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PROOF OF INSURANCE (2023 - 2023) CLOSEDCERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 6/30/2022 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 endorsements . PRODUCER Artex Risk Solutions, Inc. (CB) 2850 Golf Road, 5th Floor Rolling Meadows IL 60008-4050 INSURER A : Old INSURED CHRIBRO-14 INSURER B: Old_ Brothers of the Christian Schools & Affiliates Loc #1177028 DOC POW ST VINCENT SENIOR CITIZEN NTR - INSURER C 1205 Windham Parkway I„NSURERD: Romeoville IL 60446-1679 INSURER E INSURER F : Services ....y......................_.__.................................,1I COVERAGE 2 Insurance Com C E _ anion Insurance ompany 3 14 4 143 J"'.rAl1'It gt7li..f:F'M.. [_FRTIF!C--'ATE IU11.MRFR- 13335:15244 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. ...... .�.. __.-._ -... .... ADDL Y% tij ..- ....... .. --. .,.....-_. — m,.- ...-...... .. I�� R I'CY EXP ,........... ._m.. LIMITS TYPE OF INSURANCE.... DDIYY R 1 POLICY NUMBER MOILI YYYY IOM� B X COMMERCIAL GENERAL LIABILITY Y Y 8222001325596 6/15/2022 6/15/2023 EACH OCCURRENCE $4,900 000 ' CLAIMS -MADE OCCUR _ ....bAIV1AC�t 1"O REN PED PRFlutISES_tEa,ggcurrenr.,g,1 _ _$ Included ,........... .........— MED EXP (And one persa,n) $ 15 000 ,.,..,... __. ,.-..... ... .,._-.. ....�_; ---... PERSONAL & ADV INJURY 1 $ Included ... PER: G;Erve°L AGGREGATE LIMIT APPLIES� /A GENERAL AGGREGATE $-M,..a_ ,�_ N X...I POLICY j LOC S COMP/OPAGG $Included PRODUCTS __ m 1 $ OTHER: A AUTOMOBILE LIABILITY Y Y MWTB 21543 6/15/2022 6/15I2023 COMBINED SINGLE LIMN r $1 . 000 T7 dBIiSED 1 X ANY AUTO -BODILY INJURY (Per person)$ OWNED SCHEDULED I ciden BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS X ED NON-OWNED EPR. X AUTOS ONLY AUTOS ONLY _............. ........._...... --- UMBRELLA LIAB HOCCUR URREN E EACH OCC _ .. $ —. SS LIAB CLAIMS MADE EXCESS ,. ._., AGGREGATE $ ._, — .,., .. DED G RETENTION $ $ A WORKERS COMPENSATION Y MWC 305311 07 1/1/2022 1/1/2023 OTRH X AND EMPLOYERS' LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE N OFFICER/MEMBEREXCLUDED? � N/A j E L EA�PSCH ACCIDENT ... $1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE, $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below EL DISEASE- POLICY LIMIT $ 1,000.000 B Ltd, Prof. Healthcare -Claims Made N N 822200 1125196 -7 6/15/2022 6/15/2023 Occurrence $2,000,000 Aggregate $4.000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) is provided under General Liability, Auto Liability & Worker's Compensation coverage Waiver of Subrogation (where allowed bylaw) per attached endorsement p y, tY p when required by fully executed written contract. Certificate Molder is added as Additional Insured (per attached endorsement) for General Liability & Automobile flability coverages solely„ strictly and specifically with regards to: Consultant Services for the Community Development Block Grant Program for Home Delivered Meals. l I [Ht;A, t Ic MULULK I lend City of El Segundo its Official and Employees Office of City Clerk 350 Main Street El Segundo CA 90245 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. (U 1988-2015 AGUKU GUKF'UKA I IUN. Au rlgnss reserves. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD OLD REPUBLIC UNION INSURANCE COMPANY Attaching to and forming part of Policy No. 8222 00 1325596 Named Insured: THE RELIGIOUS AND CHARITABLE RISK POOLING TRUST OF THE BROTHERS OF THE CHRISTIAN SCHOOLS AND AFFILIATES Effective date of this endorsement is June 15, 2022 THIS ENDORSEM ENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under SECTION II INSURING AGREEMENT C, GENERAL LIABILITY COVERAGE def fined w ithin the Coverage Agreement SECTION 1: Schedule Name of Additional Insured Persons(s) or Organization(s): Designated Location(s) Of Covered Operations: ANY PERSON OR ORGANIZATION WHEN YOU HAVE AGREED IN A WRITTEN CONTRACT FOR THAT PERSON OR ORGANIZATION TO BE ADDED AS AN ADDITIONAL INSURED ON YOUR POLICY. If no entry appears above, information required to complete this endorsement ill be show n in the Certificate of Coverage as applicable to this endorsement. Section II InsuringAgreement C -Name of Insured Amended A. Who Is An Insured defined in the General Insurance Agreement is amended to include as an Additional Insured the person(s) or organization(s) shown in the Schedule above, but only w ith respect to liability in the performance of the Named Insured's ongoing operations forthe Additional Insured(s) at the Location(s) designated in the Schedule above for "bodily injury" or "property damage", caused in whole or in part, by the Named Insured's acts or omissions which takes place after the execution of a