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PROOF OF INSURANCE (2023 - 2024) CLOSED0 DATE (MMIDDIYYYY)
CERTIFICATE OF LIABILITY INSURANCE
02/28/2023
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 NONT CT Serge S')nanian
MBISI, Inc - Meridian Brokers a PHONE � (818) 225-7025 FAX (818) 225-7026
9 gpfNo ammq�r, AIC Noll:_._.
18980 Ventura Blvd., Suite 330 E-MAIL serge@mbisi,com
ADDRESS:
...............................
INSURER(S) AFFORDING COVERAGE NAIC #
Tarzana CA 91356 INSURERA: Sentinel Insurance Company, Ltd
....................._............ _.._ ._.
INSURED INSURER B : Allstate Insurance Company
..__......_,._..........._________ ...._.__ ._
Govinvest Inc. INSURER C : HISCOX Insurance Company Ina.
......_,...... _.........................._ ..........._.._.._..
1230 Rosecrans Ave , St 300 PMB 754 INSURER D
INSURER E
Manhattan Beach CA 90266 INSURER F;
COVERAGES CERTIFICATE NUMBER: CL2271309454 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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
............................................................- _ ,x�.
iR t POLICY EF LY Y' CAP LIMITS
R ,TYPE OF INSURANCE INSD W, VD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY m.........._..........................__._.m.
_. _ ,. ......... ...............__.._
COMMERCIAL GENERAL LIABILITY 2,000,000
EACH OCCURRENCE S
AMAF N 1,000,000
CLAIMS MADE OCCUR PRFMISES,IFa ocr,arrence„ $
A
ITLAGGREGAIL LI M IT A PPLI ES PER
POLICY
POLICY .............. JEO [............1.. LOC
AUTOMOBILE
LIABILITY
ANYAUTO
BI
OWNED
AUTOS ONLY,,,,,
SCHEDULED
AUTOS
HIRED
NON -OWNED
AUTOS ONLY
..
AUTOS ONLY
MED EXP (Any one person)
S 10,000
Y
N
72 SBM BB5518
06/25/2022
06/25/2023
PERSONAL &ADV INJURY
2 000,000
'. S '
GENERALAGGREGATE
''.S 4,000.000
PRODUCTS - COMP/OP AGG
_.,.._...... ._.._,_,_,._.._.._.�._.__
S 4,000,000
5
. ................
www __.
_.n ._�..
COMB4I+IEDSdN ALE LiMur
s 1,000,000
_(E.a_acotda nB
............_
BODILY INJURY (Per person)
S
N
N
648847300
04/17/2022
04/17/2023
BODILY INJURY (Per accident)
S
PROBa'ERTi°f"�AruiA4s��:
............
�
$
x UMBRELLA LIAR IXI OCCUR
A EXCESS LAB El CLAIMS -MADE Y N 72 SBM BB5518
DED I X1 RETENTION S 10,000
WORKERS COMPENSATION
'.. AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE . NIA
'OFFICER/MEMBER EXCLUDED? _I
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
Cyber Liability & Professional Liability
C Claims Made Y N MPL2075241 22
EACH OCCURRENCE S 1.000,000
06/25/2022 06/25/2023 AGGREGATE S 1,000,000
S
PER
EL EACH ACCIDENT S
E L. DISEASE - EA EMPLOYEE S
E L. DISEASE - POLICY LIMIT $
Aggregate 2,000,000
09/28/2022 09/28/2023 Each Claim 2.000,000
Retention 5.000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Application Service Provider,
City of El Segundo, its elected or appointed officers, officials, employees, agents and volunteers are named as additional insureds on the CGL policy with
respect to liability arising out of work or operations performed by or on behalf of the consultant or any subcontractors including materials, parts or equipment
furnished in connection with such work or operations, including completed operations. Coverage under the policy is Primary and Non -Contributory. Refer to
attached policy form IH 12 00 11 85 T for scope of additional insured status, Waiver of Subrogation endorsement form IH 12 00 11 85 T is attached,
Regarding Commercial Auto policy, please refer to attached policy form CA 20 01 10 13 for scope of additional insured status.. 30 Days Notice of
Cancellation Or Reduction of Coverage. 10 Days Notice of Cancellation for Non -Payment of Premium,
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of El Segundo ACCORDANCE WITH THE POLICY PROVISIONS.
350 Main Street
AUTHORIZED REPRESENTATIVE
EI Se undo CA 90245
©1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
BUSINESS LIABILITY COVERAGE FORM
(b) Rented to, in the care, custody or
b. Coverage under this provision does not
control of, or over which physical
apply to:
control Is being exercised for any
(1) "Bodily injury" or "property damage*
purpose by you, any of your
that occurred: or
"employeas", `volunteer workers°.
any partner or member (if you are
(2) "Personal and advertising injury"
a partnership or joint venture), or
arising out of an offense committed
any member (if you are a limited
before you acquired or formed the
ilablitty company).
organization.
b. ideal Estate Manager
4. Operator Of Mobile Equipment
Any person (other than your "employee" or
Wth respect to "mobile equipmenr registered in
"volunteer workee), or any organization
your name under any motor veh1da registration
while acting as your real estate manager.
law, any is an Insured while driving such
c. Temporary Custodians Of Your
tf along a public highway with your
Proparty
pe rr. Any other person or organizallon
responsible for the conduct of such person is
Any person or organization having proper
also an Imured, but only with respell to liaa'idy
temporary custody of your property if you
arising out of the operation of the equipmerk and
ft but onty:
only if no oilier Insurance of any kind is available
41) VM respect to Mobility arising out of the
to that person or otganizzfim for this
malrdonance or use of that property; and
However, no person or orgonkstion, Is an Ins ,
(2) Until your legal representative has
with respec um
been appointed
a. °Bodily injury" to a co -°employee" of the
d. Legal RepreserrUdIve If You Die
person driving the equipment; or
Your legal reptesentafte if you die, but
b. "Propertydamage" to property owned by,
only with respect to duties as such. That
rented to, in the charge of or occupied by
representative will have all your rights and
you or the employer of any person who Is
duties under this insurance.
an insured under this provision.
6. Unnamed Subsidiary
5. Operator of Nonowned Watercraft
Any subsidiary and subsidiary thereof. of
With respect to watercraft you do not own that
yours which is a legally Incorporated entity
is less than 51 feet long and is not being used
of which you own a financial Interest of
to carry persons foor a charge. any person is an
more then 50% of the voting stock on the
insured while operating such watercraft with
effective date of this Coverage Part.
your permission. Any other person or
The Insurance afforded herein far arty
organization responsible for the conduct of
such person Is also an insured, but anty with
subsidiary not shown in the Declarations
respect to debility arising out of the operation
as a named Insured does not apply to
no other
the watercraft, and onlysurance
Injury or damage with respect to which an
ab� to that
In of arty tdnd is avafia
n
insured under this insurance Is also an
person or organization for this Rabil[fy.
insured under another policy or would be
an Insured under such policy but for its
However, no peracn or organization Is an
termination or upon the exhaustion of Its
insured with respect to:
Herne of Insurance.
a. "Bodily Injury" to a WomploW of the
3. Newly Acquired Or Fomred Organisadon
Person operating the watetwaft: or
Any orgaftallon you newly acquire or form,
b. "Property doge° to party owned by,
other than a partnership, joint venture or
rented to, in the charge of or occupied by
limited liability company, and over which you
you or the employer of arty person who is
maintain financial Interest of more than 50% of
an insured under this provision.
the voting stock, vAll qualify as a Named
G Additional Ineureft When Required By
Insured If there is no other similar insurance
Written Contra*, Written Agreement Or
avaiiabie bo that organiztion. However.
Permit
a. Coverage under this provision Is afforded
The person(s) or organization(s) Mendfied In
only until the IBM day after you acquire
Paragraphs a. through L below are additional
or corm the organization or the end of the
insureds when you have agreed, In a written
Policy period, whichever is earlier, and
Form SS 00 OB 04 05 Page 11 of 24
BUSINESS LIABILITY COVERAGE FORM
contract written agreement or because of a
(e) Any failure to make such
permit Issued by a state or political
Inspections, adjustments, tests or
subdivision, that such person or organzation
servicing as the vendor has
be added as an additional insured on your
agreed to make or normally
Policy, Provided the injury or damage occurs
undertakes to make in the usual
subsequent to the execution of the contract or
course of business, in connection
agreement. or the issuance of the permit
with the distribution or sale of the
A person or organization is an additional
proms;
lf) Derreo on, Installation,
Insured under this provision only for that
period of time required by the contract
servicing or repair operations,
agreement or permit.
except such operations performed
at the vendor's premises In
However, no such person or organization is an
connection with the sale of the
additional insured under this provision If such
Produce
person or organzation Is included as an
additional insured by an endorsement issued
(g) Products which, after distribution
by us and a part of this Coverage learn
or sale by you, have been labeled
Including aiI mesons or organizations added
or relabeled or used as a
container, part or Ingiedent of any
as additional Insureds under the specific
other thing or substance by or for
additional insured coverage grants in Section
the vendor, or
F. — Optional Additional Insured Coverages. V
a. Vendors
(h) "Bodily injury" or "property
damage° arising out Of the sole
Any s) or lr.atlon(s) (releried to
negligence of the vendor for Its
bkw as vendor), but arty with respect to
own acts or omIssions, or those of
I or Voperty damaW arlsing
its employees or anyone else
out of °"yo prodwhich are distributed
acting on its behalf. However, this
or sold to the regular course of the vendors
exclusion does not apply to:
business and only If this Coverage Part
(h The exceptions contained to
provides coverage for 'bodily injury" or
Subparagraphs (d) or M; or
°property damage" included within the
"prod repro opw4orns hazard".
(M) Such inspections, ad" ,
(1) The Insurance afforded to the vendor
tests or servidng as the vendor
has sWeW to make or normally
is subject to the following additional
widertakes to make in the usual
exclusions:
course of bushms, to
This insurance does not apply to:
connection with the disti1bution
(a) 'bodily Injury" or "Property
or sale of the products.
damages fdr Which the vendor is
(2) This insurance does not apply to any
obligated to pay damages by
Insured person or organkdon, from
mason of the mumption of
whom you have acquired such acts,
liability in a contract or agreement.
or any ingredient part or conntainer,
This exclusion does not apply to
entering into, accornpanying or
liability for damages that the
cord*ft such products.
vendor would have in the absence
b, Lessors, Of E4ui1m�
of the contract or agreement
(b) Any express warranty
11) Any person or organ from
whom you lP but only
unauthorized by You;
with respect to their liability for `bodily
(c) Any physical or chemical change
Info , aproperty damage! or
In the product made Intentionally"Personal
and advertising Injury"
by the vendor,
caused, In whole or In part by your
(d) R ql% except Mien
matntenance, operation or use of
unpacked ad* for the purpose of
equipment leased to you by such
inspection, demonstratIM teWrig,
person or organization.
or the aLtboftifon of parts under
Instructions from the manufacturer.
and then repackaged in the
original container,
Page 12 of 24 Form 88 00 08 04 05
S'.
(2) vft respect to the Insurance afforded
to these additional Insureds, this
Insurance does not apply to any
"o=rrence" which takes place after
you cease to lease that equipment
c. Lessors Of Land Or Premises
(1) Any person or organization from
whom you lease land or premises, but
only with respect to liability arising out
of the ownership, maintenarim or use
of that part of the land or premises
[eased to you.
(2) With respect to the insurance afforded
to these additional insureds, this
insurance does not apply to:
(a) Any -=wmweP which takes
place after you cease to lease that
land or be a tenant in that
premises; or
(b) Structural alterations, new
construction or demolition
operations performed by or on
behalf of such person or
organbuition.
d. Arrchhacts, Engineers Or Swveyors
(1) Any architect, engineer, or surveyor, but
only with respect to iiabllity for "bodily
injury", "property darroW or Wsonol
and adverUng Injury" caused. in whole
or in part, by your acts or omissions or.
the ads or onftskm of arose acting on
your behralt
(a) In connection with your premises;
or
(b) In the performance of your
ongoing operations performed by
you or on your behalf.
(2) With respect to the insurance aftrded
to these additional Insureds, the
following additional exclusion applies:
BUSINESS LIABILITY COVERAGE FORM
e. Permits Inued By State Or Political
Subdivisions
(1) Any state or political subdMsion, but
only with respW to operations
performed by you or on your behalf for
which the state or political subdivision
has issued a pern'dL
(2) With respect to the insurance afforded
to these additional insureds, this
insurance does not apply to:
(a) Todill► lnJW, "property damage°
or "personal and advertising
injury" arising out of operations
performed for the state or
municipality; or
(b) Ilodly MAW or "property darnage.
Included within the "products -
completed alwaftm hazard'.
L Any Other Party
(1) Any other person or organization who
is not an Insured under Paragraphs a.
through e. above, but only with
respect to liability for "bodily Injury",
"property damage" or nal and
advertising injury" caused, In whole or
in part, by your ads or omissions or
the acts or omissions of those acting
on your behalf.
(a) In the performance of your
ongoing ape ns;
(b) in connection with your premises
owned by or rented to you; or
(c) In connection with nyourwortr" and
included within the "products -
completed operalions, rd"', but
only if
(i) The written corrtract or written
agreement requires you to
provide such coverage to
such additional insured; and
This insurance does nat apply to
(a) This Coverage Part provides
abodily Injury", "property damage or
coverage for "bodily injury' or
"personal and advertising injury"
"property damage" Included
arising out of the rendering of or the
within the "products -
failure to render any professional
completed operations hazard".
services by or for you, including:
(2) With respect to the insurance afforded
(a) The preparing. approving, or
to these additional Insureds, this
failure to prepare or approve,
insurance does not apply to:
maps, shop drawings, opinions,
"Bodily injury"', "property damage" or
reports. surveys, field orders,
"personal and adverf rtg it ury"
change orders, designs or
arising out of the rendering of, or the
drawings and specifications; or
failure to render, any professional
(b) Supervisory, inspection,
architectural, engineering or surveying
architectural or engineering
services, including:
activities.
