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PROOF OF INSURANCE (2023 - 2023) CLOSEDDATE (MM/Y) CERTIFICATE OF LIABILITY INSURANCE 05/06/2022 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(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 endorsement(s). PRODUCER CONTACT STEVE INDRAJANA, LIC# OD77756 NAME.Steve indrajana AX 3617 MARCONI AVE sac°, o,ExI) ,f 16) 920 2 (A „Na}: (16) 920 2 11 E•MAM SACRAMENTO, CA 95821-5309 ADDRE:5:5 Steve,i �drataiiai,ngkp s'tatefarm corn INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: INSURED DONNOE OI ASSOCIATES INC INSURER B State Farm Flre and Cas„llalty Company _p _ .,-25143 10940 FAIR OAKS BLVD STE 700 INSURERc FAIR OAKS, CA 95628 INSURER D INSURER E r r.... INSURER F n�i�onr�c f`CCTICI(`ATC NIIInnRGoWaNe..„cGI Q—,­a� RFVISIf1N NIIMRFR• n+;..rhr?d'4J9 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. ®„ ,.......e.,+$,Di)V. d'wb R° ,.�,....... .ee POLICY FF� POLICYEXCt,,.®. TYPE OFL........ LTR NSURANCE POLICY NUMBER MMIDD/YYYY MI�pD08YYYY LIMITS GENERAL LIABILITY � � A 90-CS-Q046-2 03/23/2022 03/23/2023 EACH OCCURRENCE 5 2,000,000 _... DA �Cq.TadrdinNI'8ER_ 5, 300,000 X COMMERCIAL GENERAL LIABILITY _,kFPJVISB' r_QIC•t3 oca;d,sore�.nc:art . „ X X CLAIMS -MADE OCCUR MED EXP (Any one, ¢swamonj S 5,000 _ „ PERSONAL & ADV INJURY $ 0 GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP/OP AGO $ ......... ......... _ _ .... 4,000,000 ...— ,e �7_,., X POLICY P� Ot LOC $ _ AUTOMOBILE LIABILITY M1..4 MBIN- 511�1d,�LE LIIwVtlI' .,BEa ncAdmr!S) � m 5_ ANY AUTO BODILY INJURY (Per person) $ " ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ ., AUTOS AUTOS � NON -OWNED f."R'OPE'Rtl5"DAMAG3k� - ,,,,,,,,,,,,, HIRED AUTOS ,,.,.,.,,, .. AUTOS _(Pea ncpdentj ... .... ;g UMBRELLA LIAB OCCUR '', EACH OCCURRENCE S EXCESS LIAB '.. CLAIMS-MADE AGGREGATE S DED '',. RETENTION 5 $ B WORKERS COMPENSATION 90-E3-W020-9 03/23/2022 03/23/2023 X . 1i7O S'FiitU- O Fk AND EMPLOYERS' LIABILITY y / N ANY PROP RI ETOR(PARTN ER(EXECUTIVE EXCLUDED? N / A ��..... E.L EACH ACCIDENT S .... ,,.,,,, .... 1,000,000 ..... ,.... OFFICE/MEMBER L, DISEASE - EA EMPt,OVEE S 1,000,000 (Mandatory in NH) ..,,,E If yes, describe under EL DISEASE- POLICY LIMIT 5 1,OC')O.OUO R PTIn E.S3P..E�A?:.IDN� below _ �;., DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Additional Insured: City of El Segundo its officers, officials, employees, agents, representatives, and certified volunteers. 350 Main Street El Segundo, CA 90245 Attention: Human Resources Dept CERTIFICATE HOLDER CANCELLA ELLED City of El Segundo THEULD EXANY OFPIRATIIONHDATE VTHER OF, NOTICE DESCRIBEDPOLICI ES WILL BE CBE CDELVERED BEFOREIN 350 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE Attention: Human Resources Dept � 05/06/2000 © 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