
premises in connection with the sale of
the product;
(7) 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
su stance by or for the vendor;
(8) "Bodily injury" or "property damage"
arising out of the sole negligence of the
vendor for its own acts or omissions or
those of its employees or anyone else
acting on its behalf. However, this
exclusion does not apply to:
(a) The exceptions contained within the
exclusion in subparagraphs (4) or (6)
above; or
(b) Such inspections, adjustments, tests
or servicing as the vendor has
agreed to make or normally
undertakes to make in the usual
course of business, in connection
with the distribution or sale of the
products.
(9) "Bodily injury" or "property damage"
arising out of an "occurrence" that took
place before you have signed the
contract or agreement with the vendor.
(10)To any, person or organization included
as an insured by another endorsement.
issued by us and made part of this
Coverage Part
(11)Any insured person or organization,
from whom you have acquired such
products, or any Ingredient„ part or
container„ entering into, accompanying
or containing such products.
POLICY PERIOD: 08/19/2021 TO: 08/19/2022
The most we will pay on behalf of the vendor
for a covered claim is the lesser of the
amount of insurance:
1. Required by the contract or agreement
described in Paragraph a.; or
2. Available under the ap licable Limits of
Insurance shown in the Declarations;
This endorsement shall not increase the
applicable Limits of Insurance shown in the
Declarations.
3. Alienated Premises
SECTION II - LIABILITY, B. Exclusions, 1.
Applicable To Business Liability Coverage k.
Damage to Property, paragraph (2) is replaced by
the following:
(2) Premises you sell, give away or abandon, if
the "property damage" arises out of any part
of those premises and occurred from hazards
that were known by you, or should have
reasonably been known by you, at the time
the property was transferred or abandoned.
4. Broad Form Property Damage - Borrowed
Equipment, Customers Ooods, Use of Elevators
a. The following is added to SECTION 11 -
LIABILITY, B. Exclusions, 1. Applicable To
Business Liability Coverage, k.. Damage to
Property:
Paragraph (4) does not apply to "'property
damage„` to borrowed equipment while at a
jobsite and not being used to perform
operations.
Paragraph (3), (4) and (6) do not apply to
"property damage" to "customers goods"
while on your premises nor to the use of
elevators.
b. For the purposes of this endorsement, the
followin definition is added to SECTION' II -
LIABILIN F. Liability and Medical Expenses
Definitions:
1. "Customers goods" means property of
your customer on your premises for the
purpose of being:
a. Worked on; or
b. Used in your manufacturing process.
c. The insurance afforded under this provision is
excess over any other valid and collectible
property insurance (including deductible)
available to the insured whether primary,
excess, contingent or on any other basis.
5. Incidental Malpractice - Employed Nurses, EMT's
and Paramedics
d. With respect to the insurance afforded to SECTION II - LIABILITY, C. Who Is An Insured ,
these vendors, the following is added to paragraph 2.a.(1)(d) does not apply to a nurse,
SECTION 11 - LIABILITY, D. Liability and
Medical Expense Limits of Insurance:
391-1006 08 16 Includes copyrighted materials of Insurance Services Offices, Inc., with its permission„ Page 3 of 6
INSURED: KNN Public Finance LLC
POLICY#: OHFD50198804 POLICY PERIOD: 08/19/2021 TO: 08/19/2022
emergency medical technician, or paramedic o. Recall of Products, Work or Impaired
employed by you if you are not engagedin the Property is replaced by the following:
business or occupation of providing medical,
paramedical, surgical, dental, x-ray or nursing o. Recall of Products, Work or Impaired
services. Property
6. Personal Injury - Broad Form
a. SECTION II - LIABILITY, B. Exclusions, 2.
Additional Exclusions Applicable only to
"Personal and Advertising Injury", paragraph
e. is deleted.
b. SECTION 11 - LIABILITY, F. Liability and
Medical Expenses Definitions, 14. "Personal
and advertising injury", paragraph b.. is
replaced by the following:
b. Malicious prosecution or abuse of
process.
c. The following is added to SECTION If -
LIABILITY, F. Liability and Medical Expenses
Definitions, Definition 14. ""Personal and
advertising injury":
"Discrimination" (unless insurance thereof is
prohibited by law) that results in injury to the
feelings or reputation of a natural person,
but only if such "discrimination" is:
(1) Not done intentionally by or at the
direction of:
(a) The insured;
(b) Any officer of the corporation,
director, stockholder, partner or
member of the insured; and
(2) Not directly or indirectly related to an
"employee"", not to the employment,
prospective employment or termination
of any person or persons by an insured.
d. For purposes of this endorsement, the
following definition is added to SECTION II -
LIABILITY, F. Liability and Medical Expenses
Definitions:
1. "Discrimination" means the unlawful
treatment of individuals based upon race,
color, ethnic origin, gender, religion, age,
or sexual preference. "Discrimination"
does not include the unlawful treatment
of individuals based upon developmental,
physical, cognitive, mental, sensory or
emotional impairment or any
combination of these.
e. This coverage does not apply if liability
coverage for "personal and advertising
injury" rs excluded either by the provisions of
the Coverage Form or any endorsement
thereto.
Damages claimed for any loss, cost or
expense incurred by you or others for
the loss of use, withdrawal, recall,
inspection, repair, replacement,
adjustment, removal or disposal of:
(1) "Your product';
(2) "Your work"; or
(3) "Impaired property";
If such product, work or property is
withdrawn or recalled from the market or
from use by any person or organization
because of a known or suspected defect,
deficiency, inadequacy, or dangerous
condition in it, but this exclusion does
not apply to "product recall expenses"
that you incur for the "covered recall" of
"your product".
However, the exception to the exclusion
does not apply to "product recall
expenses" resulting from:
(4) Failure of any products to accomplish
their intended purpose;
(5) Breach of warranties of fitness,
quality, durability or performance;
(6) Loss of customer approval, or any
cost incurred to regain customer
approval;
(7) Redistribution or replacement of
"your product" which has been
recalled by like products or
substitutes;
(8) Caprice or whim of the insured;
(9) A condition likely to cause loss of
which any insured knew or had
reason to know at the inception of
this insurance;
(10)Asbestos, including loss, damage or
clean up resulting from asbestos or
asbestos containing materials; or
(11)Recall of "your products" that have
no known or suspected defect solely
because a known or suspected
defect in another of "your products""
has been found..
b. The following is added to SECTION II -
LIABILITY, C. Who Is An Insured, paragraph
3.b.:
7. Product Recall Expense "Product recall expense" arising out of any
a. SECTION II - LIABILITY, B. Exclusions, 1. withdrawal or recall that occurred before you
Applicable To Business Liability Coverage, acquired or formed the organization.
391-1006 08 16 Includes copyrighted materials of Insurance Services Offices, Inc., with its permission. Page 4 of 6
INSURED: KNN Public Finance LLC
POLICY#: OHFD50198804 POLICY PERIOD: 08/19/2021 TO: 08/19/2022
c. The following is added to SECTION II - of a deductible amount, you shall
LIABILITY', D. Liability and Medical Expenses promptly reimburse us for the part of the
Limits of Insurance: deductible amount we paid.
Product Recall Expense Limits of Insurance
a. The Limits of Insurance shown in the
SUMMARY OF COVERAGES of this
endorsement and the rules stated below
fix the most that we will pay under this
Product Recall Expertise Coverage
regardless of the number of:
(1) Insureds;
(2) "Covered Recalls" initiated; or
(3) Number of "your products"
withdrawn.
b. The Product Recall Expense Aggregate
Limit is the most that we will reimburse
you for the sum of all "product recall
expenses" incurred for all "covered
recalls" initiated during the policy period.
c. The Product Recall Each Occurrence
Limit is the most we will pay in
connection with any one defect or
deficiency.
d. All to product recall expenses'" in
connection with substantially the same
general harmful condition will be
deemed to arise out of the same defect
or deficiency and considered one
"occurrence".
e. Any amount reimbursed for "product
recall expenses" in connection with any
one "occurrence" will reduce the amount
of the Product Recall Expense Aggregate
Limit available for reimbursement of
"product recall expenses" in connection
with any other defect or deficiency.
f. If the Product Recall Expense Aggregate
Limit has been reduced b
reimbursement of "product recall
expenses" to an amount that is less than
the Product Recall Expense Each
Occurrence Limit, the remaining
Aggregate Limit is the most that will be
available for reimbursement of "product
recall expenses' in connection with any
other defect or deficiency,
g. Product Recall Deductible
We will only pay for the amount of
product recall expenses" which are in
excess of the $500 Product Recall
Deductible. The Product Recall
Deductible applies separately to each
"covered recall". The limits of insurance
will not be reduced by the amount of this
deductible.
