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PROOF OF INSURANCE (2023) CLOSED DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 12/12/2022 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). CONTACT PRODUCER Julie Bushinger NAME: FAX PHONE North Risk Partners(763) 536-8006 (A/C, No): (A/C, No, Ext): E-MAIL P.O. Box 64016Julie.Bushinger@NorthRiskPartners.com ADDRESS: INSURER(S) AFFORDING COVERAGENAIC # St PaulMN55164-0016Great Northern Insurance Company20303 INSURER A : INSURED Federal Insurance Company20281 INSURER B : CliftonLarsonAllen LLPChubb Indemnity Insurance Company12777 INSURER C : 220 South 6th Street INSURER D : Suite 300 INSURER E : MinneapolisMN55402-1436 INSURER F : 22/23 CERT #3 COVERAGESCERTIFICATE 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. ADDLSUBR INSRPOLICY EFFPOLICY EXP TYPE OF INSURANCELIMITS POLICY NUMBER LTR(MM/DD/YYYY)(MM/DD/YYYY) INSDWVD COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE$ DAMAGE TO RENTED 1,000,000 CLAIMS-MADEOCCUR$ PREMISES (Ea occurrence) 10,000 MED EXP (Any one person)$ A3598356912/31/202212/31/20231,000,000 PERSONAL & ADV INJURY$ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ PRO- 2,000,000 POLICYLOCPRODUCTS - COMP/OP AGG$ JECT Combined Total10,000,000 $ OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY 1,000,000 $ (Ea accident) ANY AUTOBODILY INJURY (Per person)$ OWNEDSCHEDULED B7357282512/31/202212/31/2023 BODILY INJURY (Per accident)$ AUTOS ONLYAUTOS HIREDNON-OWNEDPROPERTY DAMAGE $ (Per accident) AUTOS ONLYAUTOS ONLY Uninsured Motorist1,000,000 $ UMBRELLA LIAB 50,000,000 OCCUREACH OCCURRENCE$ B EXCESS LIAB 7988074712/31/202212/31/202350,000,000 CLAIMS-MADEAGGREGATE$ 0 DEDRETENTION$$ PEROTH- WORKERS COMPENSATION STATUTEER AND EMPLOYERS' LIABILITY Y / N 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT$ CN N / A 7174927612/31/202212/31/2023 OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS belowE.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of El Segundo, its directors, officers, employees, agents and volunteers are included as additional insureds on General Liability per form 80-02-2367 Rev 5-07 and on Automobile per form 16-02-0292 Ed 4-11 when required in prior written contract. General Liability is primary and non-contributory per form 80-02-2367 Rev 5-07 and Auto Liability is primary per form 16-02-0292 Ed 4-11 when required in prior written contract. Waiver of Subrogation included on General Liability per form 80-02-2000 & on Auto per form 16-02-0292 when required in prior written contract. General Liability & Auto Policies have been endorsed to provide 30 days notice of cancellation, with the exception of 10 days notice of cancellation for non-payment of premium per form 80-02-9779 and 16-02-0306 respectively. Umbrella Policy is follow form. Waiver of Subrogation is included on Workers' Compensation Policies for all states except Kentucky where prohibited by law utilizing the following policy forms: California WC 99 03 04, Texas WC 42 03 04, All Other States, CERTIFICATE HOLDERCANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of El Segundo 350 Main Street AUTHORIZED REPRESENTATIVE El SegundoCA90245 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD 00106559 AGENCY CUSTOMER ID: LOC #: Pageof ADDITIONAL REMARKS SCHEDULE AGENCYNAMED INSURED North Risk Partners POLICY NUMBER CARRIERNAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, 25Certificate of Liability Insurance FORM NUMBER:FORM TITLE: Except Kentucky WC 00 03 13, when required by prior written agreement. Workers' Compensation coverage is not provided in the following monopolistic states: ND; OH, WA; and WY. ACORD 101 (2008/01)© 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 00106559 AGENCY CUSTOMER ID: LOC #: Pageof ADDITIONAL REMARKS SCHEDULE AGENCYNAMED INSURED CliftonLarsonAllen LLP North Risk Partners POLICY NUMBER CARRIERNAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, 25Certificate of Liability Insurance FORM NUMBER:FORM TITLE: forms: California WC 90 03 75, Texas WC 42 03 04, All Other States, Except Kentucky WC 00 03 13, when required by prior written agreement. Workers' Compensation coverage is not provided in the following monopolistic states: ND; OH, WA; and WY. ACORD 101 (2008/01)© 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!DPNNFSDJBM!BVUPNPCJMF! ! UIJT!FOEPSTFNFOU!DIBOHFT!UIF!QPMJDZ/!QMFBTF!SFBE!JU!DBSFGVMMZ/! OPUJDF!PG!DBODFMMBUJPO!! )PUIFS!UIBO!OPOQBZNFOU!PG!QSFNJVN*! 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Jowbmjebuf!tvdi!dbodfmmbujpo/! 27.13.1417!)Fe/!6.22*!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Qbhf!2!pg!2! COMMERCIAL AUTOMOBILE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL AUTOMOBILE BROAD FORM ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORMborrow in your business or your personal This endorsement modifies the Business Auto Coverage Form.affairs. 