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PROOF OF INSURANCE (2023) CLOSEDSOUTBAY-12 AfFRI.EDM IDDIY CERTIFICATE OF LIABILITY INSURANCE Dn6122/2023 ' 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 License # L1 00460 CONTACT Knauf Maxwell Insurance Services PHONE oW. 900 Nw3„3) 256-0800Ls A le, Broadway 0041 E E-MAILMAI�knaufreceptIcnkmIns.com INSURER(§)AFFORDING COVERAGE ______ __ NAIC # INsuRER A Nonprofits Insurance Alliance of California, Inc. 0 INSURED [ liy . _M INSURER B NOVA Cast'amn.n..,.Com an!?Y42552------ South Bay Children's Health Center Association, Inc. INsuRRc Llo,dsr 0 _ 410 S. Camino Real ''. INSURER D : Redondo Beach CA 90277 INSURERE: ........................... ...INSURER.F....................................................................................................................................................................................................L.........................,_, _......................................-w .._._____"" COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INT R jg TYPE OF INSURANCE AINDDL SUBRI POLICY NUMBER ........ ......... ...... ......... ......... POLICY EFF POL ICY EXP MM LIMITS A X COMMERCIAL GENERAL LIABILITY 1 CLAIMS -MADE C X OCCUR 2022-15361 12/1/2022 12/1/2023 DAMAGE TO TED� 500,000 „ X X „ $ _._.., ........ _ .. -_.. ...._._.. MED EXP GAny one Eers p) $ .......................�. 20,000 PERSONALBADVINJURY $ 1,000,000 GEN L AGGREGA.Y'E LIMIT APPLIES PER: GENERAL AGGREGATE $ ,000,000 POLICY PET LOO e ❑ PRODUCTS P A ... n.._... ,000,000 ._X... OTHER Abuse/M olestP/o �......_�3 � ...... ,000,000 A AUTOMOBILEABILITY SINGLE LIMIT , COMBINE IT � ] 1,000 000 AUTO 2022-15361 12/1/2022 12/1/2023 BODILY IN URV Per e rson $ ( � ) OWNED SCHEDULED AUTOS ONLY AUTOS �_.PODILYINJJJRY(Perarcdent $,,,, _._...,. �' ''...IxA AUT�S ONLY ,..X. NLIl' tl L , F` rO�ro tl ryERTY DAMA E. $..,......____.__._._, _..___ _i A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 _—..-._ EXCESS LIAB CLAIMS -MADE 2022-15361-UMB .... 1211 /2022 12/1/2023 AGGREGATE $ 1,000,000 DED X RETE _ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITYYIN X ,., PA—I�I,.T rv,.�RH _._..,...________ ANY PROPRIETOR/PARTNER/EXECUTIVE� X CFI-WK-10000401-02 12/1 /2022 12/1 /2023 EL EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A E L DISEASE- EA EMPLOYEE _ $ 1,000,000 If yes, describe under 1 000,000 DESCRIPTION OF OPERATIONS below E..L., DISEASE -POLICY LIMIT $ C Cyber Liability ESK0139439879 4/13/2023 4/13/2024 Limit 2,000,000 A Liquor Liability 2022-15361 121l/2022 12/1/2023 Limit 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additlonal Rernerks Schedule, me tie attached if snore space is required) RE: Counseling of abused children and their families who are referred to the South F ay Youth Project The City of El Segundo is included as additional insured as per attached policy language. "Medical Expense" coverage is EXCLUDED for inmates, PATIENTS or prisoners, per form CG22521093 " "Medical Expense" coverage is EXCLUDED for inmates, PATIENTS or prisoners, per form CG22521093 " SEE ATTACHED ACORD 101 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN tY El 9 ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street 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 AGENCY CUSTOMER ID: SOUTBAY-12 AFRIEDMAN LOC # 1 "`CR ADDITIONAL REMARKS SCHEDULE 1 Page 1of.... .._.,,,,._. ...............- ....... AGENCY License # L100460 NAMED INSURED nauf Maxwell Insurance Services South Say Children's Health Center Association, Inc. 410 S. Camino Real aoucY NUMBER...... ................. ....... ...------ -------- Redondo Beach, CA 90277 SEE PAGE 1 EE PAGE 1................. .................. ---- -- ..__..... I CARRIER NA C CO �SEE. P.�E.� EFFECTIVE DATE: SEE.,„ ............ .... _..._..... ..._......_.. PAGE 1 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 2022-15361 COMMERCIAL GENERAL LIABILITY Named Insured: South Bay Children's Health Center Association, Inc. CG 20 12 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: Any state or political subdivision that issues a permit or authorization to the named insured. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II —Who Is An Insured is amended to include as an additional insured any state or governmental agency or subdivision or political subdivision shown in the Schedule, subject to the following provisions: 1. This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a B permit or authorization. However: a. The insurance afforded to such additional insured only applies to the extent permitted by law; and b. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. 2. This insurance does not apply to: a. "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or b. "Bodily injury" or "property damage" included within the "products -completed operations hazard". With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contractor agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 12 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 1 NONPROFITS INSURANCE ALLIANCE OF CALIFORNIA A Head for Insurance. A Heartfor Nonprofits. POLICY NUMBER: 2022-15361 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY ENDORSEMENT FOR PUBLIC ENTITIES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: A. Section II —WHO IS AN INSURED is amended to include: 4. Any public entity as an additional insured, and the officers, officials, employees, agents and/or volunteers of that public entity, as applicable, who may be named in the Schedule above, when you have agreed in a written contract or written agreement presently in effect or becoming effective during the term of this policy, that such public entity and/or its officers, officials, employees, agents and/or volunteers be added as an additional insured(s) on your policy, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: a. Your negligent acts or omissions, or b. The negligent acts or omissions of those acting on your behalf; in the performance of your ongoing operations. No such public entity or individual is an additional insured for liability arising out of the sole negligence by that public entity or its designated individuals, The additional insured status will not be afforded with respect to liability arising out of or related to your activities as a real estate manager for that person or organization. B. Section III — LIMITS OF INSURANCE is amended to include: 8. The limits of insurance applicable to the public entity and applicable individuals identified as an additional insured(s) pursuant to Provision A. 4, above, are those specified in the written contract between you and that public entity, or the limits available under this policy, whichever are less, These limits are part of and not in addition to the limits of insurance under this policy. C. With respect to the insurance provided to the additional insured(s), Condition 4. Other Insurance of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is replaced by the following: 4. Other Insurance a. Primary Insurance This insurance is primary if you have agreed in a written contract or written agreement: (1) That this insurance be primary. If other insurance is also primary, we will share with all that other insurance as described in c. below; or N IAC-E61 02 19 Page 1 of 2 NONPROFITS INSURANCE WRIMM ALLIANCE OF CAUFORN1A A Head for Insurance. A Heartfor Nonprofits. POLICY NUMBER: 2022-15361 (2) The coverage afforded by this insurance is primary and non-contributory with the additional insured(s)' own insurance. Paragraphs (1) and (2) do not apply to other insurance to which the additional insured(s) has been added as an additional insured or to other insurance described in paragraph b. below. b. Excess Insurance This insurance is excess over: 1. Any of the other insurance, whether primary, excess, contingent or on any other basis: (a) That is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for "your work"; (b) That is fire, lightning, or explosion insurance for premises rented to you or temporarily occupied by you with permission of the owner; (c) That is insurance purchased by you to cover your liability as a tenant for "property damage" to premises temporarily occupied by you with permission of the owner; or (d) If the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of SECTION I — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE. (e) Any other insurance available to an additional insured(s) under this Endorsement covering liability for damages which are subject to this endorsement and for which the additional insured(s) has been added as an additional insured by that other insurance. (1) When this insurance is excess, we will have no duty under Coverages A or B to defend the additional insured(s) against any "suit" if any other insurer has a duty to defend the additional insured(s) against that "suit", If no other insurer defends, we will undertake to do so, but we will be entitled to the additional insured(s)' rights against all those other insurers. (2) 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: (a) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (b) The total of all deductible and self -insured amounts under all that other insurance. (3) 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 Limits of Insurance shown in the Declarations of this Coverage Part. c. Methods of Sharing If all of the other insurance available to the additional insured(s) 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 other the other insurance available to the additional insured(s) does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. NIAC-E61 02 19 Page 2 of 2 NONPROFITS POLICY NUMBER: 2022-15361 FORM: NIAC-E2611 17 INSURANCE NAMED INSURED: South Bay Children's Health Center Association, Inc. ALLIANCE OF CALIFORNIA A Head for Insurance. A Heart fir Nonproffm THIS ENDORSEMENT CHANGES THE POLICY.. PLEASE READ IT CAREFULLY, WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SOCIAL SERVICE PROFESSIONAL LIABILITY COVERAGE FORM SCHEDULE Name of Person or Organization: Where you are so required in a written contract or agreement currently in effect or becoming effective during the term of this policy, we waive any right of recovery we may have against that person or organization, who may be named in the schedule above, because of payments we make for injury or damage. NIAC-E26 11 17 Page 1 of 1 POLICY NUMBER: COMMERCIAL AUTO CA04441013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF FIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Endorsement Effective Date: SCHEDULE Name(s) Of Person(s) Or Organization(s): Any person or organization with whom you have a written contract currently in effect or becoming effective during the term of this policy. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the 'loss" under a contract with that person or organization. CA 04 44 10 13 C Insurance Services Office, Inc., 2011 Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) 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 2 % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER PRIOR TO A LOSS. 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 05-19-22 Policy No. CF1—WK-10000401-01 Endorsement No. 001 Insured SOUTH BAY CHILDREN' S HEALTH Premium $ INCL . Insurance Company NOVA Casualty Company Countersigned By ©1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB's California Workers' Compensation Insurance Forms Manual © 1999. INSURED