Form 68 00 08 04 05 Page 13 of 24
BUSINESS LIABILITY COVERAGE FORMA
(a) The preparing, •approving, or
failure to prepare or approve,
maps, shop drawings, opinions,
reports, surveys, field orders,
change orders, designs or
drawings and specifications; or
lb) Supervisory, inspection,
architectural or engineering
activnift
The limits of insurance that apply to additional
insureds are described In Section D. — Limits
Of Insurance.
How this Insurance applies when other
Insurance is available to an additional insured
is described in the Other Insurance Condition
in Section E. — Liability And Medical Expenses
General Conditions.
No person or organization is an insured with
respect to the conduct of any current or past
emblp, joint verdure or limited liability
company that is not sham as a Named Insured In
the Declarations.
D. LIABILITY AND MEDICAL EXPENSES
LIMITS OF INSURANCE
1. The Most We VWR Pay
The Limits of Insurance shown in the
Declarations and the rules below fix the most
we will pay regardless of the number of:
a. Insureds;
b. Claims made or "suits" brought; or
e. Petsons or organb2tIons malting claims or
bringing "suits".
2. Aggregate Limits
The most we will pay for.
a. Damages because of "bodfly Injury" and
°property damage° Included in the
products-compieted operations hazard" Is
Me Producte-Completed Operations
Aggregate Limit shown to the
Declarations.
b. Damages because of all other °bodily
injwryO% "property damaW or*Personal
and advertising injury", Including medical
expenses, is the General Aggregate Limit
shown In the Declarations.
This General Aggregate Limit applies
separately to each of your "locations°
owned by or rented to you.
"Location" means premises involving the
same or connecting lots, or premises
whose connection Is interrupted only by a
street, roadway or right-of-way of a
railroad.
This General Aggregate limit does not
apply to "property Oamage" to premises
while rented to you or temporarily
or,pied by you with permission of the
owner, arising out of fire, 119WIng or
explosion.
3. Each Occurrence Limit
Subject to 2.a. or 2.1b above, whichever
applies, the most we will pay for the sum of all
damages because of all "bodily injury".
"property damage" and medical expenses
arising out of any one "occurrence" is the
Liability and Medical Expenses halt shown in
the Declarations.
The most we will pay for all medical expenses
because of "bodily injury" sustained by any
one person Is the Medical Expenses Limit
shown to the Deckwations.
4. Personal And Advertising Injury Limit
Subject to 2.b. above, the most we will pay for
the sum of all damages because of all
"personal and advertising Injury" sustained by
any one person ororgartization is the Personal
and Advertising Injury Limit shown In the
Declarations.
5. DanwW To Premises Rented To You Limit
The Damage To Premises Rented To You
LhnR is the most we will pay under Business
Liability Coverage for damages because of
"property damage" to any one premkok while
rented to you, or in the case of damage by fire,
lighWng or explosion, while rented to you or
temporanly occupied by you with permission of
the owner.
In the case of damage by fine, Bghtntng or
explosion, the Damage to Premises Rented To
You Limit applift to all damage t*
caused by the same evenk whether such
damage results from fire, lightning or explosion
or any combination of these.
6. Haw Limits Apply To Additional Insureds
The most we will pay on behalf of a person or
organtzation who Is an additional Insured
under this Coverage Part is the laser at
a. The limes of insurance specified In a
written conftct, written agreement or
permit Issued by a state or political
subdivision; or
b. The Limits of Insurance shown In the
Declarations.
Such amount shad be a part of and not in
addition to the Limits of Insurance shown In
the Declarations and described in this Section.
