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PROOF OF INSURANCE (2023 - 2024) CLOSED
ACCOV CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/9/2022 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'„ It 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 Artex Risk Solutions, Inc. (CB) 2850 Golf Road, 5th Floor Rolling Meadows IL 60008-4050 INSURED CHRIBRO-14 Brothers of the Christian Schools & Affiliates Loc #1177028 DOC POW ST VINCENT SENIOR CITIZEN NTR 1205 Windham Parkway Romeoville IL 60446-1679 C: Services -0300 Old _Republic Union Insurance Company u _ .. 3114 e ubllo QOsurarr_Company ......._ Old R .. r+Apn* c!^A•mC KI inAQro.1A41s-rKA.!nii REVISION NUMBER: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD THIS IS TO CERTIFY THAT ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS INDICATED. NOTWITHSTANDING MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CERTIFICATE BEEN REDUCED BY PAID CLAIMS. OF SUCH POLICIES.�LIMITS SHOWN MAY HAVE .._.. .,. ,.,.,.. .... _.._..... ..m. EXCLUSIONSAND. J AI�b1. IYN.Y POL,ICYNUMaER MMPD YYY MMPO. YYY. LIMITS OF SDUIRAQNCE .- "N�9�LNC'W`FXP B X COMMERCIAL GENERAL LIABILITY N N 8222001325596 6/15/2022 6/15/2023 EACH OCCURRENCE 4,.000.000i S _ CLAIMS -MADE �. OCCUR L1AM0 T0l1ElsTEO pFlEMfiIS_,tal d¢Stircrw rInJ $ lrcdUded . _X"1 MED EXP fArcwy one pSr8 I) $1 000 ' PERSONALS NOV INJURY $ II>cIwded IT APPLIES PER: G N°L AGGREGATE LIMIT �NERAIL AGGREGATE _;___ -.a�. $ N/ ....__ LL ...... VPRO- %� POLICY JET, LOC " - COMP/OP AGG PRODUCTS _ S Included �. _ A OTHERr AUTOMOBILE LIABILITY Y Y MWTB21543 6/15/2022 6/15/2023 MIS ..LEA fir: �,qt�R1,.INC�d.E LI .. — � 000 ..$100, X ANY AUTO BODILY INJURY (Per person) :.."..,, ..... .. $ ,,.—,,.... ... .... OWNED " SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY ALT Xm, HIRED NON -OWNED X ( dP Ah%A.... , $. .. ... m AUTOS ONLY AU OS ONLY .. $_ UMBRELLALAB '. ACHOCCURRENC"E E:. .......� ..,..,, _. _ .,�- ..._.,..,_ ..... .,�. __ �OC�CUR ....MS•MADE EXCESS LIAB _AGGREGATE -_ ..�m ......� � ,,,. �..�.......... ...... A _...... ...., �,.e,. ,............_,:,_ t}ED RETEN TICtiNS WORKERSCOMPE'NSATION Y MWC 305311 08 1/1/2023 1/1/2024 ER OTI"d X P n AND EMPLOYERS LIABILITY YIN N (90Ch4T $.1000000 OFFICER/IMEMBEREXCGwUDEWD7EC.,U..11NE .N/A E.EAEIdIP �_ E L rI SEAS LOYE $1000 000 (Y� andotM m NH)' _: ... ____.. PP yyas„ d-s"arlLto und.e�m DESCRIPTION'0'n r.7PERATIONS WOW E.L. DISEASE- POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 10t, Addifianol Retnarks Scbadule, maybe attached Ctl' more space is r"uired) Waiver of Subrogation (where allowed by law) per attached endorsement is provided udder Auto Liability & Worker's Com nsation coverage when required by Certif'scate Holder is added as Additional Insured (per attached endorsement) for Automobile fdablIty coverages solely, strictly fuiiy execrated written cdntracL, and specifically with regards to: Consultant Services for the Community Development Bloch Grant Program for 'Home Delivered Meals. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Of El Segundo Its Official and Employees Office Of City ACCORDANCE WITH THE POLICY PROVISIONS. Clerk 350 Main Street AUTHORIZED REPRESE TATIVE & 1 El Segundo CA 90245 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 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 MVTrB 21543 Religious and Charitable Risk Pooling Trust 06/15/22 - 06/15/23 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 respect to COVERED AUTOS LIABILITY COVERAGE, Who Is An 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: 1. You; 2. an "employee" of yours; or 3. 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 10 13 MWTB21543 Religiousand Chadtable RiskPoolingTrud 06/15/2022-06/15/2023 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) POLICY NUMBER: MWC 305311 08 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. 6 The additional premium for this endorsement shall be 0 % of the California workers' compensation premium otherwise due on such remuneration. PERSON OR ORGANIZATION ALL PERSONS OR ORGANIZATIONS WHERE REQUIRED BY WRITTEN CONTRACT DATE OF ISSUE: 11-29-22 SCHEDULE 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.