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PROOF OF INSURANCE (2023) CLOSEDI N FOSTA-0KBO 1 ''� DATE (MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 12/16/2022 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 NHOE ......... 2000 ....... .— 1 BHS Insurance - Holland Exy (616) 396- jvc No .(616) 574 3317 2822 Westshore Drive Holland, MI 49424 _ INsu,p�ttySj,,,���FOROING couERAGE N�Ic #� _ __ INSURER A: Cincinnati Insurance Co 10677 INSURED ... .:-..... .......... .... ......................._ . - - --....._.. INSURER B . Accident Fund CO ...,rr......,.__. .._ ........., w_ ...-........ 10166 Information Station Specialists, Inc. IN up w?c P.O. Box 51 INSURER D Zeeland, MI 49464 INSgFgR E ., INSURER F ..........................�............. ... .........�.. COVERAGES CERTIFICATE NUMBER. REVISIONw UMBER;. 2 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, .. BY PAID CLAIMS .:.:.: .__' ------- POLICY NUMBER ..... ,. __..__...__ __...... ,,,.,,.._. --I SIR :ADDL SUBR POLICY SUCH POLICIES M EX A DWOLIY E�i�� LTR TYPE OF INSURANCE )� EFF P LIMITS A X COMMERCIAL GENERAL LIABILITY EACU,O_ CURRENCE --_ 1,000,000 CLAIMS -MADE j X occuR X X EPP 0170320 12/26/2022 12 26/2023 DAMAGE roIrn QED -- 500,000 MED EXP (Any one per $ 1 0'000 PERSONAL nw IN IURY �. .. 1,000,000 m..... m__._ .......... _ ..... ...w 7AGGREGATE $ 0 PRo- 0 u 2, GEN POLICY �G T JL4 T APPLIES PER: PROPP � 4 COMP/OP Af G $ 2,000,00 OTHER................. � ................ $ _ A AUTOMOBILE LIABILITY .(P�is,In.6s,:EI3G) ... _.......... COMBINED SINGLE LIMIT 1,000,000 X... (Per oersan:._ $ ANY AUTO X X EBA 0055634 12/26/2022 12/26/2023 BODILY IN IURx, OWNED SCHEDULED AUTOS ONLY AUTOS BODILYyINJURY(pera ident) & AUTOS ONLY NON -OWNED PROPERTY DAMAGI X HIRED X:n. AUTOS ONLY (Par ,5__d l� �. $ mm UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2,000,000 ............. EPP 0170320 12/26/2022 12/26/2023 2,000.... m" EXCESS LIAB CLAIMS -MADE AGGREGATE $ '��0 X_...R.. ..............------------- ._ DI_ D ETENTLO.N.$ .0i .... ............ .. B WORKERS COMPENSATION X C PER OTH AND EMPLOYERS' LIABILITY I 1 0 ANY PROPRIETOR/PARTNER/EXECUTIVE YIN X 100079271 12/26/2022 12/26/2023 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N / A E L EAC,HA,CCIDENT (Mandatory In NH) E L DISEASE - EA EMPLOYEE $ 1,000,000 If DESCRIPTION OF OPERATIONS:t below E L DISEASE -POLICY $ -0 Dyes, describe under .1,000 '00 A Installation/Builder EPP 0170320 12/26/2022 12/26/2023 Deductible: $500 100,000 A Professional Liab. EPP 0170320 12/26/2022 12/26/2023 Errors & Omissions 1,000,000 DESCRIPTION OF OPERATIONS I' LOCATIONS IWVEHICLES (ACORD 101„ Additional Remarks Schedule, may be attached if more space is required) City of El Segundo, its officials, and employees are named as additional insureds as per the Insureds policy form on a primary and non-contributory basis. A 30 day notice of cancellation applies except 10 days notice applies for non payment of premium. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN tY 9 ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main St 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 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY BROADENED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Endorsement - Table of Contents: Coverage Beginon Page: 1. Employee Benefit Liability Coverage ................................................. ....... --.... -- ........ ....... .......... ...2 2. Unintentional Failure to Disclose Hazards .......................................... ........................... ...................-7 3. Damage to Premises Rented to You......................................................................................a..,.....,, 7 4. Supplementary Payments.............................................................. ......... ......... ......... 9 5. Medical Payments..............................................................................................................................9 6. 180 Day Coverage for Newly Formed or Acquired Organizations...................................................9 7. Waiver of Subrogation.......................................................................................................................9 8. Automatic Additional Insured - Specified Relationships: .............................................................. —9 • Managers or Lessors of Premises; • Lessor of Leased Equipment; • Vendors; and • State or Political Subdivisions - Permits Relating to Premises 9. Property Damage to Borrowed Equipment.....................................................................................12 10. Employees as Insureds - Specified Health Care Services: ............................................................12 • Nurses; • Emergency Medical Technicians; and • Paramedics 11. Broadened Notice of Occurrence.....................................................................................................12 B. Limits of Insurance: The Commercial General Liability Limits of Insurance apply to the insurance provided by this endorsement, except as provided below: 1. Employee Benefit Liability Coverage Each Employee Limit: $ 1,000,000 Aggregate Limit: $ 3,000,000 Deductible: $ 1,000 3. Damage to Premises Rented to You The lesser of: a. The Each Occurrence Limit shown in the Declarations; or b. $500,000 unless otherwise stated $.................................. 4. Supplementary Payments a. Bail bonds: $ 1,000 b. Loss of earnings: $ 350 5. Medical Payments Medical Expense Limit: $ 10,000 9. Property Damage to Borrowed Equipment Each Occurrence Limit: $ 10,000 Deductible: $ 250 GA 210 02 07 Page 1 of 12 C. Coverages 1. Employee Benefit Liability Coverage a. The following is added to SECTION I - COVERAGES: Employee Benefit Liability Coverage. (1) Insuring Agreement (a) We will pay those sums that the insured becomes legally obligated to pay as damages caused by any act, error or omission of the insured, or of any other person for whose acts the insured is le- gally liable, to which this in- surance applies. We will have the right and duty to defend the insured against any "suit" seeking those damages. However, we will have no duty to defend against any "suit" seeking damages to which this in- surance does not apply. We may, at our discretion, inves- tigate any report of an act, error or omission and settle any claim or "suit" that may result. But: 1) The amount we will pay for damages is limited as described in SEC- TION III - LIMITS OF INSURANCE; and 2) Our right and duty to de- fend ends when we have used up the appli- cable limit of insurance in the payment of judg- ments or settlements. No other obligation or liability to pay sums or perform acts or services is covered unless explicitly provided for under Supplementary Pay- ments. (b) This insurance applies to damages only if the act, er- ror or omission, is negli- gently committed in the "administration" of your "em- ployee benefit program"; and 1) Occurs during the policy period; or 2) Occurred prior to the ef- fective date of this en- dorsement provided: a) You did not have knowledge of a claim or "suit" on or before the effective date of this en- dorsement. You will be deemed to have knowledge of a claim or "suit" when any "author- ized representa- tive'; i) Reports all, or any part, of the act, error or omission to us or any other insurer; ii) Receives a written or ver- bal demand or claim for dam- ages because of the act, er- ror or omis- sion; and b) There is no other applicable insur- ance. (2) Exclusions This insurance does not apply to: (a) Bodily Injury, Property Damage or Personal and Advertising Injury "Bodily injury", "property damage" or "personal and advertising injury'. (b) Dishonest, Fraudulent, Criminal or Malicious Act Damages arising out of any intentional, dishonest, fraudulent, criminal or mali- cious act, error or omission, committed by any insured, including the willful or reck- less violation of any statute. (c) Failure to Perform a Con- tract Damages arising out of fail- ure of performance of con- tract by any insurer. (d) Insufficiency of Funds Damages arising out of an insufficiency of funds to GA 210 02 07 Page 2 of 12 meet any obligations under (j) Employment -Related Prac- any plan included in the tices "employee benefit program". Any liability arising out of (e) Inadequacy of Perform- any: ance of Investment / Ad- vice Given With Respect (1) Refusal to employ; to Participation (2) Termination of emplo- Any claim based upon: ment; 1) Failure of any invest- (3) Coercion, demotion, ment to perform; evaluation, reassign- ment, discipline, defa- 2) Errors in providing in- mation, harassment, formation on past per- humiliation, discrimina- formance of investment tion or other employ - vehicles; or ment-related practices, acts or omissions; or 3) Advice given to any person with respect to (4) Consequential liability that person's decision to as a result of (1), (2) or participate or not to par- (3) above. ticipate in any plan in- cluded in the "employee exclusion applies benefit program". whls etherthe insured may be held liable as an employer or (f) Workers' Compensation in any other capacity and to and Similar Laws any obligation to share dam - ages with or repay someone An claim arising out of our y g y else who must pay damages failure to comply with the because of the injury. mandatory provisions of any workers' compensation, un- (3) Supplementary Payments employment compensation insurance, social security or SECTION I - COVERAGES, disability benefits law or any SUPPLEMENTARY PAYMENTS similar law. - COVERAGES A AND B also apply to this Coverage. (g) ERISA b. Who is an Insured Damages for which any in- sured is liable because of li- As respects Employee Benefit Liability ability imposed on a fiduciary Coverage, SECTION II -WHO IS AN by the Employee Retirement INSURED is deleted in its entirety and Income Security Act of 1974, replaced by the following: as now or hereafter (1) If you are designated in the Dec - amended, or by any similar larations as: federal, state or local laws. (a) An individual, you and your h ( ) Available Benefits spouse are insureds, but Any claim for benefits to the only with respect to the con - extent that such benefits are duct of a business of which available, with reasonable you are the sole owner. effort and cooperation of the (b) A partnership or joint ven- insured, from the applicable ture, you are an insured. funds accrued or other col- Your members, your part- lectible insurance. ners, and their spouses are (i) Taxes, Fines or Penalties also insureds but only with respect to the conduct of Taxes, fines or penalties, in- your business. cluding those imposed under the Internal Revenue Code (c) A limited liability company, or any similar state or local you are an insured. Your law. members are also insureds, but only with respect to the conduct of your business. Your managers are insur- GA 210 02 07 Page 3 of 12 eds, but only with respect to c. Limits of Insurance their duties as your manag- ers. As respects Employee Benefit Liability Coverage, SECTION III - LIMITS OF (d) An organization other than a INSURANCE is deleted in its entirety partnership, joint venture or and replaced by the following: limited liability company, you are an insured. Your "ex (1) The Limits of Insurance shown in ecutive officers" and direc- Section B. Limits of Insurance, tors are insureds, but only 1. Employee Benefit Liability with respect to their duties Coverage and the rules below fa as your officers or directors. the most we will pay regardless Your stockholders are also of the number of: insureds, but only with re- (a) Insureds; spect to their liability as stockholders. (b) Claims made or "suits" (e) A trust, you are an insured. brought; Your trustees are also insur- (c) Persons or organizations eds, but only with respect to making claims or bringing their duties as trustees. "suits'; (2) Each of the following is also an (d) Acts, errors or omissions; or insured: (e) Benefits included in your (a) Each of your "employees" "employee benefit program". who is or was authorized to administer your "employee (2) The Aggregate Limit shown in benefit program'. Section B. Limits of Insurance, 1. Employee Benefit Liability (b) Any persons, organizations Coverage of this endorsement is or "employees" having the most we will pay for all dam - proper temporary authoriza- ages because of acts, errors or tion to administer your "em- omissions negligently committed ployee benefit program" if in the "administration" of your you die, but only until your "employee benefit program". legal representative is ap- pointed. (3) Subject to the limit described in (2) above, the Each Employee (c) Your legal representative if Limit shown in Section B. Limits you die, but only with respect of Insurance, 1. Employee to duties as such. That rep- Benefit Liability Coverage of resentative will have all your this endorsement is the most we rights and duties under this will pay for all damages sus - Coverage Part. tained by any one "employee", (3) Any organization you newly ac- including damages sustained by such employees dependents quire or form, other than a part- and beneficiaries, as a result of: nership, joint venture or limited liability company, and over which (a) An act, error or omission; or you maintain ownership or major- ity interest, will qualify as a (b) A series of related acts, er- Named Insured if no other similar rors or omissions, regard - insurance applies to that organi- less of the amount of time zation. However, coverage un- that lapses between such der this provision: acts, errors or omissions, (a) Is afforded only until the negligently committed in the 180th day after you acquire "administration" of your "em- or form the organization or ployee benefit program". the end of the policy period, However, the amount paid under whichever is earlier; and this endorsement shall not ex- (b) Does not apply to any act, ceed, and will be subject to the error or omission that was limits and restrictions that apply committed before you ac- to the payment of benefits in any quired or formed the organi- plan included in the "employee zation. benefit program". GA 210 02 07 Page 4 of 12 (4) Deductible Amount a. You must see to it that we are notified as soon (a) Our obligation to pay dam- as practicable of an act, ages on behalf of the in- error or omission which sured applies only to the may result in a claim. amount of damages in ex- To the extent possible, cess of the deductible notice should include: amount stated in the Decla- rations as applicable to Each (1) What the act, error Employee. The limits of in- or omission was surance shall not be reduced and when it oc- by the amount of this de- curred; and ductible. (2) The names and (b) The deductible amount addresses of any - stated in the Declarations one who may suf- applies to all damages sus- fer damages as a tained by any one "em- result of the act, er- ployee", including such "em- ror or omission. ployee's" dependents and beneficiaries, because of all b. If a claim is made or acts, errors or omissions to "suit" is brought against which this insurance applies. any insured, you must: (c) The terms of this insurance, (1) Immediately record including those with respect the specifics of the to: claim or "suit" and the date received; 1) Our right and duty to de- and fend the insured against any "suits" seeking (2) Notify us as soon those damages; and as practicable. 2) Your duties, and the du- You must see to it that ties of any other in- we receive written no- volved insured, in the tice of the claim or "suit" event of an act, error or as soon as practicable. omission, or claim, c. You and any other in - apply irrespective of the ap- volved insured must: plication of the deductible (1) Immediately send amount. us copies of any (d) We may pay any part or all demands, notices, of the deductible amount to summonses or le - effect settlement of any gal papers re- claim or "suit" and, upon no- ceived in connec- tification of the action taken, tion with the claim you shall promptly reimburse or "suit; us for such part of the de- (2) Authorize us to ob- ductible amount as we have tain records and paid. other information; d. Additional Conditions (3) Cooperate with us As respects Employee Benefit Li- in the investigation ability Coverage, SECTION IV - or settlement of the COMMERCIAL GENERAL LIABIL- claim or defense ITY CONDITIONS is amended as fol- against the "suit'; lows: and (1) Item 2. Duties in the Event of (4) Assist us, upon our Occurrence, Offense, Claim or request, in the en - Suit is deleted in its entirety and forcement of any replaced by the following: right against any person or organi- 2. Duties in the Event of an zation which may Act, Error or Omission, or be liable to the in - Claim or Suit sured because of GA 210 02 07 Page 5 of 12 an act, error or omission to which this insurance may also apply. d. No insured will, except at that insured's own cost, voluntarily make a payment, assume any obligation, or incur any expense without our consent. (2) Item 5. Other Insurance is de- leted in its entirety and replaced by the following: 5. Other Insurance If other valid and collectible c, No Coverage This insurance shall not cover any loss for which the insured is entitled to recovery under any other insurance in force previous to the effective date of this Coverage Part. e. Additional Definitions As respects Employee Benefit Li- ability Coverage, SECTION V - DEFINITIONS is amended as follows: (1) The following definitions are added: insurance is available to the 1. "Administration" means: insured for a loss we cover a. Providing information to under this Coverage Part, "employees", including our obligations are limited as their dependents and follows: beneficiaries, with re - a. Primary Insurance spect to eligibility for or scope of "employee This insurance is pri- benefit programs"; mary except when c. below applies. If this in- b. Interpreting the "em- surance is primary, our ployee benefit pro - obligations are not af- grams'; fected unless any of the c. Handling records in other insurance is also connection with the primary. Then, we will "employee benefit pro - share with all that other grams"; or insurance by the method described in b. d. Effecting, continuing or below. terminating any "em- ployee's" participation in b. Method of Sharing any benefit included in If all of the other insur- the "employee benefit ance permits contribu- program". tion by equal shares, we However, "administration" will follow this method does not include: also. Under this ap- proach each insurer a. Handling payroll deduc- contributes equal tions; or amounts until it has paid its applicable limit of in- b. The failure to effect or surance or none of the maintain any insurance loss remains, whichever or adequate limits of comes first. coverage of insurance, including but not limited If any of the other insur- to unemployment insur- ance does not permit ance, social security contribution by equal benefits, workers' com- shares, we will contrib- pensation and disability ute by limits. Under this benefits. method, each insurer's share is based on the 2. "Cafeteria plans" means ratio of its applicable plans authorized by applica- limit of insurance to the ble law to allow "employees" total applicable limits of to elect to pay for certain insurance of all insur- benefits with pre-tax dollars. ers. GA 210 02 07 Page 6 of 12 3. "Employee benefit pro- ages are claimed and to grams" means a program which the insured must providing some or all of the submit or does submit following benefits to "em- with our consent; ployees", whether provided through a "cafeteria plan" or b. Any other alternative otherwise: dispute resolution pro- ceeding in which such a. Group life insurance; damages are claimed group accident or health and to which the insured insurance; dental, vision submits with our con - and hearing plans; and sent; or flexible spending ac- counts; provided that no c. An appeal of a civil pro - one other than an "em- ceeding. ployee" may subscribe g. "Employee" means a person to such benefits and actively employed, formerly such benefits are made employed, on leave of ab- generally available to sence or disabled, or retired. those "employees" who Employee" includes a satisfy the plan's eligibil- "leased worker". "Em- ity requirements; ployee" does not include a b. Profit sharing plans, "temporary worker". employee savings 2. Unintentional Failure to Disclose Haz- plans, employee stock ards ownership plans, pen- sion plans and stock SECTION IV - COMMERCIAL GENERAL subscription plans, pro- LIABILITY CONDITIONS, 7. Representa- vided that no one other tions is hereby amended by the addition than an "employee" may of the following: subscribe to such bene- fits and such benefits Based on our dependence upon your rep - are made generally resentations as to e)asting hazards, if un- available to all "employ- intentionally you should fail to disclose all ees" who are eligible such hazards at the inception date of your under the plan for such policy, we will not reject coverage under benefits; this Coverage Part based solely on such failure. c. Unemployment insur- ance, social security 3. Damage to Premises Rented to You benefits, workers' com- a, The last Subparagraph of SECTION pensation and disability - COVERAGES, COVERAGE A. benefits; and BODILY INJURY AND PROPERTY d. Vacation plans, includ- DAMAGE LIABILITY, 2. Exclusions ing buy and sell pro- is hereby deleted and replaced by the grams; leave of ab- following: sence programs, includ- Exclusions c. through q. do not apply ing military, maternity, to damage by fire, explosion, light - family, and civil leave; ning, smoke or soot to premises while tuition assistance plans; rented to you or temporarily occupied transportation and by you with permission of the owner. health club subsidies. (2) The following definitions are de- b. The insurance provided under SEC- TION I - COVERAGES, COVERAGE leted in their entirety and re- A. BODILY INJURY AND PROP- placed by the following: ERTY DAMAGE LIABILITY applies 21. "Suit" means a civil proceed- to "property damage" arising out of ing in which money dam- water damage to premises that are ages because of an act, er- both rented to and occupied by you. ror or omission to which this (1) As respects Water Damage Le - insurance applies are al- gal Liability, as provided in Para- leged. "Suit" includes: graph 3.b. above: a. An arbitration proceed- ing in which such dam - GA 210 02 07 Page 7 of 12 The exclusions under SECTION I a) Foundations, walls, - COVERAGES, COVERAGE A. floors or paved sur- BODILY INJURY AND PROP- faces; ERTY DAMAGE LIABILITY, 2. Exclusions, other than i. War b) Basements, and the Nuclear Energy Liabil- whether paved or ity Exclusion, are deleted and not; or the following are added: c) Doors, windows or This insurance does not apply to: other openings. (a) "Property damage": (c) Loss caused by or resulting from water that leaks or 1) Assumed in any con- flows from plumbing, heat - tract; or ing, air conditioning, or fire protection systems caused 2 Loss caused b y or re- by or resulting from freezing, sulting from any of the unless: following: 1) You did your best to a Wear and tear; maintain heat in the b) Rust, corrosion, building or structure; or fungus, decay, de- 2) You drained the equip- terioration, hidden ment and shut off the or latent defect or water supply if the heat any quality in prop- was not maintained. erty that causes it to damage or de- (d) Loss to or damage to: stroy itself; 1) Plumbing, heating, air c) Smog; conditioning, fire protec- tion systems, or other equipment or appli- down including rup- antes; or ture or bursting caused by cen- 2) The interior of any build- trifugal force; ing or structure, or to personal property in the e) Settling, cracking, building or structure shrinking or ex- caused by or resulting pansion; or from rain, snow, sleet or f) Nesting or infesta- ice, whether driven by tion, or discharge wind or not. or release of waste c. Limit of Insurance products or secre- tions, by insects, The Damage to Premises Rented to birds, rodents or You Limit as shown in the Declara- other animals. tions is amended as follows: (b) Loss caused directly or indi- (2) Paragraph 6. of SECTION III - rectly by any of the following: LIMITS OF INSURANCE is hereby deleted and replaced by 1 Earthquake, volcanic q the following: eruption, landslide or any other earth move- 6. Subject to 5. above, the ment; Damage to Premises Rented to You Limit is the 2) Water that backs up or most we will pay under overflows from a sewer, COVERAGE A. BODILY IN - drain or sump; JURY AND PROPERTY 3) Water under the ground DAMAGE LIABILITY for "prop surface pressing on, or damages because of - flowing or seeping erty damage" to premises through: while rented to you or tem- porarily occupied by you with permission of the owner, arising out of any one "oc- GA 210 02 07 Page 8 of 12 currenoe" to which this in- Us is hereby amended by the addition of surance applies. the following: (3) The amount we will pay is limited We waive any right of recovery we may as described in Section B. Limits have because of payments we make for of Insurance, 3. Damage to injury or damage arising out of your ongo- Premises Rented to You of this ing operations or "your work" done under a endorsement. written contract requiring such waiver with that person or organization and included in 4. Supplementary Payments the "products -completed operations haz- Under SECTION I - COVERAGE SUP- and". However, our rights may only be PLEMENTARY PAYMENTS - COVER- waived prior to the "occurrence" giving rise AGES AAND B: to the injury or damage for which we make payment under this Coverage Part. The a. Paragraph 2. is replaced by the fol- insured must do nothing after a loss to im- lowing: pair our rights. At our request, the insured will bring "suit" or transfer those rights to Up to the limit shown in Section B. us and help us enforce those rights. Limits of Insurance, 4.a. Bail Bonds of this endorsement for cost of bail 8. Automatic Additional Insured - Speci- bonds required because of accidents fied Relationships or traffic law violations arising out of the use of any vehicle to which the a. The following is hereby added to Bodily Injury Liability Coverage ap- SECTION II -WHO IS AN INSURED: plies. We do not have to furnish (1) Any person or organization de - these bonds. scribed in Paragraph 8.a.(2) be- b. Paragraph 4. is replaced by the fol- low (hereinafter referred to as lowing: additional insured) whom you are required to add as an additional All reasonable expenses incurred by insured under this Coverage Part the insured at our request to assist us by reason of: in the investigation or defense of the claim or suit', including actual loss of a A written contract or agree - () g earnings up to the limit shown in Sec- tion B. Limits of Insurance, 4.b. (b) An oral agreement or con - Loss of Earnings of this endorsement tract where a certificate of per day because of time off from insurance showing that per - work. son or organization as an 5. Medical Payments additional insured has been issued, The Medical Expense Limit of Any One Person as stated in the Declarations is is an insured, provided: amended to the limit shown in Section B. (a) The written or oral contract Limits of Insurance, 5. Medical Pay- or agreement is: ment of this endorsement. 1) Currently in effect or 6. 180 Da Coverage for Newly Formed or Y g Y becomes effective dur- Acquired Organizations ing the policy period; SECTION II - WHO IS AN INSURED is and amended as follows: 2) Executed prior to an Subparagraph a. of Paragraph 4. is hereby "occurrence" or offense deleted and replaced by the following: to which this insurance would apply; and a. Insurance under this provision is af- forded only until the 180th day after (b) They are not specifically you acquire or form the organization named as an additional in - or the end of the policy period, which- sured under any other provi- ever is earlier; sion of, or endorsement added to, this Coverage 7. Waiver of Subrogation Part. SECTION IV - COMMERCIAL GENERAL (2) Only the following persons or or - LIABILITY CONDITIONS, 9. Transfer of ganizations are additional insur- Rights of Recovery Against Others to eds under this endorsement, and insurance coverage provided to GA 210 02 07 Page 9 of 12 such additional insureds is lim- a) "Bodily injury" or ited as provided herein: "property damage" for which the ven- (a) The manager or lessor of a dor is obligated to premises leased to you with pay damages by whom you have agreed per reason of the as - Paragraph 8.a.(1) above to sumption of liability provide insurance, but only in a contract or with respect to liability aris- agreement. This ing out of the ownership, exclusion does not maintenance or use of that apply to liability for part of a premises leased to damages that the you, subject to the following vendor would have additional exclusions: in the absence of This insurance does not ap- the contract or ply to: agreement; 1) Any "occurrence" which b) Any express war - takes place after you ranty unauthorized cease to be a tenant in by you; that premises. c) Any physical or 2) Structural alterations, chemical change in new construction or the product made demolition operations intentionally by the performed by or on be- vendor; half of such additional d) Repackaging, un- insured. less unpacked (b) Any person or organization solely for the pur- from which you lease pose of inspection, equipment with whom you demonstration, have agreed per Paragraph testing, or the sub- 8.a.(1) above to provide in- stitution of parts surance. Such person(s) or under instructions organization(s) are insureds from the manufac- solely with respect to their li- turer, and then re - ability arising out of the packaged in the maintenance, operation or original container; use by you of equipment e) Any failure to make leased to you by such per- such inspections, son(s) or organization(s). adjustments, tests However, this insurance or servicing as the does not apply to any "oc- vendor has agreed currence" which takes place to make or nor - after the equipment lease mally undertakes expires. to make in the (c) Any person or organization usual course of (referred to below as vendor) business, in con - with whom you have agreed nection with the per Paragraph 8.a.(1) above distribution or sale to provide insurance, but of the products; only with respect to "bodily f) Demonstration, in - injury" or "property damage" stallation, servicing arising out of "your products" or repair opera - which are distributed or sold tions, except such in the regular course of the operations per - vendor's business, subject to formed at the ven- the following additional ex- dor's premises in clusions: connection with the 1) The insurance afforded sale of the product; the vendor does not ap- g) Products which, af- ply to: ter distribution or sale by you, have GA 210 02 07 Page 10 of 12 been labeled or re- elevators covered by labeled or used as this insurance. a container, part or ingredient of any (3) Any insurance provided to an ad - other thing or sub- ditional insured designated under stance by or for the Paragraph 8.a.(2) Subpara- vendor. graphs (a), (b) and (d) does not apply to "bodily injury", "property 2) This insurance does not damage" or "personal and adver- apply to any insured tising injury!' arising out of the person or organization: sole negligence or willful miscon- duct of the additional insured or a) From whom you their agents, "employees" or any have acquired other representative of the addi- such products, or tional insured. any ingredient, part or container, enter- b. SECTION IV - COMMERCIAL GEN- ing into, accompa- ERAL LIABILITY CONDITIONS is nying or containing hereby amended as follows: such products; or Condition 5. Other Insurance is b) When liability in- amended to include: cluded within the "products- (1) Where required by a written con - completed opera- tract or agreement, this insur- tions hazard" has ance is primary and / or noncon- been excluded un- tributory as respects any other der this Coverage insurance policy issued to the Part with respect to additional insured, and such such products. other insurance policy shall be excess and / or noncontributing, (d) Any state or political subdivi- whichever applies, with this in- sion with which you have surance. agreed per Paragraph 8.a.(1) above to provide in- (2) Any insurance provided by this surance, subject to the fol- endorsement shall be primary to lowing additional provision: other insurance available to the additional insured except: This insurance applies only with respect to the following (a) As otherwise provided in hazards for which the state SECTION IV - COMMER- or political subdivision has CIAL GENERAL LIABILITY issued a permit in connec- CONDITIONS, 5. Other In- tion with premises you own, surance, b. Excess Insur- rent or control and to which ance; or this insurance applies: (b) For any other valid and col- t) The existence, mainte- lectible insurance available nance, repair, construc- to the additional insured as tion, erection, or re- an additional insured by at- moval of advertising tachment of an endorsement signs, awnings, cano- to another insurance policy pies, cellar entrances, that is written on an excess coal holes, driveways, basis. In such case, the manholes, marquees, coverage provided under hoist away openings, this endorsement shall also sidewalk vaults, street be excess. banners, or decorations 9. Property Damage to Borrowed Equip - and similar exposures; ment or a. The following is hereby added to Ex- 2 The construction, erec- clusion j. Damage to Property of or removal of ele- Paragraph 2., Exclusions of SEC- vato TION I - COVERAGES, COVERAGE 3) The ownership, mainte- A. BODILY INJURY AND PROP- nance, or use of any ERTY DAMAGE LIABILITY. GA 210 02 07 Page 11 of 12 Paragraphs (3) and (4) of this exclu- sion do not apply to tools or equip- ment loaned to you, provided they are not being used to perform operations at the time of loss. b. With respect to the insurance pro- vided by this section of the endorse- ment, the following additional provi- sions apply: (1) The Limits of Insurance shown in the Declarations are replaced by the limits designated in Section B. Limits of Insurance, 9. Property Damage to Borrowed Equipment of this endorsement with respect to coverage pro- vided by this endorsement. These limits are inclusive of and not in addition to the limits being replaced. The Limits of Insur- ance shown in Section B. Limits of Insurance, 9. Property Dam- age to Borrowed Equipment of this endorsement fix the most we will pay in any one 'occurrence" regardless of the number of: (a) Insureds; (b) Claims made or "suits" brought; or (c) Persons or organizations making claims or bring "suits". (2) Deductible Clause (a) Our obligation to pay dam- ages on your behalf applies only to the amount of dam- ages for each 'occurrence" which are in excess of the deductible amount stated in Section B. Limits of Insur- ance, 9. Property Damage to Borrowed Equipment of this endorsement. The limits of insurance will not be re- duced by the application of such deductible amount. (b) SECTION IV - COMMER- CIAL GENERAL LIABILITY CONDITIONS, 2. Duties in the Event of Occurrence, Offence, Claim or Suit, ap- plies to each claim or "suit' irrespective of the amount. (c) We may pay any part or all of the deductible amount to effect settlement of any claim or "suit" and, upon no- tification of the action taken, you shall promptly reimburse us for such part of the de- ductible amount as has been paid by us. 10. Employees as Insureds - Specified Health Care Services It is hereby agreed that Paragraph 2.a.(1)(d) of SECTION II - WHO IS AN INSURED, does not apply to your "em- ployees" who provide professional health care services on your behalf as duly li- censed: a. Nurses; b. Emergency Medical Technicians; or c. Paramedics, in the jurisdiction where an 'occurrence" or offense to which this insurance applies takes place. 11. Broadened Notice of Occurrence Paragraph a. of SECTION IV - COM- MERCIAL GENERAL LIABILITY CONDI- TIONS, 2. Duties in the Event of Occur- rence, Offence, Claim or Suit is hereby deleted and replaced by the following: a. You must see to it that we are notified as soon as practicable of an 'occur- rence" or an offense which may result in a claim. To the extent possible, no- tice should include: (1) How, when and where the 'oc- currence" or offense took place; (2) The names and addresses of any injured persons and witnesses; and (3) The nature and location of any in- jury or damage arising out of the "occurrence" or offense. This requirement applies only when the 'occurrence" or offense is known to an "authorized representative". GA 210 02 07 Page 12 of 12 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective: Policy Number: 03/17/2020 EBA 0055634. Named Insured: Information Station Specialigs, Inca Countersigned by. (Authorized Pepresntative) The person or organization named in the following schedule is an "insured" to the extent of their liability for the conduct of another "insured" as provided in SECTION II - LIABILITY COVERAGE, A. Coverage, 1. Who is an Insured, Paragraph c. Schedule Additional Insured City of El Segundo, its officials, and employees Address: 350 Main St, El Segundo, CA 90245 AA 4004 03 06 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 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 Any person or organization that you perform work for that is liable for an injury, covered by this policy, that prior to the injury has written contract requiring a waiver of our right to recover from them. 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 Policy No. Endorsement No. Insured Premium $ Insurance Company Countersigned by WC000313 (Ed. 4-84) Copyright 1983 National Council on Compensation Insurance.