We may, or will' it required by law" pay all
or any part of any deductible amount, if
applicable. Upon notice of our payment
The Product Recall Expense Limits of
Insurance apply separately to each
consecutive annual period and to any
remaining period of less than 12 months,
starting with the bening of the policy
period shown in the Dgineciarations, unless the
poll cy eriod is extended after issuance for
an addiitional period of less than 12 months.
In that case, the additional period will be
deemed part of the last preceding, period for
the purposes of determining the Limits of
Insurance..
d. The following is added to 'SECTION II -
LIABILITY, E. Liability and Medical Expense
General Conditions, 2. Duties in the Event of
Occurrence, Offense, Claim or Suit:
You must see to it that the following are
done in the event of an actual or anticipated
"covered recall" that may result in "product
recall expense,":
(1) Give us prompt notice of any discovery
or notification that "your product" must
be withdrawn or recalled.. Include a
description of "your product" and the
reason for the withdrawal or recall;
(2) Cease any further release, shipment,
consignment or any other method of
distribution of like or similar products
until it has been determined that all
such products are free from defects that
could be a cause of loss under this
insurance.
e. For the purposs of this endorsement, the
following definitions are added to SECTION
II - LIABILITY, F. Liability and Medical
Expenses Definitions:
1. "Covered recall" means a recall made
necessary because you or a government
body has determined that a known or
suspected defect, deficiency,
inadequacy„ or dangerous condition in
'.your product" has resulted or will result
in "bodily injury" or ""property damage"
2. "Product recall expense(s)" means:
a. Necessary and reasonable expenses
for:
(1) Communications, including radio
or television announcements or
printed advertisements including
stationary, envelopes and
postage;
391-1006 08 16 Includes copyrighted materials of Insurance Services Offices, Inc., with its permission. Page 5 of 6
INSURED: KNN Public Finance LLC
POLICY#: OHFD50198804
POLICY PERIOD: 08/19/2021 TO: 08/19/2022
(2) Shipping the recalled products
from any purchaser, distributor or
user to the place or places
designated by you;
(3) Remuneration paid to your
regular "employees" for
necessary overtime;
(4) Hiring additional persons, other
than your regular "employees";
(5) Expenses incurred by "employees" 8.
including transportation and
accommodations;
(6) Expenses to rent additional
warehouse or storage space;
(7) Disposal of "your product", but
only to the extent that specific
methods of destruction other than
those employed for trash
discarding or disposal are 9.
required to avoid "bodily injury""
or "°property damage" as a result
of such disposal,
you incur exclusively for the purpose
of recalling "'your product'; and
b. Your lost profit resulting from such
"covered recall".
f. This Product Recall Expense Coverage does
not apply:
(1) If the :products - completed operations
hazard"' is excluded from coverage under
this Coverage Part including any
endorsement thereto; or
(2) To "product recall expense" arising out of
any of "your products" that are otherwise
excluded from coverage under this
Coverage Part including endorsements
thereto,
Unintentional Failure to Disclose Hazards
The following is added to SECTION II -
LIASILITY, E. Liability and Medical Expenses
General Conditions:
Representations
e will not disclaim coverage under this
Coverage Part if you fail to disclose all hazards
existing as of the inception date of the policy
provided such failure is not intentional.
Unintentional Failure to Notify
The following is added to SECTION II -
LIASILITY, E. Liability and Medical Expenses
General Conditions, 2. Duties in the Event of
Occurrence, Offense, Claim or Suit:
Your rights afforded under this Coverage Part
shall not be prejudiced if you fail to give us
notice of an "occurrence", offense, claim or "suit"
solely due to your reasonable and documented
belief that the "bodily injury"" ""properly damage"''
or "personal and advertising injury" is not
covered under this Policy.
ALL OTHER TERMS, CONDITIONS, AND EXCLUSIONS REMAIN UNCHANGED.
391-1006 08 16 Includes copyrighted materials of Insurance Services Offices, Inc., with its permission. Page 6 of 6
40 DATE (MMIDONYYY)
CERTIFICATE OF LIABILITY INSURANCE 06/14/2021
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(iies) 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 =OWTA_C�
Doug Jones PHONE -4177 1AX 411, 951-4266
'411, 151
mvc-mv, ............. . .. . . .
c/o Artex Risk Solutions, Inc. E-MAIL
8840 E. Chaparral Rd.; Suite 275 ADDRESS S D L. BS D Certificates@artex risk -com
... . . . . ...... . . . . . ....... . . . . ............ . ..... . ............... . . .....
Scottsdale, AZ 85250 IN URER(S) AFFORDING COVERAGE NAIC #
. . .... . .......... ..... . ........... . . ... .. ...
INSURER A: American Zurich Insurance ComDanv 40142
INSURED ' INSURER B:
TriNet HR IV, LLC Labor Contractor, for co -employees of: KNN Public Finance, LLC
One Park Place Suite 600 INSIUIRIER,C:
Dublin, CA 94568 INSURER P11_ . .........................
INSURER, E:
COVERAGES CERTIFICATE NUMBER:21NY605912196 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,
fF...... ---------- — ------ _POLf6_ft)(P- ' ' ' " 1 1-11,11111--- ___ 1111111111111-111 ............
sv. ..... . . ...................... . . ............................. ......... . . . ............... — ... ........ ... 74661�NOA
LTR TYPEOFINSURANCE !O—LICYN.UMBERLINpTS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE I's
CLAIMS MADE OCCUR (.WSE .......... .
- ___ I S ...... --- — -- ....... ...
GEN'L AGGREGATE LIMIT APPLIES PER
POLICY DLICY Ppg
JECT
r LOG
OCHER
AUTOMOBILE LIABILITY
ANY AUTO
OWNED
SCHEDULED
AUTOS ONLY
AUTOS
HIRED
NON -OWNED
....... .. . J AUTOS ONLY
AUTOS ONLY
UMBRELLA LIAB OCCUR
EXCESS LIAB
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANYPCIOPRIETOR/PART I'BER/EXFrUrIVE
-O'
A OFFICE-R/MEEN ? MBEREXCLU
D NIA
(Mandatory in NH)
11 vas. describe under
MED EXP fhiy one pcimri
PERSONAL & ADV INJURY
GENERAL Arc" GREGA7E
I , - - --
1 11 .111111_1_1M ...... .. ............
PRODUCTS - COMP/OP AGO
--- I I I .... 111111 ------------
5
JE................
BODILY INJURY (Per Person)
$
BODILY INJURY (Per acciderfl)
rir0pantYDAMAdE
. ..........
EACH OCCURRENCE
AGGREGATE
i Is
X , "" P!i
sTA;TE UT , E
WC 16-62-791-06 07/01/2021 07/0112022 ......... . . . .
E.L. DISEASE - EA EMPI-0YEE
E I_ DISFASE, POLICY LIMIT S
Location Coverage Period: 107/01/2021 07/01/20221 Client# 9FYK-CA
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
coverage is provided for KNN Public Finance, LLC
2054 University Avenue Suite 300
01, but not subcontractors Berkeley, CA 94704
to:
CERTIFICATE HOLDER
City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
350 Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Attention: Joseph LINO ACCORDANCE WITH THE POLICY PROVISIONS.
El Segundo, CA 90245
AUTHORIZED REPRESENTATIVE
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are reciistered marks of ACORD 2'of2 0712
WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT — CALIFORNIA
WC 04 03 06
(Ed. 4-84)
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 per-
form 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 .lob Description
IN FAVOR OF: Waiver of subrogation is granted to City of El Segundo where required
City of El Segundo by written contract.
350 Main Street
Attention: Joseph Lillio
El Segundo, CA 90245
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.
(The Information below is required only when this endorsement is issued subsequent to preparation of the policy.)
Endorsement Effective: 07/31/2020 Policy No: WC 16.62-791-05 Endorsement No:
Insured: TriNet HR IV, LLC Labor Contractor, for co -employees of: KNN Public Finance, LLC
909 Third Ave FI 10
Insurance Company: American Zurich Insurance Company Countersigned by
WC 04 03 06
Copyright 1983 National Council on Compensation Insurance