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PROOF OF INSURANCE (2022 - 2023) CLOSEDDATE (MMIDDrC) REY CERTIFICATE OF LIABILITY INSURANCE 01/07/2022 M 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 enclorsement(s). PRODUCER KI X/E 1M0A IAKIA I ir'44 f)n777r_a CO�Z NTACT t- - InArsii STE PHONE FAX 3617 MARCONI AVE Wr"O'Extt P1,6)_920-,28. .. . . . . . . ......... . .... ......... . . .... 92011-2811 SACRAMENTO, CA 95821-5309 ErMAIL 1 9kp@ptatefanm corn .......................... INSURER(S� AFFORDING NAIC# .......... . . . .......... . ............... . INSURER A: state Farm General Insurance C,p,mpqpy ... . ........... 25151 INSURED DONNOE & ASSOCIATES INC INSURER B:-State Farm Fire -and Casualty Company ................................................. ............ ?5j 4� 10940 FAIR OAKS BLVD STE 700 INSURER C ...... . ........... FAIR OAKS, CA 95628 INSURER E . . ....................... ..... . . . . . . . I INSURER F: —1 rf1VI=RAr.1=_q rFPTIFIrATF NI1MRFR-(.itwofFI R.nEondn REVISION NUMRFR- n1n79n99 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. NS_ Abbt. dfiSk ........ . . . . ... tI-1 I ....... . ..... P I OLCY FF PO0 Y EXP LTRRTYPE OF INSURANCE POLICY NUMBER �MM,.I.,�,) JMMDDYyyy� LIMITS A GENERAL LIABILITY Y N 90-CS-QO46-2 03/2312021 03123/2022 EACH OCCURRENCE S 2.000,000 X COMMERCIAL GENERAL LIABILITY 16 D AMAGE PRr �M*SE$ (E4RENItb i, uyanpo) 300,000 .......... . . . X CLAIMS -MADE OCCUR MED EXP (Any one person) .......... . s 5,000 , ........... . . .. . . PERSONAL & ADV INJURY s 0 ............. .. ........ GENERAL AGGREGATE S 4.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMPIOP AGG S 4,000,000 -------------- X POLICY J%Iclil $ .. ....--LOC c AUTOMOBILE LIABILITY N01 (Eaarud�.Pl____ -- - - — ------- ANY AUTO BODILY INJURY (Per person) ............... • ALL OWNED SCHEDULED ......... . . _ BODILY INJURY (Per accident) AUTOS AUTOS $ NON -OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS r,,i is a de n q UMBRELLA LIAB OCCUR .......... 1:1 E] 1�,OCCURRENCE S EXCESS LIAB CLAIMS -MADE AGGREGAJ E . ....................... .............................. S DIED RETENTION S S B WORKERS COMPENSATION WCSIATU- 07H- AND EMPLOYERS' LIABILITY YIN 90-EV-BO91-9 03/23/2021 03/23/2022 _ FR ANY PROPRIETOR' OFFICE/MEMBER EXCLUDED? FY-1 N/A H E L, EACH ACCIDENT S 1,000,000 (Mandatory in NH) EL DISEASE - EA EMPLOYEE S 1,000,000 .. ...... . . If yes, describe under LIJ4RATIONS betim E.L. DISEASE - POLICY LIMIT S 1,000.000 OF], DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Additional Insured endorsement will be processed directly by the main office. A request to add City of El Segundo as an additional insured has been submitted to the main office: City of El Segundo its officers, officials, employees, agents, representatives, and certified volunteers 350 Main Street I Segundo, CA 90245 Attention: Human Resources Dept UILK I IFIL;A 11- MULUILK LANLrLLA I lUtNI City of El Segundo 350 Main Street El Segundo, CA 90245 Attention: Human Resources Dept SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 01/07/2022 9 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 1001486 132849.6 11-15-2010 r't H I SCOX HISCOX INSURANCE COMPANY INC. (A Stock Company) em°t=Air' tm e cotjilrage104 South Michigan Avenue, Suite 600, Chicago, Illinois 60603 (914)273-7400 Professional Liability Errors & Omissions Insurance Declarations This is a "Claims Made and Reported" Policy in which Claim Expenses are included within the Limit of Liability unless otherwise noted. Those words (other than the words in the captions) which are printed in Boldface are defined in the Policy. Declaration Effective Date: Policy No.: Renewal of: 1. Named Insured: 2. Address: Email Address: 3.A. Limit of Liability: 3.13. 4. Deductible: 5. Notice: 6. Policy period: March 1, 2022 P100.128.884.2 UDC4751566-EO-21 ..._....... Donnoe &Associates, Inc 10940 Fair Oaks Blvd Suite 700 Fair Oaks, CA 95628 exams@donnoe.com $1,000,000 Each Claim $2,000,000 Aggregate for all Claims $500 Each Claim Phone: 866-424-8508 Email: reportaclaim@hiscox.com Mail: Hiscox 520 Madison Avenue-32nd Floor Attn: Direct Claims New York, NY, 10022 From: March 1, 2022 To: March 1, 2023 At 12:01 A.M. (Standard Time) at the address shown above. 