written agreement with the Additional Insured(s). B. For the coverage provided by this endorsement: the following paragraph is added to Section IV -General Conditions, Section II, Insuring Agreement C-General Liability. This insurance is primary insurance as respects to this coverage to the additional insured person or organization, w here thew ritten contract or w ritten agreement requires that this insurance be primary and noncontributory. In that event, w e w ill not seek contribution fromany other insurance policy available to the additional insured on w hich the additional insured person or organization is a Named Insured. C. Who Is An Insured is also amended to include as an additional insured the person(s) or organizations) shorn in the Schedule, w ith respectto liability for "bodily injury" or "property damage" caused, in w hole or in part, by the "Flamed Insured's work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard'. The mostw ewill pay is the amount of insurance requiredby thewritten contract orthe amount of applicable limits of insurance under this policy; w hichever is less. This Insurance does not apply to any claims or suits seeking damages, including defense, arising out of, directly or indirectly, from any actual or alleged participation in any act of sexual misconduct, sexual harassment, sexual molestation, sexual abuse or any claim sexual in nature, physical or mental, of any person. Except as amended in this endorsement, this insurance is subject to all coverage terms, clauses and conditions in the policy to w hich this endorsement is attached and only applies to the extent permitted by law. OLD REPUBLIC UNION INSURANCE COMPANY Attaching to and forming part of Policy No. 8222001325596 Named Insured: THE RELIGIOUS AND CHARITABLE RISK POOLING TRUST OF THE BROTHERS OF THE CHRISTIAN SCHOOLS ANDAFFILIATES Effective date of this endorsement is June 15, 2022 COMBINED PROPERTYAND CASUALTY AND CRIME PACKAGE THE FOLLOWING WORDING HAS BEEN EXTRACTED FROM THE ABOVE MENTIONED POLICY FORM TO PROVIDE PROOF OF COVERAGE PLEASE READ IT CAREFULLY. SECTION IV -GENERAL CONDITIONS 15. WAIVER OF SUBROGATION: This Insurance shall not be invalidated if the Insured by written agreement has waived or shall waive its right of recovery from any party for loss or damage covered hereunder; provided, that any such waiver is made prior to the occurrence of said loss or damage. IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM SCHEDULE Name of Person(s) or Organization(s): All persons or organizations as required by contract or agreement With respectto COVERED AUTOS LIABILITY COVERAGE, Who IsAn Insured is changed with the addition of the following: Each person or organization shown in the Schedule for whom you are doing work is an "insured". But only for "bodily injury" or "property damage" that results from the ownership, maintenance or use of a covered "auto" by: You; an "employee" of yours; or anyone who drives a covered "auto" with your permission or with the permission of one of your "employees". However, the insurance afforded to the person or organization shown in the Schedule shall not exceed the scope of coverage and/or limits of this policy. Not withstanding the foregoing sentence, in no event shall the insurance provided by this policy exceed the scope of coverage and/or limits required by the contract or agreement. PCA 001 1013 MWTB21543 Religiousand charitable Risk Pooling Trust 06/15/2022-06/15/2023 IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM SCHEDULE Name of Person or Organization: Only those persons or organizations for whom you are required to waive your rights of recovery under the terms of a written contract. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The Transfer Of Rights Of Recovery Against Others To Us Condition is changed by adding the following: We waive any right of recovery we may have against the person(s) or organization(s) shown in the Schedule because of payments we make for injury or damage. This waiver applies only to the person or organization shown in the Schedule. PCA 024 10 13 Page 1 of 1 MV TB 21543 Religious and Charitable Risk Pooling Trust 06/15/22 - 06/15/23 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) POLICY NUMBER: MWC 305311 07 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA 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 perform 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 ALL PERSONS OR ORGANIZATIONS WHERE REQUIRED BY WRITTEN CONTRACT DATE OF ISSUE: 11-08-21 JOB DESCRIPTION ©1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB's California Workers' Compensation Insurance Forms Manual © 1999. INSURED COPY