Page 14 of 24 Form SS 00 08 04 05
BUSINESS UABILr Y COVERAGE FORMA
If more than one limit of insurance under this
(1) Immediately send us copies of any
policy and any endorsements attached thereto
demands, nolices, summonses or
applies to any claim or "suit', the most we will pay
legal papers received in connection
under this policy and the endorsements is the
with the claim or"suir,
single highest limit of liability of all ge$
(2) Authorize us to obtain records and
applicable to such claim or "suit'. However, this
other Information;
paragraph does not apply to the Medical Expenses
(3) Coopeatte with us in the investigation,
limit set forth in Paragraph & above.
the claim or d
efianse
The LW ts of Insurance of this �9e Part aPPhr
ts
gadtst the "suit'; and
against
sepmaWly to each consecutive annual period and to
(4) Assist us, upon our request, in the
any remaining period of less than 12 months, starting
enforcement of any right against any
with the begbWng of the policy period shown In the
person or ergo that may t
Declarations. unless the policy period Is eduaded
liable the insured because of Injuryry
after for an add period of less than 12
ar damage which this insurance
mmnd . In that case. the l period will be
so-aPplYb
my allso a
deemed part of the last p period for purposes
d . Obligations At The Itsnued� Own Cost
of the Llndla of Insurance..
E. LIABILITY AND MEDICAL S
s awn
No tvolInsured arilw1ila eke at payment fnsur assume
�.o voluntarily make a
GENERAL CONDITIONS
any u,Iation, or sour any expense, other
1. Bankruptcy
than forfirst all, without our consent
Bankruptcy or Insolvency of the Insured or of
e. Additional Insured's Other Insurance
the irsured's estate will not relieve us of our
if we cover a claim or "suit' under this
obligations under this Coverage Part.
Coverage Part that may also be covered
2. Duties In The Event Of Occurrence.
by other Insurance available to an
Claim Or Suit
additional irhsured, such additional insured
a. Notice Of Occurrence Or Offense
must submit such claim or "suit" to the
other Insurer for defense and Indemnity.
You or any additional insured must see W
However, this provision does not apply to
It that we are notified as soon as
the extent that you have ' in a
practicable of an "occurrence" or an
written certrack written agreement or
offense which may result in a claim. To
pelt that this insurance is primary and
the extent possible, notice should Include:
non-co�ry with the additional
(1) How, when and where the '0=00WW
insured's awn insurance.
or offense book place;
C Knowledge Of An Occurrence, Offense,
(2) The names and addresses of any
Claim Or Suit
injured persons and witnesses; and
paragraphs a. and b. apply to you or to
(3) The nature and location of any injury
any additional insured only when such
or damage arising out of the
"occurrence", oilense, claim or "suit" is
10muffencaP or offense.
known to:
b. Notice Of Claim
(1) You or any additional insured that is
If a claim is made or "suit is brought
an individual;
against any insured, you or any additional
(2) Any partner, if you or an additional
Insured must:
Insured Is a partnershlp;
(1) Munediately record the specifics of the
(3) Any manager, if you or an additional
claim or "suit' and the date received;
Insured is a limited Mabtiity oompwW,
and
(4) Any "executive ottio '" or Insurance
(2) Notify us as soon as practicable.
manager, if you or an additional
You or arty additional insured must see to
insured is a corporation;
lt that we receive a writban notice of the
(5) Any oustee, 9 you or an additionad
claim or "suit' as soon as practicable.
Insured is a trust: or
c. Amdeftrice And Cooperation Of The
(6) Any elected or appointed otiictal. If you
Insured
or an additional insured Is a political
You and any other involved insured must:
subdivision or public entity.
Form SS 00 08 04 05 Page 15 of 24
BUSINESS LIABILITY COVERAGE FORM
This Paragraph L appGes separately to
you and any additional insured.
3. Financial Responsibility Laws
a. When this policy is ceriffliedi as proof of
fxnandal responsibility for the future under
the provisions of any motor vehicle
financial responsibility low, the insurance
provided by the policy for "bodily injury"
liability and "property damage" labllty will
comply with the provisions of the law to
the extent of the coverage and limits of
Insurance required by that low.
b. With respect to "mobile equipment" to
which this Insurance applies. we will
provide any lability, uninsured motorists,
underinsured motorists, no-fault or other
coverage required by any motor vehicle
law. We wrfl provide the required limits for
those coverages.
4. Legal Action Against Us
No person or organization has a right under
this Coverage Form:
a. To join us as a party or otherwise bring us
Into a "suit asidng for damages from an
Insured; or
b. To sue us on this Coverage Form unless
all of its terms have been fully complied
with.
A person or organization may sue us to recover
on an agreed settlement or on a final judgment
agaInat an Insured; but we will not be HaMe for
damages that are not payable under the imms of
this Insurance or that are In excess of the
appliceWe fimdt of Insurance. An agreed
settlement means a settlement and release of
Daft signed by us, the insured and the
claimant or the clairnalft legal represeMativa
& Separation Of Irmuetis
Except with respect to the Limits of Insurance,
and any rights or duties specifically assigned
In this policy to the first Named Insured, this
Insurance apples:
a. As If each Named Insured were the only
Named Insured; and
b. Separately to each Insured against whom
a claim is made or `sure Is brought.
