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PROOF OF INSURANCE (2024 - 2024) CLOSEDDATE (MMIDDNYYY) C40R " CERTIFICATE OF LIABILITY INSURANCE ,,, 1 1 6/16/2023 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 CONTACT NAkIg•._- Christian Brothers Services _ Artex Risk Solutions, Inc. (CB) PHONE FAX 2850 Golf Road, 5th Floor (A/p,N.q_Exty 800-807 0300 tArC N_a:630-378-2508 _ Rolling Meadows IL 60008-4050 E-MAIL nkfs -- ----- -.. INSURER(S) AFFORDING COVERAGE NAIC # -.-. ...... . — .... NSURERA: Old Republic Insurance Company 24147 INSURED CHRIBRO-14..... INSURERB: Old Republic Union Insurance Co 31143 Brothers of the Christian Schools & Affiliates -- _____. TT"""mm _. Loc#1177028 DOC POW ST VINCENT SENIOR CITIZEN NTR INSURER : ..SURER D ... ---- ------ -........ w ... ...... ___ _.. __ 1205 Windham ParkwayI.._INS _.r'....... ................... Romeoville IL 60446-1679 INSURER E: COVERAGES CERTIFICATE NUMBER:301416828 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. .... .... .... .,..,.... .... ....„ ...-...,............ ........ ............ ................ .—____............r,. .__AADDLS0611k POLI1d ILT R POLICYNUMBER.... MMLDDPOLICYEFF TYPE OF INSURANCE LIMITS 1'YYX B X COMMERCIAL GENERAL LIABILITY N N 8223001325596 6/15/2023 6/15/2024 EACH OCCURRENCE'. $10,000,000 CLAIMS -MADE X, OCCURda,Mi/ri`1i�ft.... 4gFurr�^raei .w��tFnn��,�.1�s? ...$Induded �,..r... ..... .... .... ..... MED EXP (Any one person) $ 15 000 ..,. PERSONAL 8 ADV INJURY $Induded GEN'LAGGR AGGREGATE APPLIES GENERAL AGGREGATE $ NO Ac��. JLIIMIITA PRO POLICY LOG S- AGG ... COMP/OP .. ... ..... $Induded OTHER'; $ A AUTOMOBILE LIABILITY Y Y MWTB 21543 6/15/2023 l 6/15/2024COMBINED SINGLE IT JgAz'.. $ 1.000,000 X ANY AUTO j .__._.). BODILY INJURY Per person) '.. $ OWNED SCHEDULED BODILY INJURY $ _ AUTOS ONLY AUTOS (Per accident) HIREDX X ROPER7Y DAMAGE AUTOS ONLY AUTOS ONLY .__ .I, _(Per accident) .... .... .......... UMBRELLA LIAB �OCCUR EACH OCCURRENCE $ EXCESS LIAB AGGREGATE $ ---- DED RETENTION $ $ . WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y / N ER _STATUTE ANYPROPRIETOR/PARTNER/EXECUTIVE E.L., EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N / A — ------------------- --- _ .___.__ (Mandatory in NH) E„L. DISEASE -EAEMPLOYEEI $ If yes, describe under DESCRIPTION OF OPERATIONS below E,L. DISEASE- POLICY LIMIT $ B Excess Automobile L Y Y 822300 1325596 6/15/2023 6/15/2024 Occurrence/No Agg. $9,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Waiver of Subrogation(where allowed by law) per attached endorsement is provided under the Automobile Liability coverages per fully executed written contract. Certificate Holder is added as Additional Insured (per attached endorsement)for Automobile Liability coverages solely, strictly and specifically with regards to: Consultant Services for the Community Development Block Grant Program for Home Delivered Meals. CERTIFICATE HOLDER City of El Segundo its Official and Employees Office of City Clerk 350 Main Street El Segundo CA 90245 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ©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. 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 MWTB 21543 Religious and Charitable Risk Pooling Trust 06/15/23 - 06/15/24 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 MWTB 21543 Religious and Charitable Risk Pooling Trust 06/15/23 - 06/15/24 ,­10 11 ACC>RV CERTIFICATE OF LIABILITY INSURANCE 1DATE2/912(MWDDNYYY) 022 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, ih-epollcy(tes) 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 rimhts to the certificate holder in lieu of such endorsamanLs). PRODUCER Christian Brothers Services Artex Risk Solutions, Inc. (CB) _AWL__ TTA-9-- 2850 Goff Road, 5th Floor Rolling Meadows It. 600084050 CHRIBRO-14 INSURER 8 0!q iNSURED Brothers of the Christian Schools & Affiliates INSUflERC7, Loc #1177028 DOC POW ST VINCENT SENIOR CITIZEN NTR 1205 Windham Parkway ,S4R REf Romeoville IL 60446-1679 EJ� 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. W YEFF LIMITS TYPE OF INSURANCE x6or gTJ IN" wv POLICY ;UMBEH ;Y YY rR X COMMERCIAL GENERAL LIABILITY N N 822200 1325596 6/15/2022 6/15/2023 EACHOOCURRENCE 54,000.000 CLAIM. -MADE rR] OCCUR _1 I MED EXP IA(w one Person) V �N ffj$R�� 4��o JURY sinduded . . .... GEN,L AGGREGATE LIMIT APPLIES PER: ENIPRAL �281' S NIA POLICY 0 [D LOC PRODUCTS • COMMOP AGq_ $,Included JERa ALrromOBILELIABIUTY OTHEW Y Y MWTB 21543 6/1512022 6115/2023 COMBINED SiNGLE LIMIT $1,000,000 )C ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY fPer accident) $ AUTOS ONLY AUTOS HIRED NON -OWNED 'A PERTY OAwa $ AUTOS ONLY AUTOS ONLY $ T__ UMBRELLALIAB OCCUR I OCCURRENCE '!L H 0CPUAF�5t4c' $ EXCESS LIAB AWe,.MAJ ;iH A A WORKERSCOMPIENSATION y � MWC 305311 Oil 11112023 � 111/2024 IX J_R.'T TE 0 E", AND EMPLOYERS' LIABILITY YIN A 'YP" L. EACH ACCIDIE 14Y%PROP$IIEIOPJPARTNEM-XECUTtV'C FN 1 � N I A OrrIC F OFFICEPIMEMBEIREXCLUDED? ILL, DISEASE . CA LIMIT DESCRIPTION OF OPERAJIDNSO LOCATIONS t VEHICLES (ACOR0 101, Addiftr,44 Remarks ftbodulo, may twaltachad sr more spotois raqvirod) waiver of Subrogatlon (where allowed by law) per attached endorsement is provided under Auto Liability & Worker's Com re nsalion Coverage when, required by fully executed written contract. Certificate Holder is added as Aftitional Insured (per attached endorsement) for Automobile liability coverages solely, Strictly and spedfloally with regards W Consultant Services W the Community Development Block 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 AEFRES 9 El Segundo CA 90245 0 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) POLICY NUMBER: MWC 306311 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. The additional premium for this endorsement shall be 0 % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ALL PERSONS OR ORGANIZATIONS WHERE REQUIRED BY WRITTEN CONTRACT DATE OF ISSUE: 11-29-22 @1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB's California Workers' Compensation Insurance Forms Manual@ 1999.