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PROOF OF INSURANCE (2024 - 2025)111 CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 05/28/2024 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 Michael Geffre Insurance Agency 32392 Coast Hwy Ste 260 Laguna Beach, CA 92651 INSURED URBAN FUTURES, INC. dba ISOM ADVISORS 1470 MARIA LANE, SUITE 315 WALNUT CREEK, CA 94596 rOVFRAGES f"ERTIEICATE NUMRFR- 949-494-7261 q, C N�„ 949�94�481 ... .. INSURER(S) AFFORDING COVERAGE —...."""" _ NAIC # A ATEGRITY SPECIALTY INSURANCE CO 16427 B: MID-CENTURY INSURANCEmmm• •• Tn COMPANY wwww......._ 21687 .._ c, PENNwSTAR INSURANCE COMPANY 10673 mmm D WESTCHESTER SURPLUS LINES 10172 F. UNDERWRITERS AT LLOYDS OF LONDON 15792 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. w_...............—..._..._,. "w,.,_... _....._._..-......-_. ._-...,Y EFF � POLICY EX ILTR ................ .Jif4E SUBR ........... POLICY EFF ........ ..... ...., TYPE OF INSURANCE POLICY NUMBER MWDD. MMIDD LIMITS K COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000........... A CLAIMS -MADE occuR Y Y 01-C-PK-P20094043-0 12/27/202312/27/2024 100,000 MED EXP (Any one person) m .. $ 5,000 PERSONAL&ADVINJURY $ 1,000,000 __.. __._....--_. GY:NLAGG ...--...- .......w. REGATELIMITAPPLIESPER: ---- .. GENERALAG_GREGATE $ 2,000,000 X JECT POLICY PRCw LOC PRODUCTS-COMP/OPAGG .._ $ NotmCovered OTHERr $ B AUTOMOBILE LIABILITY COMBINEDSRr-L! I..IMVT _ $ 1,000,000 ANY AUTO BODILY INJURY (Per person) $mmm _.._. OWNED SCHEDULED X Y 605900024 03/11/2024 03/11/2025 BODILY INJURY (Per accident) INN $ xAUTOS ONLY X,. AUTOS HIRED _ NON -OWNED PRGaPIiRTYOAMAGE ••••••••••--••••••• $ AUTOS ONLY AUTOS ONLY .,.gr"ex ew4deni9 UMBRELLALIAB OCCUR EACHOCCU RRENCE $ 2,000,000 (�, X 'EXCESS LIAB CLAIMS -MADE XPA0010121 12/27/202312/27/2024 AGGREGATE ... $ 2,000,000 ........................... DED RETENTION $ $ WORKERS COMPENSATION STATTETRFi AND EMPLOYERS' LIABILITY ANYPROPRIETORIPARTNER/EXECUTIVE —1 OFFICER/MEMBEREXCLUDED? N / A E.L. EACH ACCIDENT $ ..... (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE'.. $mm If yes, describe under DESCRIPTION OF OPERATIONS below; E.L. DISEASE- POLICY LIMIT $ A SEXUAUPHYSICAL ABUSE 01-C-PK-P20094043-0 12/27/202312/27/2024 LIMIT $25K/$50K D PROFESSIONAL LIABILITY G74382708002 12/23/202312/23/2024 PER OCCURRENCE $2,000,000 E CYBER LIABILITY ESM0039844278 12/23/202312/23/2024 LIMIT $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) THE CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS, EMPLOYEES AND VOLUNTEERS ARE NAMED AS ADDITIONAL INSURED AS RESPECTS GENERAL AND AUTO LIABILITY AS REQUIRED BY WRITTEN CONTRACT OR AGREEMENT. GENERAL LIABILITY INSURANCE IS PRIMARY/NON-CONTRIBUTORY PER POLICY FORM WORDING. INSURANCE INCLUDES WAIVER OF SUBROGATION PER THE ATTACHED ENDORSEMENT(S). 30 DAY NOTICE OF CANCELLATION. rFRTICIt-ATF HOLDER CANCELLATION CITY OF EL SEGUNDO 350 MAIN STREET SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN EL SEGUNDO, CA 90245-3895 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHOR RES TAT ©1988-2015 ACORD CORPORATION. All rights reservea. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD eg % y ATEGRITY SPECIALTY INSURANCE COMPANY 14000 N. Pima Road, Suite 200,Scottsdale, AZ 85260 ACCOUNT NUMBER: NAMED INSURED AND MAILING ADDRESS Urban Futures Inc DBA ISOM Advisors FORMS SCHEDULE 17 POLICY NO: 01-C-PK-P20094043-0 AGENCY NUMBER: 0000002067 AGENCY AND MAILING ADDRESS CRC Insurance Services, Inc. 6200 South Syracuse Way Ste 100 Greenwood Village Colorado 80111 POLICY PERIOD: FROM 12/27/2023 TO 12/27/2024 AT 12:01 AM STANDARD TIME AT YOUR MAILING ADDRESS SHOWN ABOVE. POLICY FORMS ASIC-AF-0000 0123 Cover Pa e ASIC-AF-0003 0123 Service Of Suit Clause ASIC-AF-0004 0918 Minimum Earned Cancellation Premium ASIC-AF-0006 1018 Amendatory Endorsement - California ASIC-GL-0015 1221 Punitive Or Exempla Damages Exclusion ASIC-GL-0026 j 0818 Contractors Special Conditions ASIC-G��L-0027 07119 Minimum Andg Advance Premium Endorsement ASIC-GL-0029 0818 Amendnerrt Ofcr�Nion 4nonrenw�rC} ASIC-GL-0031 0818 Continuin Or O:n2oing Dama a Exclusion ASIC-GL-0037 0818 Premium Audit ASIC-GL-0038 0818 Amendment Of Nonpayment Cancellation Condition ASIC-GL-0039 0818 Lead Contamination Exclusion ASIC-GL-0040 0818 Asbestos Exclusion ASIC-GL-0045 0818 Marijuana Cannabis Liability Exclusion ASIC-GL-0050 0818 Hydraulic Fracturing Exclusion ASIC-GL-0062 0818 Communicable Disease Exclusion ASIC-GL-0069 0818 Known Injury Or Damage Exclusion - Personal And Advertisin In u ASIC-GL-0071 0818 Amendment To Other Insurance Condition ASIC-GL-0077 0919 Sexual And Or Physical Abuse Liability Coverage 11 Form ASIC-GL-0085 0323 Total Pollution Exclusion Endorsement ASIC-GL-0109 0918 Deductible Endorsement ASIC-GL-0181 1022 Occupational Disease Exclusion ASIC-GL-0185 0323 Exclusion Unmanned Aircraft ASIC-NOT-0002 0922 Claim Re o ing Information ASIC-NOT-0004 1220 Policyholder Disclosure - Notice Of Terrorism Insurance Coverage ASIC-NOT-0011 0822 Important Notice ASIC-PR-0011 02 19 Wind Or Hail Deductible ASIC-PR-0032 0119 Marijuana/cannabis Exclusion ASIC-PR-0038 0822 Commercial Property Extension ASIC-PR-0042 0822 Earth Movement Fire Exclusion ASIC-PR-0043 0822 Earthquake S rinkler Leaks a Exclusion ASIC-PR-0044 0223 Maintenance Of Heat Condition CG 00 01 0413 N,'rriaer �V . ,.a �� ,, ry I 4-' I M)r�ll�i.' .^*I dY lr.. c r 1 rl �" of k..l Y JAG E'vA'I �Y)N aimzuPu� „iVy a V7, (✓Vy r ¢U;uW N� .. 12/26/2023 FORMS -SCHEDULE -Page 1 ATEGRITY SPECIALTY INSURANCE COMPANY AtegrIty14000 N. Pima Road, Suite 200,Scottsdale, AZ 85260 ACCOUNT NUMBER: NAMED INSURED AND MAILING ADDRESS Urban Futures Inc DBA ISOM Advisors FORMS SCHEDULE POLICY NO: 01-C-PK-P20094043-0 AGENCY NUMBER: 0000002067 AGENCY AND MAILING ADDRESS CRC Insurance Services, Inc. 6200 South Syracuse Way Ste 100 Greenwood Village Colorado 80111 POLICY PERIOD: FROM 12/27/2023 TO 12/27/2024 AT 12:01 AM STANDARD TIME AT YOUR MAILING ADDRESS SHOWN ABOVE. CG 20 11 0413 rH ni r� drv+r� � �,raw,rm r�r� ,�u,rrw r,ti,.narr9 C� . , 4 ,"�� ...,„ Add itional-insured-managers-or-lessors-of-premises CG 2104 1185 Exclusion Prod/comp O s Hazard CG 2107 0514 Exclusion - Access Or Disclosure Of Confidential Or Personal Information And Data - related Liabili - Limited Bodily Injury CG 21 16 0413 Exclusion Designated Professional Services CG 2147 1207 Exclusion Employment -related Practices CG 2167 1204 Exclusion Fungi Or Bacteria CG 2173 0115 Exclusion Of Certified Acts Of Terrorism CG 2186 1204 Exclusion Exterior Insulation FinishingS stems CG 22 43 0413„ Exc)0z-5n 9 In gers,., t jtect5,,! r,$,wv vrs.I'rpfe sIof4, ' is"O�1'H)t ;. , .,ii r�wtr vrer arum+m uy� -.., ���.t;� �'Q"1�,:. ,�wm�l� „+� ,verwuwj� ,✓r "%+"'5�;,v� ,,��'' Amendment Of Insured Contract Definition t I r' CG...2.4 26 � 1, 0413 CG 32 34 0105 California Changes CP 00 10 CP 00 30 CP 00 90 1019 1012 0788 Building And Personal Property Coverage Form Business Income Coverage Form (and Extra Ex ense) Commercial Property Conditions CP 0140 0706 Exclusion Of Loss Due To Virus Or Bacteria CP 02 99 0607 Cancellation Changes CP 04 49 1219 California Changes - Replacement Cost CP 10 30 0917 Causes Of Loss - Special Form CP 10 33 1012 Theft Exclusion CP 10 75 1220 C ber Incident Exclusion IL 00 17 1185 Common Policy Conditions IL 00 21 0908 Nuclear Energy Liability Exclusion IL 0102 IL 09 53 0505 0115 California Chan es - Actual Cash Value Exclusion Of Certified Acts Of Terrorism 12/26/2023 FORMS -SCHEDULE -Page 2 ATEGRITY SPECIALTY INSURANCE COMPANY ENDORSEMENT NO. ATTACHED TO AND FORMING A ENDORSEMENT EFFECTIVE NAMEDINSURED AGENT NO. PART OF POLICY NUMBER DATE (12:01 AM STANDARD TIME) 01-C-PK-P20094043-0 12/27/2023 Urban Futures Inc 0000002067 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERICAL GENERAL LIABILITY COVERAGE PART With respect to this endorsement, SECTION II —WHO IS AN INSURED is amended to include as an additional insured any person