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PROOF OF INSURANCE (2022) CLOSEDA, ., lMf„v'i"'""iRi-.'"' CERTIFICATE OF LIABILITY INSURANCE DATE (MMI2022 Y) 1/4/2022 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 CONIACII NAME: Mary Strohman PHONE (909) 931-1500 SAX (909)932-2133 AAC„ Ner,)r, Kessler Alair Insurance Services, Inc MAIL mstrohman@kessleralair.com ADORE:SS:: License # CIA91387 INSURERS AFFORDING COVERAGE NAIC # 12487 N. Mainstreet, Ste. 240 INSURER A:Philadel hia Insurance Rancho Cucamonga CA 91739 INSURED INSURER B: to ers Compensation Ins Co (#170900( 11512 INSURER C: Revenue & Cost Specialists, LLC INSURER D: 1519 E. Chapman Ave., Suite C INSURER E: Fullerton CA 92831-4013 INSURER F: CnVFRArFR CERTIFICATE NUMBER,2021-22 GL AUTO PROF WC 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 MAYBE 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.. iNSR �� POLICY =YYY CIOfYME'p'XYY _ LTR. TYPE OF INSURANCE POLICY NUMBER. MMIDDdY15 M1%M'IDFF ... LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 EI _ NTE , 500,000 A CLAIMS -MADE OCCUR PREMi ES Ea oacurra ms. $ '.. X PHBX20001810 12/31/2021 12/31/2022 MED EXP(Any One person) $ 10,000 PERSONAL &ADV INJURY S 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY F—] JECTI�RO- F I LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTH..E.R'.. $ AUTOMOBILE LIABILITY COMBINED iNMEEMIT Ea �acci,da�m $ 1,000,000 BODILY INJURY (Per person) $ ANYAUTO AALL OWNED SCHEDULED PHBX20001810 12/31/2021 12/31/2022 BODILY INJURY (Per accident) $ AUTOS AUTOS NON -OWNED X X PROPERTY DAMAGE Per accide're $ HIREDAUTOS AUTOS X UMBRELLA LIAB .00CUR '.. EACH OCCURRENCE Is 1,000,000 X ''.. AGGREGATE S 1 , 000, 000 A EXCESS LIAB ''.. CLAIMS -MADE DED X RETENTION $ 1.0 000 PHUB791604 12/31/2021 12/31/2022 $ WORKERS COMPENSATION X I P TH- TAT UTE ER AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? NIA E L DISEASE- EA EMPLOYEE $ 1,000,000 B (Mandatory in NH) EIG29B0142-02 12/31/2021 12/31/2022 I If yes, describe under DESCRIPTION. OF OPERATIONS below E.L.. DISEASE - POLICY LIMIT $ 11000,000 ''.. A Professional Liability PHBX20001810 12/31/2021 12/31/2022 Aggregale $2,000,000 Each Claim $1, 000 , 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Additional Insured is City of El Segundo, it's officers, officials, employees and volunteers as per attached, PI-BOP-001 (01-18), CERTIFICATE HOLDER CANCELLATION pharada@elsegundo.org SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ATTN: Paricia Harada, City Clerks Office ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE (Mary Strohman/MARY TYlai.) C.1+I k, © 1988-2014 ACORD CORPORATION. All rights reser ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 (201401) ADDITIONAL COVERAGES Ref # Description Business Auto Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description State surcharge 1 Coverage Code STSR1 Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $27.00 Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Form No. Edition Date Premium Ref # Description Coverage Code Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Form No. Edition Date Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Form No. Edition Date Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Ref # Description Coverage Code Premium Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Form No. Edition Date Premium Ref # Description Coverage Code Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Form No. Edition Date Premium rOFADTLCV Copyright 2001, AMS Services, Inc. Philadelphia Indemnity Insurance Company PI-BOP-003 (01/18) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM A. SECTION II — LIABILITY, C. Who Is An Insured is amended to include the following as an additional insured: Any person(s) or organization(s) for whom you are performing "your work" under a written contract or agreement, that requires such person(s) or organization(s) to be added as an additional insured on your policy. Such person(s) or organization(s) is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" occurring after the effective date of such contract or agreement that is caused, in whole or in part by: a. Your acts or omissions; or b. The acts or omissions of those acting on your behalf; in the performance of "your work" for the additional insured. Coverage for an additional insured under this endorsement ends when "your work" for that additional insured ends or is put to its intended use by any person or organization. B. The following is added to SECTION II — LIABILITY, B. Exclusions, 3. Applicable To Both Business Liability Coverage And Medical Expenses Coverage — Nuclear Energy Liability Exclusion with respect to this endorsement only: There is no coverage under this endorsement for loss or expense, including but not limited to the cost of defense for "bodily injury", "property damage" or "personal and advertising injury" occurring: a. After all of "your work", including materials, parts or equipment furnished in connection with ,.your work" and performed under the above referenced written contract(s) or agreement(s) has ended; or b. When that portion of "your work" out of which the "bodily injury", "property damage" or "personal and advertising injury" arises and performed under the above referenced written contract(s) or agreement(s) has been put to its intended use by any person or organization; whichever occurs first PI-BOP-003 (01/18) Page 1 of 1 PI-MANU-1 (01/00) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Waiver of Subrogation and Primary Non -Contributory Wording 1. Other provisions of the policy notwithstanding, this policy will be primary for all losses covered herein, and the existence of other insurance will not serve to reduce our obligation. 2. You will have the right to waive our rights of recovery prior to a loss with respect to any party. This must be done in writing to affect our rights. All other terms and conditions of this Policy remain unchanged. Philadelphia Indemnity Insurance Company PI-BOP-012 (01/18) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. HIRED AND NON -OWNED AUTO LIABILITY This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM A. Insurance is provided only for those coverages for which a specific limit or premium charge is shown in the Declarations. 1. Hired Auto Liability The insurance provided under SECTION II — LIABILITY, A. Coverages, 1. Business Liability; applies to "bodily injury' or "property damage" arising out of the maintenance or use of a "hired auto" by you or your "employees" in the course of your business. 2. Non -Owned Auto Liability The insurance provided under SECTION II — LIABILITY, A. Coverages, 1. Business Liability; applies to "bodily injury" or "property damage" arising out of the use of any "non -owned auto" in your business by any person other than you. B. For insurance provided by this endorsement only: 1. The exclusions, under SECTION II — LIABILITY, B. Exclusions, 1. Applicable to Business Liability Coverage, other than exclusions a., b., d., f. and i. and the Nuclear Energy Liability Exclusion, are deleted and replaced by the following: a. "Bodily injury" to: (1) An "employee" of the insured arising out of and in the course of: (a) Employment by the insured; or (b) Performing duties related to the conduct of the insured's business; or (2) The spouse, child, parent, brother or sister of that "employee" as a consequence of Paragraph (1) above. This exclusion applies: (1) Whether the insured may be liable as an employer or in any other capacity; and (2) To any obligation to share damages with or repay someone else who must pay damages because of injury. This exclusion does not apply to: (1) Liability assumed by the insured under an "insured contract"; or (2) "Bodily injury" arising out of and in the course of domestic employment by the insured unless benefits for such injury are in whole or in part either payable or required to be provided under any workers compensation law. PI-BOP-012 (01/18) Page 1 of 3 Includes copyrighted material of Insurance Services Office, Inc., with its permission, Philadelphia Indemnity Insurance Company PI-BOP-012 (01/18) b. "Property damage" to: (1) Property owned or being transported by, or rented or loaned to the insured; or (2) Property in the care, custody or control of the insured. 2. SECTION II —LIABILITY, C. Who Is An Insured, is replaced by the following: a. Each of the following is an insured under this endorsement to the extent set forth below: (1) You; (2) Any other person using a "hired auto' with your permission; (3) For a "non -owned auto', any partner or "executive officer" of yours, but only while such "non -owned auto" is being used in your business; and (4) Any other person or organization, but only for their liability because of acts or omissions of an insured under (1), (2) or (3) above. b. None of the following is an insured: (1) Any person engaged in the business of his or her employer for "bodily injury' to any co -"employee" of such person injured in the course of employment, or to the spouse, child, parent, brother or sister of that co -"employee" as a consequence of such "bodily injury', or for any obligation to share damages with or repay someone else who must pay damages because of the injury; (2) Any partner or "executive officer" for any "auto' owned by such partner or officer or a member of his or her household; (3) Any person while employed in or otherwise engaged in duties in connection with an "auto business", other than an "auto business" you operate; (4) The owner or lessee (of whom you are a sub lessee) of a "hired auto' or the owner of a "non -owned auto' or any agent or "employee" of any such owner or lessee; (5) Any person or organization for the conduct of any current or past partnership or joint venture that is not shown as a Named Insured in the Declarations. 3. This insurance does not apply: If you regularly deliver the good or products which you are in the business of selling, "bodily injury" or "property damage" arising out of the delivery of those goods or products. 4. This insurance does not apply: If you deliver any goods or products for a charge, "bodily injury' or "property damage" arising out of the delivery of those goods or products. C. The following additional definitions apply: 1. "Auto Business" means the business or occupation of selling, repairing, servicing, storing or parking "autos". 2. "Hired Auto" means any "auto' you lease, hire or borrow. This does not include any "auto' you lease, hire, rent or borrow from any of your "employees" or members of their households, or from any partner or "executive officer" of yours. This DOES NOT include any "Auto' you lease for a period of more than 30 consecutive days. PI-BOP-012 (01/18) Page 2 of 3 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Philadelphia Indemnity Insurance Company PI-BOP-012 (01/18) 3. "Non -Owned Auto" means any "auto" you do not own, lease, hire, rent or borrow which is used in connection with your business. However, if you are a partnership, a "non -owned auto" does not include any "auto" owned by any partner. PI-BOP-012 (01/18) Page 3of3 Includes copyrighted material of Insurance Services Office, Inc., with its permission.