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PROOF OF INSURANCE (2025)n DATE (MM/DD/YYYY) +►� CERTIFICATE OF LIABILITY INSURANCE I_ .. 02/10/2024 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 SUBROGATIONIS 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 HAYS COMPANIES INC/OHS 41716730 NAME: PHONE (A/C, No, Ext): (866)467-8730 IFAX (A/C, No): The Hartford Business Service Center 3600 Wiseman Blvd E-MAIL San Antonio, TX 78251 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# ......... ..... INSURED INSURER A: Sentinel Insurance Company Ltd. 11000 HR DYNAMICS & PERFORAMANCE & MANAGEMENT INSURER B : - 461 GREEN ORCHARD PL RIVERSIDE CA 92506-7590 INSURER C t WWWWW_ INSURER D : ••••• INSURER E : INSURER F ; 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 TYPE OF INSURANCE ADDLSUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS ® IDD I. ir11 - - COMMERCIAL GENERAL LIABILITY m EACH OCCURRENCE $2,000,000 CLAIMS -MADE X�OCCUR DAMAGE TO RENTED R N11 occurrPncR, $1 000,000 X General Liability MED EXP (Any one person) $10,000 A X 41 SBA NN0763 01/09/2024 01/09/2025 PERSONAL & ADV INJURY $2,000,000 GENERAL AGGREGATE $4,000,000 - GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO LOC PRODUCTS - COMP/OP AGG $4,000,000 JECT OTHER: AUTOMOBILE LIABILITY COMBINED�SINGLE LIMIT $2,000,000 ANY AUTO BODILY INJURY (Per person) 4 ALL OWNED SCHEDULED 41 SBANN0763 01/09/2024 01/09I2025 BODILY INJURY (Per accident)' AUTOS AUTOS PROPERTY DAMAGE X HIRED NON -OWNED X AUTOS AUTOS (Per accident) UMBRELLA LIAB OCCUR _ EACH OCCURRENCE EXCESS LIAB CLAIMS- AGGREGATE MADE DEO RETENTION $ WORKERS COMPENSATION _ PER OTH- AND EMPLOYERS' LIABILITY LITETAT. STE ER E.L. EACH ACCIDENT ........ ANY YIN PROPRIETOR/PARTNER/EXECUTIVE N/A ... OFFICER/MEMBER EXCLUDED? E.L. DISEASE -EA EMPLOYEE (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT DES PTI NF OPE ORATIONS be _ ............ 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. Certificate holder is an additional insured per the Business Liability Coverage Form SS0008 attached to this policy, CERTIFICATE HOLDER W _. _CANCELLATION City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 350 MAIN ST BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED EL SEGUNDO CA 90245 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©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 2. Applicable To Medical Expenses Coverage We will not pay expenses for "bodily injury": a. Any Insured To any insured, except "volunteer workers". b. Hired Person To a person hired to do work for or on behalf of any insured or a tenant of any insured. c. Injury On Normally Occupied Premises To a person injured on that part of premises you own or rent that the person normally occupies. d. Workers' Compensation And Similar Laws To a person, whether or not an "employee" of any insured, if benefits for the "bodily injury" are payable or must be provided under a workers' compensation or disability benefits law or a similar law. e. Athletics Activities To a person injured while practicing, instructing or participating in any physical exercises or games, sports or athletic contests. f. Products -Completed Operations Hazard Included with the "products -completed operations hazard". g. Business Liability Exclusions Excluded under Business Liability Coverage. C. WHO IS AN INSURED 1. If you are designated in the Declarations as: a. An individual, you and your spouse are insureds, but only with respect to the conduct of a business of which you are the sole owner. b. A partnership or joint venture, you are an insured. Your members, your partners, and their spouses are also insureds, but only with respect to the conduct of your business. c. A limited liability company, you are an insured. Your members are also insureds, but only with respect to the conduct of your business. Your managers are insureds, but only with respect to their duties as your managers. d. An organization other than a partnership, joint venture or limited liability company, you are an insured. Your "executive officers" and directors are insureds, but only with respect to their duties as your officers or directors. Your stockholders are also insureds, but only with respect to their liability as stockholders. e. A trust, you are an insured. Your trustees are also insureds, but only with respect to their duties as trustees. 2. Each of the following is also an insured: a. Employees And Volunteer Workers Your "volunteer workers" only while performing duties related to the conduct of your business, or your "employees", other than either your "executive officers" (if you are an organization other than a partnership, joint venture or limited liability company) or your managers (if you are a limited liability company), but only for acts within the scope of their employment by you or while performing duties related to the conduct of your business. However, none of these "employees" or "volunteer workers" are insureds for: (1) "Bodily injury" or "personal and advertising injury": (a) To you, to your partners or members (if you are a partnership or joint venture), to your members (if you are a limited liability company), or to a co -"employee" while in the course of his or her employment or performing duties related to the conduct of your business, or to your other "volunteer workers" while performing duties related to the conduct of your business; (b) To the spouse, child, parent, brother or sister of that co - "employee" or that "volunteer worker" as a consequence of Paragraph (1)(a) above; (c) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraphs (1)(a) or (b) above; or (d) Arising out of his or her providing or failing to provide professional health care services. If you are not in the business of providing professional health care services, Paragraph (d) does not apply to any nurse, emergency medical technician or paramedic employed by you to provide such services. (2) "Property damage" to property: (a) Owned, occupied or used by, Page 10 of 24 Form SS 00 08 04 05 CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 02/10/2024 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 BIBERK P.O. Box 113247 Stamford, CT 06911 INSURED HR Dynamics & Performance Management, Inc. 461 Green Orchard PI Riverside, CA 92506 COVERAGES CERTIFICATE NUMBER: 844-472-0967 A No 203-654-3613 t..__..__.):...................... customerservice@biBERK.com INSUR RS]AFFgI D!gCLgOVERAGE A: National Liability & Fire Insurance Company INSURER B D: 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. INTSR w TYPEOFINSURANCE ADDLSUBR INSD POLICY NUMBER PODFFmm M17IYYP — LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS MADE E_JOCCUR AvG FTi_Rhiff1ff - (?Bt¢&—"$_a oc_YlAryl ),,,,,,,, $ ..m D EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- LOC PRODUCTS - COMP/OP AGG $ OTHER: $ COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY Ica accidentl ....... ............. — ... ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS DY W irk DAMAGE $ AUTOS ONLY AUTOS ONLHIRED SI'f Si 4 ...... _-- UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB El CLAIMS -MADE AGGREGATE $ OED RETENTION $ $ WORKERS COMPENSATION PER OTH- $T TUT ER .. AND EMPLOYERS' LIABILITY YIN ......., � ANYPROPRIETOR/PARTNER/E)(ECUTIVE ❑ OFFICER/MEMBER EXCLUDED? NIA E H ACCIDENT L "E""""""""AC""""" $ """"""""""""" (Mandatory In NH) E L DISEASE - EA EMPLOYEE .......�- $ �...._., If yyes, descrdtre under DESCRIPTION OF OPERATIONS below E L. DISEASE- POLICY LIMIT $ A Professional Liability (Errors & N9PL832476 oz/zo/2023 02/2o/2oz4 Per Occurrence/ $2,000,000/ Omissions): Claims -Made Aggregate $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) CERTIFICATE HOLDER 6ANL CLLA I IVI141 City of El Segundo 350 Main Street 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 ©1988-2015 AGORU CORPORA I IUN. An rlgnts reservea. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD THE HARTFORD BUSINESS SERVICE CENTER THE ` ``' 3600 WISEMAN BLVD HARTFORD SAN ANTONIO TX 78251 City of El Segundo 350 MAIN ST EL SEGUNDO CA 90245 Account Information: Policy Holder Details : HR DYNAMICS & PERFORAMANCE & MANAGEMENT February 10, 2024 0 Contact Us Need Help? Chat online or call us at (866) 467-8730. We're here Monday - Friday. Enclosed please find a Certificate Of Insurance for the above referenced Policyholder. Please contact us if you have any questions or concerns. Sincerely, Your Hartford Service Team WLTRO05 CITY OF EL SEGUNDO WORKERS' COMPENSATION DECLARATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SUBJECTS AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN LABOR CODE § 3706, INTEREST, AND ATTORNEY'S FEES. I affirm under penalty of perjury under the laws of California one of the following declarations: (U I have and will maintain a certificate of consent of self -insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Labor Code § 3700 for the performance of the work set forth the agreement with the City of El Segundo. Policy No. (_) I have and will maintain workers' compensation insurance as required by Labor Code § 3700 for the performance of the work for which the agreement with the City of El Segundo is executed. My workers' compensation insurance carrier and policy number are: Carrier Policy Number Expiration Date Name of Agent Phone # ( I certify that, in the performance of the work set forth in the agreement with the City of El Segundo, I will not employ any person in any manner spa as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of tabor Code § 3700 1 must immediately comply with those provisions the agreement reement will automatically become voud'. SignatureofApplicak�. (Date Print Name Agreement for: 4A 6-YIM-01 1 C-S fi �DIZr► /+� Dated: I'.(( -7 l -1-,3 o it& , /J/'vEG,:7-eo,-+..F.cs I- j IAJ G— Reviewed '3 al