7. Retroactive Date: October 1, 1987 8. Premium: $1,627.00 9. Attachments: DPL D001 CW (11/19) - Professional Liability Errors & Omissions Insurance Declarations DPL P001 CW (05/13) - Professional Liability Coverage Form DPL E5424 CW (02115) - Blanket Additional Insured Endorsement DPL E5015 CW (01110) - Human Resources Services Endorsement DPL E5102 CA (01/10) - California Amendatory Endorsement INT N003 CW (01119) - Policyholder Notice Electronic Delivery INT N001 CW (01/09) - Economic And Trade Sanctions Policyholder Notice DPL D001 CW (11/19) Page 1 I CERTIFICATE OF LIABILITY INSURANCE DATE (MMlDDNYYY) 01/15/2022 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 ri hts to the certificate holder In lieu of such Endorsements . PRODUCER CONrc Hiscox Inc. d/b/a/ Hiscox Insurance Agency in CA PHONE FA,X N Ya- () 883 202-3007 f 520 Madison Avenue E-MAIL 32nd Floor AD R conlacl hiscox.corn New York, New York 10022 1NSURER(S)AFFORDINGCOVERAQE NA1CN INSURED Donnoe & Associates, Inc 10940 Fair Oaks Blvd Suite 700 Fair Oaks, CA 95628 INSURER C : INSURER D : INSURER £ Hiscox Insurance COmDanv Inc COVERAGES CERTIFICATE NUMRFR! RFV1SInIJ Ni1MaFR- 10200 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. ILTR TYPEOF INSURANCE O POLICY NUMBER MMf00Y EFF mm CY .• j LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE PRFM9^TO-AE• 7 $ S MED EXP (Any one Parson) S ----- .., .,. .... ... PERSONAL & ADV INJURY ....................................................m. S GEN1 AGGREGATE LIMIT APPLIES PER POLICY PRIE T LOC ._.. GENERAL AGGREGATE PRODUCTS - COMPIOP AGG .......... _ $ $ O rHER: S AUTOMOBILE LIABILITY COWNEDNGG.. I WIT S ANY AUTO BODILY INJURY (Par poison) S ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) S -� NON -OWNED HIRED AUTOS AUTOS Pf 00,9,gI r i�AMA P r acc tl S UMBRELLALIAB OCCUR EACH OCCURRENCE S .... EXCESS LIAB CLAIMS -MADE AGGREGATE $ DIED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETORIPARTNERIEXECUTIVE OFFICE RIMEMBEREXCLUDED? Li ' N/A OTH. STATUT - R E.L. EACH ACCIDENT - s E.L. DISEASE - EA EMPLOYEE L. DISEASE - POLICY LIMIT S ..................................... $ (Mandatary In NH) If yas, desuibe under IDESCRIPTION OF OPERATIONS below A Professional Liability P 100. 128.884.2 03/01/2022 03/01/2023 Each Claim: S 1,000.000 Aggregate- $ 2,000.000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be allached if more space Is required) CATE HOLDER 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. AUTHORIZED REPRESENTATIVE 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 01 /07/2022 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 endorsement(s). PRODUCER HkR" Hiscox Inc. d/b/a/ Hiscox Insurance Agency in CA PNONE (888) 202-3007 5 Concourse Parkway Suite 2150 EVIL Co,n9acl@Nscox.c _' Atlanta GA, 30328 INSURER S AFFC INSURER A: HISCOX Insurance INSURED Donnoe & Associates, Inc 10940 Fair Oaks Blvd INSURER B : /NsuRER c Suite 700 INSURER 0 Fair Oaks. CA 95628 INSURER E; COVERAGES CERTIFICATE NUMBER: COVERAGE anv Inc REVISION NUMBER: 10200 ................ 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. EAP INS R TYPE OF INSURANCE IQ POLICY NUMBER IPWMN�OCO Y �Pr6M0DC( "' LIMITS L COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE $ ........ CLAIMS -MADE 0 OCCUR P'R MI or $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ mm GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JET LOC PRODUCTS •COMPIOPAGG $ $ OTHER: AUTOMOBILE LABILITY Ear acrJdeM� 1 L�1tSpt S ANY AUTO BODILY INJURY (Per person) S OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY BODILY INJURY (Per acddent) NCR LR"d' °DAMAG IF , awdeno S ' ' "5 $ UMBRELLA Like OCCUR HCLAIMS-MADE EACH OCCURRENCE _.....,_..... $ m$ EXCESSLIAB AGGREGATE DED I RETENTION S S WORKERS COMPENSATION AND EMPLOYERS" LIABILITY YIN ANYPROPRIETORAPARINEft(FXEC.UTIVE PER T T TE R E,L.EACH ACCIDENT $ OFFICERIMEMBEREXCLUDED? (Mandatory in NH) MIA E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ Irya s dascrVlxe under DESCRIPTION OF OPERATIONS bokrr I A Professional Liability N UDC-4751566-EO.21 03/01/2021 03/01/2022 Each Claim: $ 1.000,000 Aggregate: $ 2,000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD tei, Additional Remarks Schedule, may be attached it more space Is required) ''.... City of El Segundo 350 Main Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE El Segundo CA 90245 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE F" ID 1988-2015 ACORD CORPORATION. All rights reserved, ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD