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PROOF OF INSURANCE (2022 - 2022) CLOSED^w TRUEREC-01 SSQ �'��•"° CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY)7/14/2022 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 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 HUB International Insurance Services Inc. 1526 Faraday Avenue Suite 200 Carlsbad, CA 92008 Jyoti Phillips A INSURED INSURER B:.AIVIGO ."•.,•..._......_._._..•.I.ns.urance Gone 19900 True Recovery LP INSURER C : Nancy K. Bohl, Inc. D.B.A. The Counseling Team International�- 20351 SW Acacia Street Floor 2 Newport Beach, CA 92660 INSURER E w. INSURER F : ........................... COV'ERAGE,a 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 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. INSURANCE .....m...-.._.._.._.-- POLICY NUMBER ..-...........•-�.....-.,,m,.,.... __ INSR ........ N.•�_ ADDL. SUBR POLICY E'FF POLICY EXP LIMITS TYPE OF I �� dMMIDQINMYYI..,k_ ....................... A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X� OCCUR X ACP 3019795490 8/31/2021 8/31/2022 DAMAGE rO RENTED 1,000,000 MED EXP (Any one person}, 20,000 ....�___ PERSONALBADVINJURY $ 1,000,000 GEN L AGGREGATE... ..LIMI G 3,000,000 _POITAPPLIESLOC PRODUCTSGCOMPOPAGG $ 3000000 I "� POLICY PRO- f A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 X ANY AUTO ACP3019795490 8/31/2021 8/31/2022 BODILY INJURY Per ersan), , $ OWNED SCHEDULED AUTOS ONLY AUTOS _BODILY INJURY (Per acc[dentl 5,,,,,,,�,,,W,,, HIRED NON -OWNED p� � J' DAMAGE AUTOS ONLY ..........._, AUTOS ONLY ii (DER Y r rx__eTt ........... ...... ...w __ W_ WW ....... ___.. _ 5,000,000 B X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ ..., .. ...-...__ __- -_ ..,,�. t, _ EXCESS LIAB CLAIMS -MADE ACPCAA3019795490 8/31/2021 8/31/2022 AGGREGATE $ 5,000000.. DE X RETENTION ....m.-. ........_ �w.... _._-...._ —..,� ION $ 1 U,000 $ WORKERS COMPENSATION PER OTH AND EMPLOYERS' LIABILITY Y / N � _.. 51MUTF .. -FR .,..........__ ._,.,.. IDENT ANY OFFICER/MEMBER PROPRIETOR/PARTNER/EXECUTIVE /MM E) EXCU""} NIAE.L, DISEASECEA EMPLOYE " $ inNH DEes, describe under SCRIPTION OF OPERATIONS below E,L, DISEASE POLICY LIMIT $ ... "" "._... A Professional Liab ACP 3019796490 8/31/2021 8/31/2022 See below for limit A Abuse Liability ACP 3019795490 8/3112021 8/31/2022 See below for limit DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORO 101, Additional Remarks Schedule, may be attached If more space is required) Professional Liabilityi Occurrence Form 1 $1,000,000 Per Claiin/$3,000,000 Aggregate Abuse Liability i Occurrence Form l $1,000,000 Per Claim/$3,000,000 Aggregate Business Office Policy Property Locations: 1881 Business Center Dr. Suite 11, 12 A 8: 12 B, San Bernardino, CA 92408 1545 Anacapa Rd Suite 7C, Victorville, CA 92392 444 Camino Del Rio South, Suite 215 & #208, San Diego CA 92108 SEE ATTACHED ACORD 101 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE El Segundo Police Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 p ACCORDANCE WITH THE POLICY PROVISIONS. 348 Main Street El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: TRUEREC-01 SSONG LOC ADDITIONAL REMARKS SCHEDULE m �� �p,,,r Page..� �..__°f _...1 1.._. ....... ._.............. --- AGENCY License # 0757776- NAMED INSURED HUB International Insurance Services Inc. True Recovery LP ........�ddm......_......................_.......�.__. Nanc K. Boh , Inc,,D.B.A. The Counseling Team International POLICY NUMBER ...... 2035 SW Acacia Street Floor 2 EE PAGE 1 Newport Beach, CA 92660 CARRIER NAIC CODE SEE PAGE 1 SEE. P 1 'EFFECTIVE DATE: EE PACE ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 81 28 01 18 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GENERAL LIABILITY ENHANCEMENT: HUMAN SERVICES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM It is understood and agreed that the following extensions only apply in the event that no other specific coverage for the indicated loss exposure is provided under this policy. If such other more specific coverage applies, the terms, conditions, and limits of that coverage are the sole and exclusive coverage applicable under this policy, unless otherwise noted on this endorsement. The following is a summary of the Limits of Insurance and additional coverages provided by this endorsement. For complete details on specific coverages, consult the policy contract wording. Coverage Applicable ..w__......................... ........... Limit of Insurance .... Pale # Additional Insured — As Required by Contract _ Included 7 Additional Insured — Broad Form Vendors Included 5 Additional Insured — Fundin Source Included 4 ............................. W W...-.�. W... ...... ...... Additional Insured — Grantor of Franchise Included 6 Additional Insured — Grantor of Permits Included —— 4 Additional Insured — Home Care Providers Included 4 Additional Insured — Lessors Of Leased Equipment — Automatic Status When Required In Lease Agreement With You .__ ._.....____ ..... ......... ......... Included 4 Additional Insured — Managers, Landlords, Or Lessors Of Premises ....... ...................................... Included 4 Additional Insured — Medical Directors And Administrators Included 4 Additional Insured — State Or Political Subdivision ......................................................................................... Included _....................................................................._ 5 Broadened Definition Of Bodily Iniurr Includes Mental Anguish 9 $1,000,000 Damao e TowPremiseswRented To You Includes Ex anded Perils) 8 Damage To Property You Own, Rent Or Occu $50 000 2 Duties In The Event Of Occurrence, Claim Or Suit Included 8 Employee Indemnification_ Defense Coverage For Em lo�ee _ $25 000 3 Extended Property Damage Included 3 Key And Lock Replacement -Janitorial Services Client Coverage _ _$15 000 2 Liberalization Included 8 Limited Rental Lease Agreement Contractual Liabilit — ..................._ —— ........_ ................... $100.4000 3 Medical Payments $20,000 3 Medical Payments — Athletic Activities _ Amended 3 Medical Payments — Extended ReportingPeriod 3 Years 3 Named Insured — Broadened Named Insured Included 3 Named Insured — Newly Acquired Included _ _ 3 Non -Owned Watercraft Less than 58 feet 2 Personal And Advertising Injury — Includes Abuse Of Process And Discrimination Included 9 Su lementary Payments — Bail Bonds $7,500 3 Supplementary Payments — Loss Of Earnings $1,500 per day3 Transfer Of Rights Of Recovery Against Other To Us Clarification 8 Unintentional Failure To Disclose A Hazard Included 8 CG 81 28 01 18 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 9 with its permission. CG 81 28 01 18 A. Key and Lock Replacement — Janitorial Services Client Coverage 1. We will pay for the cost to replace keys and locks at the "client's" premises due to theft or other loss to keys entrusted to you by your "client", up to a $15,000 limit per occurrence/$15,000 policy aggregate. 2. We will not pay for loss or damage resulting from theft or any other dishonest or criminal act that you or any of your partners, members, officers, "employees", "managers", directors, trustees, authorized representatives or any one to whom you entrust the keys of a "client" for any purpose commit, whether acting alone or in collusion with other persons. 3. The following, when used in this coverage only, are defined as follows: a. "Employee" means: (1) Any natural person: (a) While in your services or for 30 days after termination of service; (b) Who you compensate directly by salary, wages or commissions; and (c) Who you have the right to direct and control while performing services for you; or (2) Any natural person who is furnished temporarily to you: (a) To substitute for a permanent "employee" as defined in Paragraph (1) above, who is on leave; or (b) To meet seasonal or short-term workload conditions; while that person is subject to your direction and control and performing services for you. (3) "Employee" does not mean: (a) Any agent, broker, person leased to you by a labor leasing firm, factor, commission merchant, consignee, independent contractor or representative of the same general character; or (b) Any "manager", director or trustee except while performing acts coming within the scope of the usual duties of an "employee". b. "Manager" means a person serving in a directorial capacity for a limited liability company. B. SECTION I — COVERAGES, COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclusions is amended as follows: 1. Exclusion a. Expected or Intended Injury is deleted and replaced with: a. "Bodily injury" or "property damage" expected or intended from the stand point of the insured. This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property. 2. Exclusion g. Aircraft, Auto or Watercraft Paragraph (2) is deleted and replaced with: (2) A watercraft you do not own that is: (a) Less than 58 feet long; and (b) Not being used to carry persons or property for a charge; This provision applies to any person, who with your consent, either uses or is responsible for the use of a watercraft. This insurance is excess over any other valid and collectible insurance available to the insured whether primary, excess, or contingent. 3. Exclusion j. is amended as follows: (a) Exclusion j.