or organization whom you are required to add as an additional insured on this policy under a written contract, written agreement or written permit which must be: a. Currently in effect or becoming effective during the term of the policy; and b. Executed prior to the "bodily injury," "property damage," or "personal and advertising injury." The insurance provided to these additional insureds is limited as follows: 1. That person or organization is an additional insured only with respect to liability for "bodily injury," "property damage" or "personal and advertising injury" caused, in whole or in part, by: a. Your acts or omissions; or b. The acts or omissions of those acting on your behalf. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. 2. With respect to the insurance afforded to these additional insureds, the following exclusions are added to item 2. Exclusions of SECTION I— COVERAGES: This insurance does not apply to "bodily injury," "property damage" or "personal and advertising injury" occurring after: a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or b. That portion of "your work" out of which the in- jury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. 3. The limits of insurance applicable to the additional insured are those specified in the written contract, written agreement or written permit or in the Declarations for this policy, whichever is less. These limits of insurance are inclusive of, and not in addition to, the Limits of Insurance shown in the Declarations for this policy. 4. Coverage is not provided for "bodily injury," "property damage," or "personal and advertising injury" arising out of the sole negligence of the additional insured. 5. The insurance provided to the additional insured does not apply to "bodily injury," "property damage," or "personal and advertising injury" arising out of an architect's, engineer's or surveyor's rendering of or failure to render any professional services including: a. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, re- ports, surveys, field orders, change orders or drawings and specifications; and b. Supervisory, inspection, architectural or engineering activities. ASIC-GL-0028-0818 Page 1 of 2 6. Any coverage provided hereunder will be excess over any other valid and collectible insurance avail- able to the additional insured whether primary, excess, contingent or on any other basis unless a written contract specifically requires that this insurance be primary. When this insurance is excess, we will have no duty under SECTION I —COVERAGES to defend the additional insured against any "suit" if any other in- surer has a duty to defend the additional insured 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. ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED. Includes some copyrighted material of Insurance Services Office, Inc., with its permission. 02/07/2024 AUTHORIZED REPRESENTATIVE / DATE ASIC-GL-0028-0818 Page 2 of 2 POLICY NUMBER:01-C-PK-P20094043-0 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVED OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO IDS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Any person or organization with whom the insured has agreed to waive rights of recovery, provided such agreement is made in writing and prior to the loss Information required to com lete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV - Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products -completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG 20 0104 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. IL + i1V M This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (i) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. CG 20 01 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: 605900024 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provi- sion of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indi- cated below. Endorsement Effective: Countersigned By: 05/28/2024 Named Insured: URBAN FUTURES, INC. Authorized Representative) SCHEDULE Name of Person(s) or Organization(s): CITY OF EL SEGUNDO ITS OFFICERS OFFICIALS (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement,) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 0 CORHCERTIFICATE OF LIABILITY INSURANCE DATE26/2023 (MMIDDIYYW) .„. PATE 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 Marsh Affinity b PHONE.. ........ ._.� 800743-8130 Marsh Affinity t�AIC„ N ., E— ACC^ ........ No a division of Marsh USA LLC.. E-MAIL ADPTotalSource marshcom ADDRESS. O° PO BOX 14404 Des Moines, IA 50306-9686 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: AIU Insurance Company 19399 INSURED INSURER B: ADP TotalSource DE IV, Inc 5800 Windward Parkway Alpharetta, GA 30005 L/C/F: Urban Futures Inc 1470 MARIA LANE STE 315 Walnut Creek, CA 945960000 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. INSR ADDLSUBR POLICYEFF POLICYIEP POLICY NUMBER (MMIDDYYY) (MMIDDIYYYY) LTR TYPEOFINSURANCE INSD WVD /Y LIMITS ..................... — .......___ _. ._....-..... �.. COMMERCIALGENERAL EACH OCCURRENCE $ yLIABILITY CLAIMS OCCUR OAMAGFTO�REI+I'rEO $ . -MADE PR ISE'S Eaoccurtenee MED EXP (Any one person) $ ,PERSONAL & ADV INJURY $ GEaLAGGREGATE LIMI"(`APPLIES PER: GENERAL AGGREGATE $ F"OLgCY ' PRO, LOC 1:1, JCT '. PRODUCTS - COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINEDSINGLE.LIMIT $ ANY AUTO BODILY INJURY IFperson) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS ............_ HIRED NON -OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accr"danf. ....$ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB 11 CLAIMS -MADE AGGREGATE $ '... DE RETENTION S ""... - - $ WORKERS COMPENSATION _ X STATUTE. ER.•••••—� AND EMPLOYERS'LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE L EACH ACCIDENT $ 2,000,000 OFFICER/MEMBER EXCLUDED? NIA X WC 034284166 CA 07/01/2023 07/01/2024 A (MandatoryinNH) E.L DISEASE - EA EMPLOYEE $ 2.000.000 es de, Bribe under VN yes" DESCRIPTION OF OPERATIONS below E..L. DISEASE - POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) All -*$"'ernphayems workanp for Urban Fularoes Nnc paid umdar AOP TOTALSC%URCE„ INC.'s yroll, are , e'-d under � e ataxva alateul WAIWER OF SUBROGATRON IN P'AVOR IMF C f of EI uxyundo, its pnlloy. oMcers, otficlags, umpplvyr es and voiuntenrs AS }iESF ECT OF JOB PEf%FORMEfi BY Urban lures Inc AS Rt.OUIREO BY WRNTTEN CONTRACT 1470 Maala Ln CERTIFICATE HOLDER CANCELLATION City of E8 Segundo 35 Main Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE El Segundo, CA 90245 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I ./"... I All rights The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 43 03 06 Ed. 4-84) 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 lamed 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 _% of the California workers' compensation premium otherwise due on such remuneration. Schedule WAIVER OF SUBROGATION IN FAVOR OF City of El Segundo, its officers, officials, employees and volunteers. AS RESPECTS OF JOB PERFORMED BY Urban Futures Inc AS REQUIRED BY WRITTEN CONTRACT. Person or Organization City of El Segundo 350 Main Street El Segundo, CA 90245 Job Description 1470 Maria Ln Notes: 1', This endorsement may be used to waive the company's right of subrogation against named third parties who may be responsible for an injury. 2. The sentence in ( ) is optional with the company. It limits the endorsement to apply to specific jobs of the insured, and only to the extent that the insured is required to obtain this waiver. This endorsement changes the poticy 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 07/01/2023 Policy No. WC 034284166 CA Endorsement No.. Insured Insurance Company AIU Insurance Company ADP TotalSource DE IV, Inc. 5800 Windward Parkway Alpharetta, GA 30005 UC/F: Urban Futures Inc 1470 MARIA LANE STE 315 Walnut Creek, CA 945960000 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 ©2001.