6. Re
a. When You Accept This Policy
By accepting this policy, you agree:
(1) The statements in the Ckwiarattons
are accurate and complete;
(2) Those staternents are based upon
representations you made to us; and
(3) We have issued this policy in reliance
upon your representations.
b. Unintentional Failure To Disclose
Hazards
If unintentionally you should fail to disclose
all hazards relating to the conduct of your
business at the inception date of lids
Coverage Part, we shall not deny any
coverage under this Coverage Part
because of such fanure.
7. Othertnsurance
If other valid and collectible Insurance Is
available for a loss we cover under this
Coverage Part, our obligations are lmlted as
follows:
a. Primary Insurance
This insurance is primary except when b.
below apples. If other insurance is also
primary, we will share with all that other
insurance by the method described in c.
below.
b. Excess Irrsrrranee
This insurance is excess over any of the
other insurance, whether primary, excess,
contingent or on any other basis:
(1) Your Work
That is Fire, Extended C
Builder's task, Installation Risk or
similar coverage for 'your work";
(2) Promises Rented To You
That is fire, lightning or explosion
Insurance for premises rented to you
or temporarily occupied by you with
pemission of the owner,
(3) Tenant Llabifrly
That is insurance purchased by you to
cover your liability as a tenant for
"properly damage" to premium rented
to you or temporarily occupied by you
with permission of the owner,
(4) Mau% Auto Or VAttercraft
If the loss arlses out of the maintenance
or use of aironA "autos" or watenzaitto,
Me not act to Emdusion g. of
Sexton A. —Coverages.
(5) Property Damage To Borrowed
Equipment Or Use Of Efentm
If the loss arises out of "property
damage" to borrowed equipment or
the use of elevators to the extent not
subject to tExclusion It. of Section A. —
coverages.
Page 16 of 24 Fong SS 00 08 04 05
(6) When You Are Added As An
Additional Insured To Other
Insurance
That is other insurance available to
you covering liability for damages
arising out of the premises or
operations, or products and completed
operations, for which you have been
added as an additional insured by that
Insurance; or
(7) When You Add Others As An
Additional Insured To This
Insurance
That is other Insurance available to an
additional Insured.
However, the following provisions
apply to other insurance available to
any person or organization who is an
additional insured under this Coverage
Rt� rt"
(a) dmary Insurance When
Required By Contract
This insurance is primary if you
have agreed in a written contract,
written agreement or permit that
this Insurance be primary. If other
Insurance Is also primary, we will
share with all that other Insurance
by the method described in c.
below.
(b) Primary And No -Contributory
To Other Insurance When
Required By Contract
if you have agreed in a written
contract, written agreement or
permit that this insurance is
primary and non-contributory with
the additional insured's own
Insurance, this insurance Is
primary and we will not seek
contribution from that other
insurance.
Paragraphs (a) and (b) do not apply to
other insurance to which the additional
Insured has been added as an
additional Insured.
When this insurance is excess, we will
have no duty under this Coverage Part to
defend the insured against any "suit" if. any
other Insurer has a duty to defend the
insured against that "suit". if no other
Insurer defends, we will undertake to do
so, but we will be entitled to the Insureds
rights against all those other insurers.
BUSINESS LIABILITY COVERAGE FORM
When this Insurance Is excess over other
insurance, we will pay only our share of
the amount of the loss, if any, that
exceeds the sum of
(1) The total amount that all such other
insurance would pay for the loss in the
absence of this insurance; and
(2) The total of all deductible and self -
insured amounts under all that other
insurance.
We will share the remaining loss, if any, with
any other insurance that is not described in
this Excess Insurance provision and was not
bought specifically to apply In excess of the
Umfts of Insurance shown in the
Declarations of this Coverage hart.
c. Method Of Sharing
If all the other insurance permits
contribution by equal shares, we will follow
this method also. Under this approach,
each insurer contributes equal amounts
until it has paid its applicable limit of
Insurance or none of the loss remains,
whichever comes first.
If any of the other Insurance does not perrrtit
contribution by equal shares, we will
contribute by limits. Under this method, each
Insurer's shalt: is based on the ratio of its
applicable limit of insurance to the -total
applicable limits of insurance of all insurers.
8. Transfer Of Rights Of Recovery Against
Others To us
a. Transfer Of Rights Of Recovery
If the insured has rights to recover a@ or
part of any payment, including
Supplementary Payments, we have made
under this Coverage Part, those rights are
transferred to us. The insured must do
nothing sifter loss to impair them. At our
request, the insured will bring "suit" or
transfer those rights to us and help us
enforce them. This condition does not
apply to Medical Expenses Coverage.
( b.) waiver Of Rights Of Recovery (Waiver
u OFSubrogation)
If the insured has waived any rights of
recovery against any person or
organization for all or part of any payment,
Including Supplementary Payments, we
have made under this Coverage Part, we
also valve that right, provided the Insured
waived their rights of recovery against
such person or organization In a contract,
agreement or permit that was executed
prior to the Injury or damage:
Form SS 00 08 04 05 Page 17 of 24
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
"'B
This endorsement modt ies insurance provided under the foliowing:
BUSINESS UABIUTY COVERAGE FORM
We welve any right of recovery we may have against:
1. Any person or organizatlon shown In the Declarations, or
2. Any person or organization with whom you have a contract that requires such walver.
Form SS 1215 03 00
0 2000, The Hartford
Page 1 of 1
A
HISCOX PRO"
Endorsement,7
NAMED INSURED: Govinvest Inc.
E..:1, BI��1Ca�*t �idGli_a1�aN Nnua�r.��i �u.,�1�rr�,ern�I. �Vif�ut erg �.nRr,u�t�,
In consideration of the premium charged, and on the understanding this endorsement leaves all other terms, conditions, and
exclusions unchanged, it is agreed the Cyber Coverage Part is amended as follows:
i. The following definition is added to the end of Section III. Who is an insured:
Additional insured means any person(s) or organization(s) the named insured has agreed in a written contract or
agreement to add as an additional insured to a policy providing the type of coverage afforded by this
Coverage Part, provided the contract or agreement:
1. is currently in effect or becomes effective during the policy period; and
2. was executed before the business operations from which the claim or event arises were
performed.
Coverage is available for additional insureds solely for their liability arising out of the named
insured's negligence or of those acting on the named insured's behalf and not for any liability arising
out of the sole negligence of the additional insured.
li. In the preamble of Section III. Who is an insured, the words "additional insured," are added after "named insured,".
III. In Section VII. Definitions, the definition of "You, your, or insured" is amended to add the words "additional insured," after
"named insured,".
Endorsement effective: 09/28/2022 Certificate No.: MPL2075241.22
Endorsement No: 7 Processed Date: 07/18/2022
Hiscox Inc.
r
r'
Authorized Representative
Kevin Kerridge
CYBCL-CYB E2013 CW (04/19) Page 1 of 1
IC1�1�►19�1i�QiCi]
GOVINVE-01 813U',
.4� CERTIFICATE OF LIABILITY INSURANCE DATE E(MM/D )
..................... ._._........................,,,,..._..........................................�_..... .e..,. _........,.........m......�..-........,....,� 11202
120 fYYYY....
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 e ndorsement(s).
PRODUCER CONTACT Ed Collins
NAME,.em ®...,®...,
Total Resources Ins Agy
(ACC,PHONE 1.. se(rricecent5454 FAX
39 Public Square F M. No, Ex11 0 (Arc N p:1 70 825-2990
EMMAIL guard corn
Wilkes-Barre, PA 18702 A wDRE3_' _ ,.,,,,..w, .,,,....,��... ... __ ., ........ „
IN4I IGFnl G1 AFKnPr1IINCi C nVFRAC'F'. NAI.0 #
INSURER A Am,GUARDInsu,rance Company ..42390,
INSURED INSURER B
Govinvest, Inc. INSURER C
8605 Santa Monica Blvd ®"� ----
PMB 52465 INSURER D s
West Hollywood, CA 90069 INSURER E : ®..... ,,,. ..
INSURER F :
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,
R ADDL S U B R EFF POLICY EXP
TYPE OF INSURANCE POLICY NUMBER LIMITS
Ai ........ ........................ _ ............!1� _.............._. m ll4!IJ�D„li LIMMIDOIYY�YL ............ _.
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
CLAIMS -MADE OCCUR DAMAGETO RENTED 1
�F �'Rk�MI"F_tiL,r��wa Vie.P 1.$ .,
L AGGREGATE LIMIT APPLIES PER:
POLICY P(n'xC,s � LOC
TEPf --
AUTOMOBILE LIABILITY
_.'
ANY AUTO
-, LSE
��.. OWNED .......... SCHEDULED
AUTOS NLY AUTOS
",PC
.'. AUTOS ONLY A A'. f7 JL ',,
'.
. .�.. UMBRELLA LIAB OCCUR
EXCESS LIAB CLAIMS -MADE
Af
DED -. RETENTION 5
..w........ ..............