(1) is deleted and replaced with: (1) Property you own, rent , or occupy, including any costs or expenses incurred by you, or any other person, organization or entity, for repair, replacement, enhancement, restoration or maintenance of such property for any reason, including prevention of injury to a person or damage to another's' property, unless the damage to property is caused by your "client", in such case we will provide coverage for such "property damage" for which you are legally obligated to pay up to a $50,000 limit per "occurrence". This limit is the only limit of insurance for such "property damage" and will not be combined with the Each Occurrence Limit set for this in Section III — Limits of Insurance and will be included within and not in addition to the Each Occurrence Limit. Any and all damages paid under the terms and condition of this provision will further be applied against and will reduce the Aggregate Limit of Insurance shown on the Declarations page, and as provided in the Commercial General Liability Coverage Form in the same manner and in addition to all other coverages of the Commercial General Liability Coverage Form that are also subject to the Aggregate Limit. 4. The following is added to Paragraph (2) of Exclusion b. Contractual Liability of SECTION I — COVERAGES, COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, under Subsection 2. Exclusions: We agree to indemnify the Named Insured for their liability assumed in a contract or agreement Page 2 of 9 Includes copyrighted material of Insurance Services Office, Inc., CG 81 28 01 18 with its permission. regarding the rental or lease of a premises on behalf of their "client", up to $100,000 per "occurrence". This limit of insurance is the only limit of insurance for your liability assumed in a contract or agreement regarding the rental or lease of a premises on behalf of your "client" whether or not such contract qualifies as an "insured contract". This limit will not be combined with the Each Occurrence Limit set forth in Section III — Limits of Insurance and is included within and not in addition to the Each Occurrence Limit. This coverage extension only applies to rental lease agreements. This coverage is excess over any renter's liability insurance of the "client". Any and all damages paid under the terms and conditions of this provision will further be applied against and will reduce the Aggregate Limit of Insurance shown on the Declarations page, as provided in the Commercial General Liability Coverage Form in the same manner and in addition to all other coverages of the Commercial General Liability Coverage Form that are also subject to the Aggregate Limit. 5. The last Paragraph of Subsection 2. Exclusions is replaced by the following: If damage by fire to premises rented to you is not otherwise excluded, exclusions c. through n. do not apply to damage by fire, lightning, explosion, smoke or sprinkler leakage to premises while rented to you or temporarily occupied by you with permission of the owner. A separate limit of insurance applies to this coverage as described in Section III — Limits of Insurance. C. SECTION I — COVERAGES, COVERAGE C — MEDICAL PAYMENTS 1. If COVERAGE C — MEDICAL PAYMENTS is not otherwise excluded from this Coverage Part: a. The Medical Expense Limit shown on the Declarations is deleted and replaced by $20,000. $20,000 is the only limit of insurance for Medical Expenses and this limit will not be combined with any other limit of insurance. b. Subsection 1. Insuring Agreement, Paragraph a.(3)(b) is replaced by: (b) The expenses are incurred and reported to us within three years of the date of the accident; and CG 81 28 01 18 b. Exclusion e. Athletics Activities is deleted and replaced with: e. Athletics Activities To a person injured while practicing or participating in any physical exercises or games, sports or athletic contests. This exclusion shall not apply to an insured while providing instruction with respect to any of the activities otherwise excluded by this provision. D. SECTION I — COVERAGES, SUPPLEMENTARY PAYMENTS — COVERAGES A AND B is amended as follows: 1. 1. b. is replaced with: b. Up to $7,500 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. 2. 1. d. is replaced with: d. All reasonable expenses incurred by the insured at our request to assist us in the "suit", including actual loss of earnings up to $1,500 a day because of time off from work. 3. The following provision is added: We will reimburse you for defense costs that you incur in the defense of an "employee" who is directly involved in a criminal proceeding that arises out of such "employee's" acts or omissions within the scope of their employment by you or while performing duties related to the conduct of your business and which would otherwise be covered by this insurance. The most we will reimburse you for defense costs that you incur in the defense of an "employee" who is alleged to be directly involved in a criminal proceeding is $25,000, subject to an aggregate limit of $25,000 for all reimbursements that we make during the policy period on behalf of all "employees", regardless of the numbers of "employees", claims or "suits" brought or persons or organizations making claims or bringing "suits". E. SECTION II WHO IS AN INSURED is amended as follows: 1. If coverage for a newly acquired or formed organization is not otherwise excluded from this Coverage Part, Paragraph 3.a. is replaced with: 2. Subsection 2. Exclusions, is amended as a. Coverage under this provision is until the follows: end of the policy period during which you a. Exclusion a. Any Insured is deleted and acquired or formed the organization; replaced with: 2. The following is also an insured: a. Any Insured Broadened Named Insured — Any organization To any insured, except "volunteer and subsidiary thereof which you control and workers" or an insured as provided in e. actively manage (whether through ownership of Athletic Activities below. voting securities, by contract, or otherwise) on the effective date of this policy. However, coverage does not apply to any organization or CG 81 28 01 18 Includes copyrighted material of Insurance Services Office, Inc., Page 3 of 9 with its permission. CG 81 28 01 18 subsidiary not named in the Declarations as a agreed in writing in a contract or agreement Named Insured, if they are also insured under that such person(s) or organization(s) be another similar policy, or would have been added as an additional insured on your insured but for such policy's termination or the policy. Such person(s) or organization(s) is exhaustion of its limits of insurance. an insured only with respect to liability for 3. Each of the following is also an additional "bodily injury", "property damage" or insured: "personal and advertising injury" caused, in whole or in part, by your maintenance, a. Medical Directors and Administrators —Your operation or use of equipment leased to you medical directors and administrators but by such person(s) or organization(s). only while acting within the scope of and However, the insurance afforded to such during the course of their duties as such. additional insured: Such duties do not include the furnishing or failure to furnish professional services as a (1) Only applies to the extent permitted by physician or psychiatrist in the treatment of law; and a patient. (2) Will not be broader than that which you b. Funding Source — Any person or are required by the contract or organization with respect to their liability agreement to provide for such additional arising out of: insured. (1) Their financial control of you; or A person's or organization's status as an additional insured under this endorsement (2) Premises they own, maintain or control ends when their contract or agreement with while you lease or occupy these you for such leased equipment ends. premises. With respect to the insurance afforded to This insurance does not apply to: these additional insureds, this insurance (a) Any "occurrence" or offense which does not apply to any "occurrence" which takes place after you cease to takes place after the equipment lease lease or occupy that premises; or expires. (b) Structural alterations, new f.. Grantors of Permits — Any state or construction or demolition governmental agency or subdivision or operations performed by or on political subdivision granting you a permit in behalf of that person or connection with your premises subject to the organization. following additional provision: c. Home Care Providers — At the first Named This insurance applies only with respect to Insured's option, any person or organization the following hazards for which the state or under your direct supervision and control governmental agency or subdivision or while providing on your behalf private home political subdivision has issued a permit or respite or foster home care for the authorization in connection with premises developmentally disabled. you own, rent or control and to which this d. Managers, Landlords, or Lessors of insurance applies: Premises — Any person or organization with (1) The existence, maintenance, repair, respect to liability arising out of the construction, erection or removal of ownership, maintenance or use of that part advertising signs, awnings, canopies, of the premises leased or rented to you cellar entrances, coal holes, driveways, subject to the following additional manholes, marquees, hoist away exclusions: openings, sidewalk vaults, street This insurance does not apply to: banners or decorations and similar (1) Any "occurrence" which takes place exposures; or after you cease to be a tenant in that (2) The construction, erection or removal of premises. elevators; or (2) Structural alterations, new construction (3) The ownership, maintenance or use of or demolition operations performed by any elevators covered by this insurance. or on behalf of the person or However: organization. (1) The insurance afforded to such e. Lessor of Leased Equipment — Automatic additional insured only applies to the Status When Required in Lease Agreement extent permitted by law; and With You - Any person(s) or organization(s) from whom you lease equipment when you and such person(s) or organization(s) have Page 4 of 9 Includes copyrighted material of Insurance Services Office, Inc., CG 81 28 01 18 with its permission. (2) If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. g. State or Political Subdivision — Any state or political subdivision with whom you agreed under a written contract or agreement to add as an additional insured to your policy but only with respect to their liability with respect to on -going operations performed by you or on your behalf for which the state or political subdivision has issued a permit or license. This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the state or political subdivision; or 2. "Bodily injury" or "property damage" included within the "products -completed operations hazard". The insurance provided to such additional insured state or political subdivision by this endorsement is further limited as follows: 1. The additional insured is covered only for such sums that such additional insured is legally obligated to pay as damages under tort law principles to the injured party because of "bodily injury", "property damage" or "personal and advertising injury" to which this insurance applies, and in accordance with the stated policy limits, exclusions, limitations and conditions except as expressly modified by this endorsement. 2. The limits of insurance are those set forth in the policy Declarations or those specified in the written contract or agreement referenced above, whichever is less. Other Insurance If specifically required by the written contract or agreement referenced above, any coverage provided by this Subsection g. to an additional insured shall be primary and any other valid and collectible insurance available to the additional insured shall be non- contributory with this insurance. If the written contract does not require this coverage to be primary and the additional insured's coverage to be non- contributory, then this insurance will be excess over any other valid and collectible insurance available to the additional insured. CG 81 28 01 18 2. Even if the requirements of Paragraph 1. immediately above are met establishing this coverage as primary and the additional insured's coverage as being non-contributory, this coverage will be excess over any other insurance available to the additional insured which is conferred onto said person or organization by a separate additional insured endorsement. h. Broad Form Vendors — Any person(s) or organization(s) which or who is or are a vendor of "your products" with whom you agreed under a written contract or agreement to add as an additional insured to your policy, but only with respect to "bodily injury" or "property damage" arising out of ,.your products" which are distributed or sold in the regular course of the vendor's business, subject to the following additional exclusions: The insurance afforded the vendor does not apply to: 1. "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; 2. Any express warranty unauthorized by you; 3. Any physical or chemical change the vendor intentionally made to the product; 4. Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; 5. Any failure to make 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. 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 substance by or for the vendor; or CG 81 28 01 18 Includes copyrighted material of Insurance Services Office, Inc., Page 5 of 9 with its permission. CG 81 28 01 18 8. "Bodily injury" or "property damage" excess over any other valid and arising out of the negligence of the collectible insurance available to the vendor for its own acts or omissions or additional insured. those of its employees or anyone else 2. Even if the requirements of Paragraph acting on its behalf and which was not 1. immediately above are met caused in whole or in part by you or any establishing this coverage as primary person or organization acting on your and the additional insured's coverage behalf. However, this exclusion does not as being non-contributory, this coverage apply to: will be excess over any other insurance (a) The exceptions contained in available to the additional insured which Subparagraphs 4. or 6.; or is conferred onto said person or (b) Such inspections, adjustments, organization by a separate additional tests or servicing as the vendor insured endorsement. has agreed to make or normally i. Grantor of Franchise — Any person(s) or undertakes to make in the usual organization(s) with whom you agreed under course of business, in connection a written contract or agreement to add as an with the distribution or sale of the additional insured to your policy but only with products. respect to their liability as grantor of a The insurance provided to such additional franchise to you. insured vendor by this endorsement is The insurance provided to such additional further limited as follows: insured franchisor by this endorsement is 1. The additional insured is covered only further limited as follows: for such sums that such additional 1. The additional insured is covered only insured is legally obligated to pay as for such sums that such additional damages under tort law principles to the insured is legally obligated to pay as injured party because of "bodily injury", damages under tort law principles to the "property damage" or "personal and injured party because of "bodily injury", advertising injury" to which this "property damage" or "personal and insurance applies, and in accordance advertising injury" to which this with the stated policy limits, exclusions, insurance applies, and in accordance limitations and conditions except as with the stated policy limits, exclusions, expressly modified by this endorsement. limitations and conditions except as 2. The limits of insurance are those set expressly modified by this endorsement. forth in the policy Declarations or those 2. The limits of insurance are those set specified in the written contract or forth in the policy Declarations or those agreement referenced above in the first specified in the written contract or paragraph of this Subsection h., agreement referenced above, whichever whichever is less. is less. This insurance does not apply to 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. Otherinsurance 1. If specifically required by the written contract or agreement referenced above in the first paragraph of this Subsection h., any coverage provided by this endorsement to an additional insured shall be primary and any other valid and collectible insurance available to the additional insured shall be non- contributory with this insurance. If the written contract does not require this coverage to be primary and the additional insured's coverage to be non- contributory, then this insurance will be Otherinsurance 1. If specifically required by the written contract or agreement referenced above in the first paragraph of this Subsection i., any coverage provided by this endorsement to an additional insured shall be primary and any other valid and collectible insurance available to the additional insured shall be non- contributory with this insurance. If the written contract does not require this coverage to be primary and the additional insured's coverage to be non- contributory, then this insurance will be excess over any other valid and collectible insurance available to the additional insured. 2. Even if the requirements of Paragraph 1. immediately above are met establishing this coverage as primary and the additional insured's coverage as being non-contributory, this coverage Page 6 of 9 Includes copyrighted material of Insurance Services Office, Inc., CG 81 28 01 18 with its permission. CG 81 28 01 18 will be excess over any other insurance 2. The limits of insurance are those set available to the additional insured which forth in the policy and Declarations or is conferred onto said person or those specified in the written contract, organization by a separate additional lease, sublease or agreement insured endorsement. referenced in the first Paragraph of this j. As Required by Contract — Any person or Subsection j., whichever is less. organization for whom "you" are performing With respect to the insurance afforded to an operations, or to whom you are leasing, additional insured under this Subsection j., subleasing or otherwise entrusting the use the following exclusions are added: or occupancy of premises owned by or 1. This insurance does not apply if the rented to "you", only as specified under a written contract, lease, sublease or written contract, lease, sublease or agreement referenced in the first agreement that requires that such person or Paragraph of this Subsection j. above organization be added as an additional "your" was not executed by the "Named insured on policy. Such person or Insured" prior to the "occurrence" giving organization is an additional insured only rise to the additional insured's potential with respect to liability caused, in whole or in "Named liability. part, by the acts or omissions of the Insured" or the acts the acts or omissions of 2. This insurance does not apply to the those acting on your behalf in the additional insured's liability to indemnify, performance of the "Named Insured's" defend or hold harmless a third party. ongoing operations for the additional insured 3. This insurance does not apply to "bodily or in connection with such premises owned injury", "property damage" or "personal by or rented to a "Named Insured", but in and advertising injury" for which the both instances only as specified under the additional insured is obligated to pay written contract, lease, sublease or damages by reason of the assumption agreement. A person's or organization's of liability in a contract or agreement. status as an additional insured under this This exclusion does not apply to liability endorsement ends the earlier of when "your" for damages that the additional insured on -going operations for that additional would have in the absence of the insured are completed or when "you" no contract or agreement. longer are contractually required to include 4. "Bodily injury", "property damage" or such person or organization as an additional "your" "personal and advertising injury" arising insured under policy. out of the rendering of, or the failure to The insurance provided to an additional render, any professional architectural, insured by this endorsement is limited as engineering or, surveying services, follows: including: 1. The additional insured is covered only (a) The preparing, approving, or failing for such damages which are caused, in to prepare or approve, maps, shop whole or in part, by the acts or drawings, opinions, reports, omissions of the "Named Insured" to surveys, field orders, change orders which the additional insured is entitled or drawings and specifications; and to be indemnified by the "Named (b) Supervisory, inspection, archi- Insured" pursuant to the written tectural or engineering activities. contract, lease, sublease or agreement referenced in the first paragraph of this 5. "Bodily injury" or "property damage" subsection i. above and only for those occurring after: sums that the additional insured is (a) All work, including materials, parts legally obligated to pay as damages or equipment furnished in under tort law principles to the injured connection with such work, on the party because of "bodily injury", project (other than service "property damage" or "personal and maintenance or repairs) to be advertising injury" to which this performed by or on behalf of the insurance applies, and in accordance additional insured(s) at the site of with the stated policy limits and policy the covered operations has been conditions. This coverage does not completed; or apply for defense or indemnity of the (b) That portion of "your work" out of additional insured if state or federal law which the injury or damage arises does not permit indemnification of the has been put tor its intended use by additional insured by the "Named any person or organization other Insured" for the claim of the third party. than another contractor or CG 81 28 01 18 Includes copyrighted material of Insurance Services Office, Inc., Page 7 of 9 with its permission. CG 81 28 01 18 subcontractor engaged in G. SECTION IV— COMMERCIAL GENERAL LIABILITY performing operations for a CONDITIONS is amended as follows: principal as a part of the same 1. Duties In The Event Of Occurrence, Offense, project. Claim Or Suit is amended as follows: Other Insurance a. The following is added to Paragraph a.: 1. If specifically required by the written However, this condition only applies when contract, lease, sublease or agreement the "occurrence" or offense is known to: referenced in the first Paragraph of this Subsection j. above, any coverage i. You, if you are an individual; provided by this endorsement to an ii. A partner, if you are a partnership; or additional insured shall be primary and iii. An executive officer or insurance any other valid and collectible insurance manager, if you are a corporation. available to the additional insured shall be non-contributory with this insurance. b. The following is added to Paragraph b.: If the written contract, lease or sublease However, this condition will not be does not require this coverage to be considered breached unless the breach primary and the additional insured's occurs after such claim or "suit" is known to: coverage to be non-contributory, then i. You, if you are an individual; this insurance will be excess over any other valid and collectible insurance ii. A partner, if you are a partnership; or available to the additional insured. iii. An executive officer or insurance 2. Even if the requirements of Paragraph manager, if you are a corporation. 1. immediately above are met 2. Subsection 4. Other Insurance, Paragraph b. establishing this coverage as primary Excess Insurance, Item (1)(a)(ii) is replaced by and the additional insured's coverage the following if damage to premises rented to you as being non-contributory, this coverage is not otherwise excluded: will be excess over other insurance available to the additional insured which (li) That is fire, lightning, explosion, smoke or is conferred onto said person or sprinkler leakage insurance for premises organization by a separate additional rented you or temporarily occupied by you insured endorsement. with permission of the owner. Definitions 3. Subsection 6. Representations is amended to include: Solely for purposes of the insurance afforded to an additional insured by this d. Your failure to disclose all hazards or prior endorsement: "occurrences" or offenses existing as of the "Named Insured" is defined as the entity to inception date of the policy shall not prejudice the coverage afforded by this whom the insurance policy is issued as policy provided such failure to disclose all shown on the Declarations. hazards or prior "occurrences" or offenses is "You" or "your" means a "Named Insured" as not intentional. This provision does not affect defined above. our right to collect additional premium or F. SECTION III — LIMITS OF INSURANCE is amended exercise our right of cancellation or as follows: nonrenewal. 1. Paragraph 6 is replaced with: 4. Subsection 8. Transfer of Rights of Recovery 6. Subject to 5. above, the Damage To Against Others to Us is amended to include: Premises Rented to You Limit is the most Therefore, the insured can waive the insurer's we will pay under Coverage A for damages Rights of Recovery prior to the occurrence of a because of "property damage" to any one loss, provided the waiver is made in a written premises, while rented to you or in the case contract. of damage by fire while rented to or 5. The following condition is added: temporarily occupied by you with permission 10. Liberalization of the owner. The limit is increased to $1,000,000. If we revise this coverage form to provide more However, if damage by fire to premises coverage without additional premium charge, rented to you is not otherwise excluded, the your policy will automatically provide the word fire in the above paragraph is replaced additional coverage as of the day the revision is with fire, lightning, explosion, smoke or effective in your state, provided that this sprinkler leakage. implementation date falls within 45 days prior to or during the policy period stated in the Declarations. Page 8 of 9 Includes copyrighted material of Insurance Services Office, Inc., CG 81 28 01 18 with its permission. H. SECTION V — DEFINITIONS is amended as follows: 1. Paragraph 3. 'Bodily Injury" is deleted and replaced with the following: "Bodily Injury": a. Means bodily injury, sickness, or disease sustained by a person and includes mental anguish resulting from any of these; and b. Except for mental anguish, includes death resulting from the foregoing (Item a. above) at any time. 2. If damage by fire to premises rented to you is not otherwise excluded, Paragraph 9. "Insured Contract", Item a. is replaced by the following: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion, smoke or sprinkler leakage to premises while rented to you or temporarily occupied by you with permission of the owners is not an "insured contract"; 3. Paragraph 14. "Personal and Advertising Injury" is amended as follows: a. Item b. is deleted and replaced with the following: b. Malicious prosecution or abuse of process; b. Item h. is added: h. "Personal and advertising injury" also means injury, including consequential "bodily injury", arising out of discrimination based on race, color, religion, sex, age or national origin, except when: (1) Done intentionally by or at the direction of, or with the knowledge or consent of: (a) Any insured; or CG 81 28 01 18 b. Any executive officer, director, stockholder, partner or member of the insured; or (2) Directly or indirectly related to the employment, former or prospective employment, termination of employment, demotion, failure to promote or application for employment of any person or persons by an insured; or (3) Directly or indirectly related to the sale, rental, lease or sublease or prospective sales, rental, lease or sub -lease of any room, dwelling or premises by or at the direction of any insured; or (4) Insurance for such discrimination is prohibited by or held in violation of law, public policy, legislation, court decision or administrative ruling This coverage does not apply to fines or penalties imposed because of discrimination. 4. "Client" as used in this endorsement means: a. An individual, company or organization with whom you have a written contract or work order for your services for a described premises and have billed for your services; or b. A person under your direct care and supervision for whom you are providing goods and/or services. All terms and conditions of this policy apply unless modified by this endorsement. CG 81 28 01 18 Includes copyrighted material of Insurance Services Office, Inc., Page 9 of 9 with its permission. POLICYHOLDER COPY SP P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 08-12-2021 EL SEGUNDO POLICE DEPARTMENT SP 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 manned 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 fisted 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 10 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 H0015 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 ENNDORSEMENT #2005 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 08-12-2011 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT N2570 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 IREV.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 NE AUGUST 25, 2021 PRESIDENT AND CEO