Press Alt + R to read the document text or Alt + P to download or print.
This document contains no pages.
PROOF OF INSURANCE (2024 - 2024) CLOSEDATE
CERTIFICATE OF LIABILITY INSURANCE ° 8/25/20/ 23'
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 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 CONIACI Stacey Tialavea
NAME:
Post Insurance Services Inc
PHONE (310) 328-3622 FANo:No:, (310)32B-e054
E-MALL ADDRESS: stacey@postinsurance.com
License #0551220
INSURERS AFFORDING COVERAGE
NAIC #
2356 Torrance Blvd
Torrance CA 90501
INSURER A: Sentinel Insurance Co LTD
11000
INSURED
INSURER B: California Automobile Ins Co
38342
INSURER C: Hartford Casualty Ins Co
29424
Teri Black and Company LLC
INSURER D:
25500 Hawthorne Blvd
INSURER E
Ste 1158
INSURER F;
Torrance CA 90505
COVERAGES CERTIFICATE NUMBER:23 ALL 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.
INSR
TR,
TYPE OF INSURANCE
ADDL
POLICYNUMBER
POLICY EF£
'.. MMID0ffYYY
POLMY EXP
MMDIYYYY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 2,000,000
A
CLAIMS -MADE � OCCUR
Ate' RIED
o�
PREMISES Ea ctrreeaiicel_....
$ 1,000,000
MED EXP (Any one person)
$ 10,000
X
72SBAIB3098
6/16/2023
6/16/2024
PERSONAL & ADV INJURY
S EXCLUDED
GENIAGGREGATE LIMITAPPLIES PER:
GENERAL AGGREGATE
$ 4,000,000
X POLICY LJ PRT LOC
JEOT
PRODUCTS- COMP/Op AGG
$ 4,000,000
$
OTHER
AUTOMOBILE
LIABILITY
COMBINED&NGLE UMIT
Ea a idenl.
$ 1,000,000
BODILY INJURY (Per person)
$
B
X
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
BA040000031958
2/2/2023
2/2/2024
BODILY INJURY (Per accident)
$
NON -OWNED
HIREDAUTOS AUTOS
PROPERTYDAMAGE
Per ecc1derwd
$
UMBRELLALIAS OCCUR
Id
EACH OCCURRENCE
$
.. AGGREGATE
$
EXCESS LIAR CLAIMS -MADE
$
DED I I RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
XPER OTH-
T.ER
,.
ANY PROPRIETORIPARTNER/EXECUTIVE
E. L. EACH ACCIDENT_
$ 1,000,000
C
OFFICER/MEMBER EXCLUDED? �.
(Mandatory in NH)
N/A
72WECZI2611
3/19/2023
3/19/2024
E L. DISEASE - EA EMPLOYEE
$ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L.. DISEASE - POLICY LIMIT
$ 1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
Those usual to the Insured's operations.
Certholder is Addtl Insured on Gen Liability.
CERTIFICATE HOLDER CANCELLATION
gressa@elsegundo.org
City of El Segundo
Attn: Gabrielle Ressa/HR Technician
350 Main St
El Segundo, CA 90245
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Post/STACEY
© 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
INS025 (201401)
Policy No: 72SBAIB3098
(b) Rented to, in the care, custody or
control of, or over which physical
control is being exercised for any
purpose by you, any of your
"employees", "volunteer workers",
any partner or member (if you are
a partnership or joint venture), or
any member (if you are a limited
liability company).
b. Real Estate Manager
Any person (other than your "employee" or
"volunteer worker"), or any organization
while acting as your real estate manager.
c. Temporary Custodians Of Your
Property
Any person or organization having proper
temporary custody of your property if you
die, but only:
(1) With respect to liability arising out of the
maintenance or use of that property; and
(2) Until your legal representative has
been appointed.
d. Legal Representative If You Die
Your legal representative if you die, but
only with respect to duties as such. That
representative will have all your rights and
duties under this insurance.
e. Unnamed Subsidiary
Any subsidiary and subsidiary thereof, of
yours which is a legally incorporated entity
of which you own a financial interest of
more than 50% of the voting stock on the
effective date of this Coverage Part.
The insurance afforded herein for any
subsidiary not shown in the Declarations
as a named insured does not apply to
injury or damage with respect to which an
insured under this insurance is also an
insured under another policy or would be
an insured under such policy but for its
termination or upon the exhaustion of its
limits of insurance.
3. Newly Acquired Or Formed Organization
Any organization you newly acquire or form,
other than a partnership, joint venture or
limited liability company, and over which you
maintain financial interest of more than 50% of
the voting stock, will qualify as a Named
Insured if there is no other similar insurance
available to that organization. However:
a. Coverage under this provision is afforded
only until the 180th day after you acquire
or form the organization or the end of the
policy period, whichever is earlier; and
BUSINESS LIABILITY COVERAGE FORM
b. Coverage under this provision does not
apply to:
(1) "Bodily injury" or "property damage"
that occurred; or
(2) "Personal and advertising injury"
arising out of an offense committed
before you acquired or formed the
organization.
4. Operator Of Mobile Equipment
With respect to "mobile equipment" registered in
your name under any motor vehicle registration
law, any person is an insured while driving such
equipment along a public highway with your
permission. Any other person or organization
responsible for the conduct of such person is
also an insured, but only with respect to liability
arising out of the operation of the equipment, and
only if no other insurance of any kind is available
to that person or organization for this liability.
However, no person or organization is an insured
with respect to:
a. "Bodily injury" to a co -"employee" of the
person driving the equipment; or
b. "Property damage" to property owned by,
rented to, in the charge of or occupied by
you or the employer of any person who is
an insured under this provision.
5. Operator of Nonowned Watercraft
With respect to watercraft you do not own that
is less than 51 feet long and is not being used
to carry persons for a charge, any person is an
insured while operating such watercraft with
your permission. Any other person or
organization responsible for the conduct of
such person is also an insured, but only with
respect to liability arising out of the operation
of the watercraft, and only if no other
insurance of any kind is available to that
person or organization for this liability.
However, no person or organization is an
insured with respect to:
a. "Bodily injury" to a co -"employee" of the
person operating the watercraft; or
b. "Property damage" to property owned by,
rented to, in the charge of or occupied by
you or the employer of any person who is
an insured under this provision.
6. Additional Insureds When Required By
Written Contract, Written Agreement Or
Permit
The person(s) or organization(s) identified in
Paragraphs a. through f. below are additional
insureds when you have agreed, in a written
Form SS 00 08 04 05 Page 11 of 24
Policy No: 72SBAIB3098
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 organization
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
products;
insured under this provision only for that
(f) Demonstration, installation,
period of time required by the contract,
servicing or repair operations,
agreement or permit.
except such operations performed
However, no such person or organization is an
at the vendor's premises in
connection with the sale of the
additional insured under this provision if such
product;
person or organization is included as an
additional insured by an endorsement issued
(g) Products which, after distribution
by us and made a part of this Coverage Part,
or sale by you, have been labeled
including all persons or organizations added
or relabeled or used as a
as additional insureds under the specific
container, part or ingredient of any
additional insured coverage grants in Section
other thing or substance by or for
F. — Optional Additional Insured Coverages.
the vendor; or
a. Vendors
(h) "Bodily injury" or "property
Any person(s) or organization(s) (referred to
damage" arising out of the sole
below as vendor), but only with respect to
negligence of the vendor for its
"bodily injury" or "property damage" arising
own acts or omissions or those of
its employees or anyone else
out of "your products" which are distributed
acting on its behalf. However, this
or sold in the regular course of the vendor's
exclusion does not apply to:
business and only if this Coverage Part
provides coverage for "bodily injury" or
(i) The exceptions contained in
"property damage" included within the
Subparagraphs (d) or (f); or
"products -completed operations hazard".
(ii) Such inspections, adjustments,
(1) The insurance afforded to the vendor
tests or servicing as the vendor
is subject to the following additional
has agreed to make or normally
exclusions:
undertakes to make in the usual
This insurance does not apply to:
course of business, in
connection with the distribution
(a) "Bodily injury" or "property
or sale of the products.
damage" for which the vendor is
(2) This insurance does not apply to any
obligated to pay damages by
insured person or organization from
reason of the assumption of
whom you have acquired such products,
liability in a contract or agreement.
or any ingredient, part or container,
This exclusion does not apply to
entering into, accompanying or
liability for damages that the
containing such products.
vendor would have in the absence
of the contract or agreement;
b. Lessors Of Equipment
(b) Any express warranty
(1) Any person or organization from
unauthorized by you;
whom you lease equipment; but only
(c) Any physical or chemical change
with respect to their liability for "bodily
"property
in the product made intentionally
injury", damage" or
"personal and advertising injury"
by the vendor;
caused, in whole or in part, by your
(d) Repackaging, except when
maintenance, operation or use of
unpacked solely for the purpose of
equipment leased to you by such
inspection, demonstration, testing,
person or organization.
or the substitution of parts under
instructions from the manufacturer,
and then repackaged in the
original container;
Page 12 of 24 Form SS 00 08 04 05
Policy No: 72SBAIB3098
BUSINESS LIABILITY COVERAGE FORM
(2) With respect to the insurance afforded
e. Permits Issued By State Or Political
to these additional insureds, this
Subdivisions
insurance does not apply to any
(1) Any state or political subdivision, but
"occurrence" which takes place after
only with respect to operations
you cease to lease that equipment.
performed b p y you or on your behalf for
c. Lessors Of Land Or Premises
which the state or political subdivision
(1) Any person or organization from
has issued a permit.
whom you lease land or premises, but
(2) With respect to the insurance afforded
only with respect to liability arising out
to these additional insureds, this
of the ownership, maintenance or use
insurance does not apply to:
of that part of the land or premises
ou
(a) "Bodily injury", 1 rY". "property damage"
leased to you.
or "personal and advertising
(2) With respect to the insurance afforded
injury" arising out of operations
to these additional insureds, this
performed for the state or
insurance does not apply to:
municipality; or
(a) Any "occurrence" which takes
(b) "Bodily injury" or "property damage"
place after you cease to lease that
included within the "products -
land or be a tenant in that
completed operations hazard".
premises; or
f. Any Other Party
(b) Structural alterations, new
(1) Any other person or organization who
construction or demolition
is not an insured under Paragraphs a.
operations performed by or on
through e. above, but only with
behalf of such person or
respect to liability for "bodily injury",
organization.
"property damage" or "personal and
d. Architects, Engineers Or Surveyors
advertising injury" caused, in whole or
(1) Any architect, engineer, or surveyor, but
in part, by your acts or omissions or
only with respect to liability for "bodily
the acts or omissions of those acting
injury", "property damage" or "personal
on your behalf:
and advertising injury" caused, in whole
(a) In the performance of your
or in part, by your acts or omissions or
ongoing operations;
the acts or omissions of those acting on
b
() In connection with your premises
your behalf:
owned by or rented to you; or
(a) In connection with your premises;
(c) In connection with "your work" and
or
included within the "products-
(b) In the performance of your
completed operations hazard", but
ongoing operations performed by
only if
you or on your behalf.
(i) The written contract or written
(2) With respect to the insurance afforded
agreement requires you to
to these additional insureds, the
provide such coverage to
following additional exclusion applies:
such additional insured; and
This insurance does not apply to
(ii) This Coverage Part provides
"bodily 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 advertising injury"
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 SS 00 08 04 05
Page 13 of 24
Policy No: 72SBAIB3098
(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
Part:
(a) Primary 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 Non -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 insured's
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
Limits of Insurance shown in the
Declarations of this Coverage Part.
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 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.
8. Transfer Of Rights Of Recovery Against
Others To Us
a. Transfer Of Rights Of Recovery
If the insured has rights to recover all 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 after 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
Of Subrogation)
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 waive 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
Policy No: 72SBAIB3098
BUSINESS LIABILITY COVERAGE FORM
F. OPTIONAL ADDITIONAL INSURED
3. Additional Insured - Grantor Of Franchise
COVERAGES
WHO IS AN INSURED under Section C. is
If listed or shown as applicable in the Declarations,
amended to include as an additional insured
one or more of the following Optional Additional
the person(s) or organization(s) shown in the
Insured Coverages also apply. When any of these
Declarations as an Additional Insured -
Optional Additional Insured Coverages apply,
Grantor Of Franchise, but only with respect to
Paragraph 6. (Additional Insureds When Required
their liability as grantor of franchise to you.
by Written Contract, Written Agreement or Permit)
4. Additional Insured - Lessor Of Leased
of Section C., Who Is An Insured, does not apply
Equipment
to the person or organization shown in the
a. WHO IS AN INSURED under Section C. is
Declarations. These coverages are subject to the
amended to include as an additional
terms and conditions applicable to Business
insured the person(s) or organization(s)
Liability Coverage in this policy, except as
shown in the Declarations as an Additional
provided below:
Insured — Lessor of Leased Equipment,
1. Additional Insured - Designated Person Or
but only with respect to liability for "bodily
Organization
injury", "property damage" or "personal
WHO IS AN INSURED under Section C. is
and advertising injury" caused, in whole or
amended to include as an additional insured
in part, by your maintenance, operation or
the person(s) or organization(s) shown in the
use of equipment leased to you by such
Declarations, but only with respect to liability
person(s) or organization(s).
for "bodily injury", "property damage" or
b. With respect to the insurance afforded to
"personal and advertising injury" caused, in
these additional insureds, this insurance
whole or in part, by your acts or omissions or
does not apply to any 'occurrence" which
the acts or omissions of those acting on your
takes place after you cease to lease that
behalf:
equipment.
a. In the performance of your ongoing
5. Additional Insured - Owners Or Other
operations; or
Interests From Whom Land Has Been
b. In connection with your premises owned
Leased
by or rented to you.
a. WHO IS AN INSURED under Section C. is
2. Additional Insured - Managers Or Lessors
amended to include as an additional
Of Premises
insured the person(s) or organization(s)
shown in the Declarations as an Additional
a. WHO IS AN INSURED under Section C. is
Insured — Owners Or Other Interests From
amended to include as an additional insured
Whom Land Has Been Leased, but only
the person(s) or organization(s) shown in the
with respect to liability arising out of the
Declarations as an Additional Insured -
ownership, maintenance or use of that part
Designated Person Or Organization; but only
of the land leased to you and shown in the
with respect to liability arising out of the
Declarations.
ownership, maintenance or use of that part of
the premises leased to you and shown in the
b. With respect to the insurance afforded to
Declarations.
these additional insureds, the following
additional exclusions apply:
b. With respect to the insurance afforded to
these additional insureds, the following
This insurance does not apply to:
additional exclusions apply:
(1) Any 'occurrence" that takes place
This insurance does not apply to:
after you cease to lease that land; or
(1) Any 'occurrence" which takes place
(2) Structural alterations, new
after you cease to be a tenant in that
construction or demolition operations
premises; or
performed by or on behalf of such
(2) Structural alterations, new
person or organization.
construction or demolition operations
6. Additional Insured - State Or Political
performed by or on behalf of such
Subdivision — Permits
person or organization.
a. WHO IS AN INSURED under Section C. is
amended to include as an additional
insured the state or political subdivision
shown in the Declarations as an Additional
Page 18 of 24 Form SS 00 08 04 05
Policy No: 72SBAIB3098
BUSINESS LIABILITY COVERAGE FORM
Insured — State Or Political Subdivision -
(e) Any failure to make such
Permits, but only with respect to
inspections, adjustments, tests or
operations performed by you or on your
servicing as the vendor has agreed
behalf for which the state or political
to make or normally undertakes to
subdivision has issued a permit.
make in the usual course of
b. With respect to the insurance afforded to
business, in connection with the
these additional insureds, the following
distribution or sale of the products;
additional exclusions apply:
(f) Demonstration, installation,
This insurance does not apply to:
servicing or repair operations,
except such operations performed
(1) "Bodily injury"," roe damage" or
"property g
at the vendor's premises in
"personal and advertising injury"
connection with the sale of the
arising out of operations performed for
product;
the state or municipality; or
(g) Products which, after distribution
(2) "Bodily injury" or "property damage"
or sale by you, have been labeled
included in the "product -completed
or relabeled or used as a
operations" hazard.
container, part or ingredient of any
7. Additional Insured —Vendors
other thing or substance by or for
a. WHO IS AN INSURED under Section C. is
the vendor; or
amended to include as an additional
(h) "Bodily injury" or "property
insured the person(s) or organization(s)
damage" arising out of the sole
(referred to below as vendor) shown in the
negligence of the vendor for its
Declarations as an Additional Insured -
own acts or omissions or those of
Vendor, but only with respect to "bodily
its employees or anyone else
injury" or "property damage" arising out of
acting on its behalf. However, this
"your products" which are distributed or
exclusion does not apply to:
sold in the regular course of the vendor's
(i) The exceptions contained in
business and only if this Coverage Part
Subparagraphs (d) or (f); or
provides coverage for "bodily injury" or
"property damage" included within the
(ii) Such inspections,
"products -completed operations hazard".
adjustments, tests or servicing
as the vendor has agreed to
b. The insurance afforded to the vendor is
make or normally undertakes
subject to the following additional exclusions:
to make in the usual course of
(1) This insurance does not apply to:
business, in connection with
(a) "Bodily injury" or "property
the distribution or sale of the
damage" for which the vendor is
products.
obligated to pay damages by
(2) This insurance does not apply to any
reason of the assumption of
insured person or organization from
liability in a contract or agreement.
whom you have acquired such
This exclusion does not apply to
products, or any ingredient, part or
liability for damages that the
container, entering into,
vendor would have in the absence
accompanying or containing such
of the contract or agreement;
products.
(b) Any express warranty
8. Additional Insured — Controlling Interest
unauthorized by you;
WHO IS AN INSURED under Section C. is
(c) Any physical or chemical change
amended to include as an additional insured
in the product made intentionally
the person(s) or organization(s) shown in the
by the vendor;
Declarations as an Additional Insured —
(d) Repackaging, unless unpacked
Controlling Interest, but only with respect to
solely for the purpose of inspection,
their liability arising out of:
demonstration, testing, or the
a. Their financial control of you; or
substitution of parts under
b. Premises they own, maintain or control
instructions from the manufacturer,
while you lease or occupy these premises.
and then repackaged in the original
container;
Form SS 00 08 04 05 Page 19 of 24
Policy No: 72SBAIB3098
BUSINESS LIABILITY COVERAGE FORM
This insurance does not apply to structural
alterations, new construction and demolition
operations performed by or for that person or
organization.
9. Additional Insured — Owners, Lessees Or
Contractors — Scheduled Person Or
Organization
a. WHO IS AN INSURED under Section C. is
amended to include as an additional
insured the person(s) or organization(s)
shown in the Declarations as an Additional
Insured — Owner, Lessees Or Contractors,
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:
(1) In the performance of your ongoing
operations for the additional
insured(s); or
(2) In connection with "your work"
performed for that additional insured
and included within the "products -
completed operations hazard", but
only if this Coverage Part provides
coverage for "bodily injury" or
"property damage" included within the
"products -completed operations
hazard".
b. With respect to the insurance afforded to
these additional insureds, this insurance
does not apply to "bodily injury", "property
damage" or "personal an advertising
injury" arising out of the rendering of, or
the failure to render, any professional
architectural, engineering or surveying
services, including:
(1) 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
(2) Supervisory, inspection, architectural
or engineering activities.
10. Additional Insured — Co -Owner Of Insured
Premises
WHO IS AN INSURED under Section C. is
amended to include as an additional insured
the person(s) or Organization(s) shown in the
Declarations as an Additional Insured — Co -
Owner Of Insured Premises, but only with
respect to their liability as co-owner of the
premises shown in the Declarations.
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.
G. LIABILITY AND MEDICAL EXPENSES
DEFINITIONS
1. "Advertisement" means the widespread public
dissemination of information or images that
has the purpose of inducing the sale of goods,
products or services through:
a. (1) Radio;
(2) Television;
(3) Billboard;
(4) Magazine;
(5) Newspaper;
b. The Internet, but only that part of a web
site that is about goods, products or
services for the purposes of inducing the
sale of goods, products or services; or
c. Any other publication that is given
widespread public distribution.
However, "advertisement" does not include:
a. The design, printed material, information
or images contained in, on or upon the
packaging or labeling of any goods or
products; or
b. An interactive conversation between or
among persons through a computer network.
2. "Advertising idea" means any idea for an
"advertisement".
3. "Asbestos hazard" means an exposure or
threat of exposure to the actual or alleged
properties of asbestos and includes the mere
presence of asbestos in any form.
4. "Auto" means a land motor vehicle, trailer or
semi -trailer designed for travel on public
roads, including any attached machinery or
equipment. But "auto" does not include
"mobile equipment".
S. "Bodily injury" means physical:
a. Injury;
b. Sickness; or
c. Disease
sustained by a person and, if arising out of the
above, mental anguish or death at any time.
6. "Coverage territory" means:
Page 20 of 24 Form SS 00 08 04 05
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
08/14/2023
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 CON ACT
Hiscox Inc. d/b/a/ Hiscox Insurance Agency in CA PHONE m888202-3007 FAx _.........._ .......... __.
A1C. NO.. Ext�; f1,49�r t'(5?.},;.�.._ ..__..____...._........_. ...
5 Concourse Parkway -MAJk
Suite 2150 AOpRF$ conlact(urhiscox.com
Atlanta GA, 30328 INSURER($) AFFORDING COVERAGE -mgt.....
INSURED
Teri Black & Company, LLC
25500 Hawthorne Blvd Ste 1158
Torrance, CA 90505
COVERAGES
CERTIFICATE NUMBER:
Hiscox Insurance Comoanv Inc 1 10200
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.
1-.�._....................................................................................................................w........................................................................................
ADaf F AP
L $wvn
'LTR
TYPE OF INSURANCE POLICY NUMBER IN VY1 NPMIC LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
......I CLAIMS -MADE L OCCUR
...-.-. .................. ...................................................... _...
...M,ED EX,P,(An� one,person)........
. m. ................. _............ �
PERSONAL INJURY _
$
GEN'LAGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$
.......
PRO-
❑ PRO- ❑
........._........�
POLICY JECT LOC
.,PRODUCTS.....,,,,,,,, GG-..._.._
COMP/0P A
OTH.ER�
AUTOMOBILE LIABILITY
mm
COMBINED SINGLE LIMIT
Ak Am.4re 0
$
ANY AUTO
BODILY INJURY (Perperson)
$
ALL OWNED SCHEDULED
BODILY INJURY (Per accident)
$
...........- AUTOS ............. AUTOS
PROPER'TYDAMAGE'.
$
NON -OWNED
HIRED AUTOS AUTOS
..iE'er�vx�adsrnty
UMBRELLA LIAB OCCUR
EACH OCCURRENCE
$
'.. AGGREGATE
$
EXCESS LIAR CLAIMS -MADE
DED RETENTION $
$
WORKERS COMPENSATION
)TH-
AND EMPLOYERS' LIABILITY Y / N
5.,, TAT ITE . FR
ANYPHOPRIETORJPAO't''•TNERME KE LDTIVE
E.L. EACH ACCIDENT $
OFFICERIMEMBEREXCLUDED?' ❑NIA
(Mandatary In. NH)
E.L. DISEASE- EA EMPLOYEE $
If as, deecrube sender
DE-SCRIPTIQ'3N OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT 1 $
A
Professional Liability
P100.588.685.10
09/28/2023
09/28/2024
Each Claim: $ 2,000,000
Aggregate: $ 2,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
CERTIFICATE. HOLD
City of El Segundo
350 Main Street
El Segundo, CA 90245
ACORD 25 (2016103)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
r
©1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD