PROOF OF INSURANCE (2024 - 2024) CLOSEDTHIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
POLICY NUMBER_ 604395845
AM
k.,
FARMERS
INSURANCE
ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION
This endorsement modifies insurance provided underthefollowing:
BUSINESSOWNERS LIABILITY COVERAGE FORM
BUSINESSOWNERS COVERAGE FORM
APARTMENTOWNERS LIABILITY COVERAGE FORM
CONDOMINIUM LIABILITY COVERAGE FORM
SCHEDULE
Name Of Additional Insured Person(s) Or Organi ation(s),
CITY -t L SE�UNDO FiGLICE DEPARTMENT
Information required to complete this Schedule, if not shown above:,, will be shown in the Declarations.
A. The following is added to Paragraph C. Who Is An Insured of the applicable Coverage Form:
3238
1 st Edition
Any person(s) or organi2ation(s) shown in the Schedule is also an additional insured, but only with respect to
liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by
your acts or omissions or the acts or omissions of those acting on your behalf in the performance of your ongoing
operations or in connection with yourpremises owned by or rented to you.
However:
a. The insurance afforded to such additional insured only appliesto the extent permitted bylaw; and
b. If coverage provided to the additional insured is required by contract oragreement, 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.
S. With respect to the insurance afforded to these additional insureds, the following is added to Paragraph D. Liability
And Medical Expenses Limits Of Insurance of the applicable Coverage Form:
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 underthe 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.
This endorsement is part of your policy. It supersedes and controls anything to the contrary. It is otherwise subject to all the
terms of the policy.
J7238-ED 1 02-19 Includes copyrighted material of 4nsurance Services Office, Inc., with its permission. Page 1 of 1
937238 J7238101
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 0630
(Ed. 6-20)
WAIVER OFOUR RIGHTTO RECOVER FROM OTHERS ENDORSEMENT- CALIFORNIA
We have the right to recover our paymentsfrom 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 agreementfrom us.)
You must maintain payroll records accurately segregating the remuneration of your employeeswhile engaged in the work
described in the Schedule.
The additional premium forthis endorsement shall be % of the California workers compensation premium otherwise due
on such remuneration, subject to a minimum chargeof�,.
Schedule
Person or Organization job Description
COMPUTER SERVICES 210 W BIRCH STSTE 207 BREA, CA92821
CITYOF ELSEGUNDO
POLICE DEPARTMENT
348 MAIN ST
ELSEGUNDO, CA90245
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 08/13/21 Policy No. A0946-59-56 Endorsement No.
Insured CROSSROADS SOFTWARE, INC
(DBA) CROSSROADS SOFTWARE
210 W BIRCH STSTE 207 Insurance Company MID-CENTURY INSURANCE COMPANY
BREA CA928214504
Countersigned By
WC 99 06 30
(Ed. 6-20)
Includes copyright material of the Workers Compensation Insurance Rating Bureau of California. All rights reserved.