1.EXTENDED CANCELLATION CONDITIONC.Lessors as Insureds Paragraph A.2.b. – CANCELLATION - of the Paragraph A.1. – WHO IS AN INSURED – of COMMON POLICY CONDITIONS form IL 00 17 is SECTION II – LIABILITY COVERAGE is deleted and replaced with the following:amended to add the following: b.60 days before the effective date of cancellation if e.The lessor of a covered “auto” while the we cancel for any other reason.“auto” is leased to you under a written 2.BROAD FORM INSUREDagreement if: A.Subsidiaries and Newly Acquired or Formed (1)The agreement requires you to Organizations As Insuredsprovide direct primary insurance for The Named Insured shown in the Declarations is the lessor; and amended to include:(2)The “auto” is leased without a driver. 1. Any legally incorporated subsidiary in which Such leased “auto” will be considered a you own more than 50% of the voting stock on covered “auto” you own and not a covered the effective date of the Coverage Form. “auto” you hire. However, the Named Insured does not include However, the lessor is an “insured” only any subsidiary that is an “insured” under any for “bodily injury” or “property damage” other automobile policy or would be an resulting from the acts or omissions by: “insured” under such a policy but for its 1.You; termination or the exhaustion of its Limit of 2.Any of your “employees” or agents; Insurance.or 2. Any organization that is acquired or formed by 3.Any person, except the lessor or you and over which you maintain majority any “employee” or agent of the ownership. However, the Named Insured lessor, operating an “auto” with the does not include any newly formed or acquired permission of any of 1. and/or 2. organization:above. (a) That is an “insured” under any other D.Persons And Organizations As Insureds automobile policy;Under A Written Insured Contract (b) That has exhausted its Limit of Insurance Paragraph A.1 – WHO IS AN INSURED – of under any other policy; orSECTION II – LIABILITY COVERAGE is (c) 180 days or more after its acquisition or amended to add the following: formation by you, unless you have given f.Any person or organization with respect to us written notice of the acquisition or the operation, maintenance or use of a formation.covered “auto”, provided that you and Coverage does not apply to “bodily injury” or such person or organization have agreed “property damage” that results from an “accident” under an express provision in a written that occurred before you formed or acquired the “insured contract”, written agreement or a organization.written permit issued to you by a B. Employees as Insuredsgovernmental or public authority to add Paragraph A.1. – WHO IS AN INSURED – of such person or organization to this policy SECTION II – LIABILITY COVERAGE is amended to as an “insured”. add the following:However, such person or organization is d.Any “employee” of yours while using a an “insured” only: covered “auto” you don’t own, hire or Form: 16-02-0292 (Rev. 11-16)Page 1 of 3 "Includes copyrighted material of Insurance Services Office, Inc. with its permission" (1)with respect to the operation, d.Rental Expense maintenance or use of a covered We will pay the following expenses that you or “auto”; and any of your “employees” are legally obligated (2)for “bodily injury” or “property damage” to pay because of a written contract or caused by an “accident” which takes agreement entered into for use of a rental place after: vehicle in the conduct of your business: (a)You executed the “insured MAXIMUM WE WILL PAY FOR ANY ONE contract” or written agreement; or CONTRACT OR AGREEMENT: (b)The permit has been issued to 1.$2,500 for loss of income incurred by the you. rental agency during the period of time that 3.FELLOW EMPLOYEE COVERAGE vehicle is out of use because of actual EXCLUSION B.5. - FELLOW EMPLOYEE – of damage to, or “loss” of, that vehicle, including SECTION II – LIABILITY COVERAGE does not apply. income lost due to absence of that vehicle for 4.PHYSICAL DAMAGE – ADDITIONAL TEMPORARY use as a replacement; TRANSPORTATION EXPENSE COVERAGE 2.$2,500 for decrease in trade-in value of the Paragraph A.4.a. – TRANSPORTATION EXPENSES rental vehicle because of actual damage to – of SECTION III – PHYSICAL DAMAGE that vehicle arising out of a covered “loss”; and COVERAGE is amended to provide a limit of $50 per 3.$2,500 for administrative expenses incurred day for temporary transportation expense, subject to a by the rental agency, as stated in the contract maximum limit of $1,000. or agreement. 5.AUTO LOAN/LEASE GAP COVERAGE 4. $7,500 maximum total amount for paragraphs Paragraph A. 4. – COVERAGE EXTENSIONS - of 1., 2. and 3. combined. SECTION III – PHYSICAL DAMAGE COVERAGE is 7.EXTRA EXPENSE – BROADENED COVERAGE amended to add the following: Paragraph A.4. – COVERAGE EXTENSIONS – of c. Unpaid Loan or Lease Amounts SECTION III – PHYSICAL DAMAGE COVERAGE In the event of a total “loss” to a covered “auto”, we will is amended to add the following: pay any unpaid amount due on the loan or lease for a e.Recovery Expense covered “auto” minus: We will pay for the expense of returning a 1.The amount paid under the Physical Damage stolen covered “auto” to you. Coverage Section of the policy; and 8. AIRBAG COVERAGE 2. Any: Paragraph B.3.a. - EXCLUSIONS – of SECTION a.Overdue loan/lease payments at the time of III – PHYSICAL DAMAGE COVERAGE does not the “loss”; apply to the accidental or unintended discharge of b.Financial penalties imposed under a lease for an airbag. Coverage is excess over any other excessive use, abnormal wear and tear or collectible insurance or warranty specifically high mileage; designed to provide this coverage. c.Security deposits not returned by the lessor: 9. AUDIO, VISUAL AND DATA ELECTRONIC d.Costs for extended warranties, Credit Life EQUIPMENT - BROADENED COVERAGE Insurance, Health, Accident or Disability Insurance purchased with the loan or lease; Paragraph C.1.b. – LIMIT OF INSURANCE - of and SECTION III - PHYSICAL DAMAGE is deleted e.Carry-over balances from previous loans or and replaced with the following: leases. b. $2,000 is the most we will pay for "loss" in any We will pay for any unpaid amount due on the loan or one "accident" to all electronic equipment that lease if caused by: reproduces, receives or transmits audio, visual 1.Other than Collision Coverage only if the or data signals which, at the time of "loss", is: Declarations indicate that Comprehensive (1) Permanently installed in or upon the Coverage is provided for any covered “auto”; covered "auto" in a housing, opening or 2. Specified Causes of Loss Coverage only if the other location that is not normally used by Declarations indicate that Specified Causes of the "auto" manufacturer for the installation Loss Coverage is provided for any covered “auto”; of such equipment; or (2) Removable from a permanently installed 3. Collision Coverage only if the Declarations indicate housing unit as described in Paragraph that Collision Coverage is provided for any 2.a. above or is an integral part of that covered “auto. equipment; or 6. RENTAL AGENCY EXPENSE (3) An integral part of such equipment. Paragraph A. 4. – COVERAGE EXTENSIONS – of SECTION III – PHYSICAL DAMAGE COVERAGE 10.GLASS REPAIR – WAIVER OF DEDUCTIBLE is amended to add the following: Form: 16-02-0292 (Rev. 11-16)Page 2 of 3 "Includes copyrighted material of Insurance Services Office, Inc. with its permission" their rights of recovery against such person or Under Paragraph D. - DEDUCTIBLE – of organization under a contract or agreement SECTION III – PHYSICAL DAMAGE COVERAGE that is entered into before such “loss”. the following is added: No deductible applies to glass damage if the glass To the extent that the “insured’s” rights to is repaired rather than replaced. recover damages for all or part of any 11. TWO OR MORE DEDUCTIBLES payment made under this insurance has not Paragraph D.- DEDUCTIBLE – of SECTION III – been waived, those rights are transferred to PHYSICAL DAMAGE COVERAGE is amended to us. That person or organization must do add the following: everything necessary to secure our rights and If this Coverage Form and any other Coverage must do nothing after “accident” or “loss” to Form or policy issued to you by us that is not an impair them. At our request, the insured will automobile policy or Coverage Form applies to the bring suit or transfer those rights to us and same “accident”, the following applies: help us enforce them. 1.If the deductible under this Business Auto Coverage Form is the smaller (or smallest) 14.UNINTENTIONAL FAILURE TO DISCLOSE deductible, it will be waived; or HAZARDS 2.If the deductible under this Business Auto Paragraph B.2. – CONCEALMENT, Coverage Form is not the smaller (or smallest) MISREPRESENTATION or FRAUD of SECTION deductible, it will be reduced by the amount of IV – BUSINESS AUTO CONDITIONS - is deleted the smaller (or smallest) deductible. and replaced with the following: If you unintentionally fail to disclose any hazards 12. AMENDED DUTIES IN THE EVENT OF existing at the inception date of your policy, we will ACCIDENT, CLAIM, SUIT OR LOSS not void coverage under this Coverage Form Paragraph A.2.a. - DUTIES IN THE EVENT OF because of such failure. AN ACCIDENT, CLAIM, SUIT OR LOSS of SECTION IV - BUSINESS AUTO CONDITIONS is 15.AUTOS RENTED BY EMPLOYEES deleted and replaced with the following: Paragraph B.5. - OTHER INSURANCE of a.In the event of “accident”, claim, “suit” or SECTION IV – BUSINESS AUTO CONDITIONS - “loss”, you must promptly notify us when the is amended to add the following: “accident” is known to: e.Any “auto” hired or rented by your “employee” (1)You or your authorized representative, if on your behalf and at your direction will be you are an individual; considered an “auto” you hire. If an (2)A partner, or any authorized “employee’s” personal insurance also applies representative, if you are a partnership; on an excess basis to a covered “auto” hired (3)A member, if you are a limited liability or rented by your “employee” on your behalf company; or and at your direction, this insurance will be (4)An executive officer, insurance manager, primary to the “employee’s” personal or authorized representative, if you are an insurance. organization other than a partnership or 16. HIRED AUTO – COVERAGE TERRITORY limited liability company. Paragraph B.7.b.(5). - POLICY PERIOD, Knowledge of an “accident”, claim, “suit” or COVERAGE TERRITORY of SECTION IV – “loss” by other persons does not imply that the BUSINESS AUTO CONDITIONS is deleted and persons listed above have such knowledge. replaced with the following: Notice to us should include: (5) A covered “auto” of the private passenger (1)How, when and where the “accident” or type is leased, hired, rented or borrowed “loss” occurred; without a driver for a period of 45 days or (2)The “insured’s” name and address; and less; and (3)To the extent possible, the names and 17.RESULTANT MENTAL ANGUISH COVERAGE addresses of any injured persons or Paragraph C. of - SECTION V – DEFINITIONS is witnesses. deleted and replaced by the following: 13.WAIVER OF SUBROGATION “Bodily injury” means bodily injury, sickness or Paragraph A.5. - TRANSFER OF RIGHTS OF disease sustained by any person, including RECOVERY AGAINST OTHERS TO US of mental anguish or death as a result of the “bodily SECTION IV – BUSINESS AUTO CONDITIONS is injury” sustained by that person. deleted and replaced with the following: 5.We will waive the right of recovery we would otherwise have against another person or organization for “loss” to which this insurance applies, provided the “insured” has waived Form: 16-02-0292 (Rev. 11-16)Page 3 of 3 "Includes copyrighted material of Insurance Services Office, Inc. with its permission" WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICYWC 42 03 04 B (Ed. 6-14) TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Texas is shown in Item 3.A. of the Information Page. 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, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule where you are required by a written contract to obtain this waiver from us. This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. The premium for this endorsement is shown in the Schedule. Schedule 1.()Specific Waiver Name of person or organization ()Blanket Waiver Any person or organization against whom you have agreed to waive your right of recovery in a written contract, provided such contract was executed prior to the date of loss. 2.Operations: 3.Premium: The premium charge for this endorsement shall be2%percent of the premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4.Advance Premium: This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 12-31-22 Policy No. 71749276 Endorsement No. Insured CLIFTONLARSONALLEN LLP Premium $ Incl. Insurance Company Chubb Indemnity Insurance Company Countersigned By WC 42 03 04 B (Ed. 6-14) © Copyright 2014 National Council on Compensation Insurance, Inc. All Rights Reserved. Producer Copy CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. 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, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Schedule 1.Specific Waiver () Name of person or organization Blanket Waiver () Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2.Operations: ALL CALIFORNIA OPERATIONS 3. Premium: The premium charge for this endorsement shall be1%percent of the California premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4.Minimum Premium: Authorized Representative This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 12-31-22 Policy No. 71749276 Endorsement No. Insured CLIFTONLARSONALLEN LLP Premium $ Incl. Insurance Company Chubb Indemnity Insurance Company Countersigned By WC 90 03 75 (05/18) Insured Copy WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICYWC 00 03 13 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Persons or organizations that you are obligated, pursuant to a contract or agreement, to provide with such insurance as is afforded by this policy. For policies or exposure in Missouri: Any person or organization for which the employer has agreed by written contract, executed prior to loss, may execute a waiver of subrogation. However, for purposes of work performed by the employer in Missouri, this waiver of subrogation does not apply to any construction group of classifications as designated by the waiver of right to recover from others (subrogation) rule in our manual. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 12-31-22 Policy No. 71749276 Endorsement No. Insured CLIFTONLARSONALLEN LLP Premium $ Incl. Insurance Company Chubb Indemnity Insurance Company Countersigned By WC 00 03 13 (Ed. 4-84) 1983 National Council on Compensation Insurance. Insured Copy