A WORKERS COMPENSATION .... _.... m
X
AND EMPLOYERS' LIABILITY Y y N X GOWC324305
'.ANYPROPRIETORtPARTNER/EXECUTIVE
8/27/2022 8/27/2023 '—
OFFICER(MEMBER EXCLUDED? Y NIA'.,
E,I
'....... ........
',. (Mandatory in NH) -- ',..
''., EA
If ves. describe under '..
'.."
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
xcluded: Jasmine Nachtigall-Fournie
waiver of subrogation in favor of the certificate holder has been included in the workers compensation policy (see attached endorsement).
1,0
1,0
1.0
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Y 9 ACCORDANCE WITH THE POLICY PROVISIONS.
350 Main Street
El Segundo, CA 90245 .....................
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03) _ 015 A .�
©1988-2 CORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06
(Ed. 4-84)
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 1.02 _..% of the California workers' compensation premium
otherwise due on such remuneration.
Schedule
Person or Organization Job Description
Blanket Waiver - Any person or organization for whom the All CA Operations
Named Insured has agreed by written contract to furnish this
waiver.
III* endorsement chanqos the pdicy to which A Is attached and is eat .Uve on the eta: Issued thnWss e thwvvise stat(A
(The Information below Is required only when this endorsement Is Issued subsequent to preparation of the policy.)
Endorsement Effective Policy No. GOWC324305 Endorsement No.
Insured Insurance m ny
=5
OM998 by the Workers' Compensation Insurance Rating Bureau of Califomla. All rights reserved.
w'01I CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDD/YYYY)
01 /03/2023
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 'CONTACT
NAME
Hiscox Inc. d/b/a/ Hiscox Insurance Agency in CA PHONE. FA7t
520 Madison Avenue f"MAAfL ntYM. 88 c 02i3007x com ..tAe Nay
EMAI
32nd Floor ADDRESS ..,
New York, New York 10022 I�WS.U'iNI,SAFFORD,ING COVERAGE NAIC #
INSURER A: HISCOX Insurance Company Inc 10200
.... ..................
INSURED INSURER B .
, .....
GoVlnvest Inc. INSURER C
8605 Santa Monica Blvd PMB 52465
West Hollywood, CA 90069 INSURER D :
INSURER F
Crl\/I=RAf_I=S CFRTII=IrATF NIIMRFR^ RFVISI(]N NIIMRFR,
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.
AfbDL. TUBA .......
.�.�. ..TYPE
INS
LTRR OF INSURANCE POLICY NUMBER I. MWDO/YYYY MMfolwy yy ''. LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
S
,..�.. �� ��
CLAIMS -MADE OCCUR
•„PRFM,ISF9�Ea cccurrnce
....., .
MED EXP (Any one person)
$
,GEN'LAGGREGATELIMITAPPLIESPER:
PERSONAL & ADV INJURY
S
GENERAL AGGREGATE
S
' PRO-
POLICY JE:CT ...� I...00
PRODUCTS - COMP/OP AGO
$
OTHER:
S
AUTOMOBILE LIABILITY
COMBINED °a"q' GLF LIMIT
LE ti �a.cc hjenq
$
'.. ANY AUTO
BODILY INJURY (Per person)
$
.................. ....
...... ALL OWNED SCHEDULED
''.....
__
'. BODILY INJURY Per accident)
( D
$
AUTOS AUTOS
'. NON -OWNED
PROPERTY DAMAGE
..
$
.......... HIRED AUTOS .,....... 'AUTOS
.t,Per u�prWppt) ......
IS
UMBRELLA LAB '.. OCCUR
EACH OCCURRENCE
., ... , ...,
$ .
EXCESS LAB CLAIMS MADE
.— ........
AGGREGATE
$
DEC) RETENTION $
`r
WORKERS COMPENSATION
OTH
',°°°,m„
AND EMPLOYERS' LIABILITY Y / N
_STI�Tµ,Rm, ,,,,.
---- --- .-••
ANYPROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
NIA A
E L EACH ACCIDENT
.., ..,. .�... ..
$ .---.......
(Mandatory in NH)
EL,. DISEASE - EA EMPLOYEE
$ -`-
If yderes, describe
unOF
... . ,.,
.-..�--
DESCRIPTION OPERATIONS below
,
E.L. DISEASE - POLICY LIMIT
$
A
Professional Liability
P100.094.137,9
02/10/2023 02/10/2024 Each Claim: $ 1,000,000
S
! Aggregate:$ 2,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
QtKIIFIC:AIt HULUtK UANUr-I LLAIIU'N
City of El Segundo
350 Main St SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
El Segundo, CA 90245 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
II
/
©1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD