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PROOF OF INSURANCE (2025 - 2025)a.. DATE (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE OB/16/2024 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 CONTACT Serge Slnanian NAME: MBISI - Meridian Brokerage Insurance Services HONNE Ex (818) 225-7025 FA XC No : (818) 225-7026 18980 Ventura Blvd., Suite 330 nnnAr-", serge@mbisi.com INSURER(S) AFFORDING COVERAGE NAIC # Tarzana CA 91356 INSURER A : Sentinel Insurance Company, Ltd INSURED INSURER B : Hiscox Insurance Company Inc. Govinvest Inc. '... INSURER C : 8605 Santa Monica Blvd., INSURER D : INSURER E : West Hollywood CA 90069-4109 1INSURER F : COVERAGES CERTIFICATE NUMBER: CL2441710359 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. SR AWUL( POLICY EFF FOL C P LIMITS LTR TYPE OF INSURANCE INSD WXO POLICY NUMBER MMlDO/XXXX '..IMMILID/YVYY X COMMERCIAL GENERAL LIABILITY E $ 2,000,000 J 9E6 1,000,000 CLAIMS -MADE � OCCUR PREM Ea occurre- $ MED EXP (Any one person) 10,000 $ A Y Y 72 SBM BCOBOK 06/25/2024 06/25/2025 PERSONAL&ADV INJURY $ 2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 4,000,000 PRO' POLICY yp;-;C'y LOG PRODUCTS AGG 4,000,000 $ OTHER: $ AUTOMOBILE LIABILITY Pi_Tdtia&YISINGLE LIMIT $ 2,000,000 ANY AUTO BODILY INJURY (Per person) $ A OWNED SCHEDULED N N 72 SBM BCOBOK 06/25/2024 06/25/2025 BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS +✓ HIRED NON-OWNEDOF"EN'I`Y DAMAGE $ AUTOS ONLY AUTOS ONLY(per acaldmr iq X UMBRELLA LIAR OCCUR EACH OCCURRENCE 1,000,000 A EXCESS LIAB CLAIMS -MADE Y Y 72 SBM BCOBOK 06/25/2024 06/25/2025 AGGREGATE DED X1 RETENTION $ 10,000 9$: WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY YIN„STATUTEEANY PROPRIETOR/PARTNER/EXECUTIVE EACH ACCIDENT OFFICER/MEMBER EXCLUDED? N/AE,L.. (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below E...L. DISEASE - POLICY LIMIT $ Aggregate 2,000,000 Cyber Liability &Professional Liability I C Claims Made Y N MPL2075241.24 09/28/2024 09/28/2025 Each Claim 2,000,000 Retention 5,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) Application Service Provider. City of El Segundo, its officers, officials, employees, and designated volunteers are named as additional insureds on the CGL policy with respect to liability arising out of work or operations performed by or on behalf of the consultant or any subcontractors including materials, parts or equipment furnished in connection with such work or operations, including completed operations. Coverage under the policy is Primary and Non -Contributory. Policy includes Waiver of Subrogation. Refer to attached endorsement forms SL 30 40 10 18 for scope of additional insured status. Regarding Auto Liability policy, please refer to attached endorsement form SL 30 26 10 18. Refer to attached endorsement for SL 30 03 10 18 for Waiver of Subrogation. 30 Days Notice of Cancellation Or Reduction of Coverage. 10 Days Notice of Cancellation for Non -Payment of Premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street AUTHORIZED REPRESENTATIVE City of El Segundo CA 90245 Serge Sinanian Jer6 Sinanian ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 0 DATE (MM/DD/YYYY) `''"E" CERTIFICATE OF LIABILITY INSURANCE �.� 04/17/2024 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 —NAMIEHiscox Inc. d/b/a/ Hiscox Insurance Agency in CA PHONE . ggg. 202-3007 mm 5 Concourse Parkway EMAIL Irltactghiscox cofil Suite 2150 - Atlanta GA, 30328 INSURERCSAFFORDINGCOVERAGE NAIC# INSURER A. Hiscox Insurance Company Inc 10200 INSURED r.NSURER URER B : GOVInvest Inc. URER C : 8605 Santa Monica Blvd PMB 52465 West Hollywood, CA 90069URER D E : l-CD..TAC'Jk AJ r' / "RADCD. RFVICInId NIIMRFR• 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, Y PAID CLAIMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED B wmmmITITITITITITITITmm m, ........�mm —'- _ IN R ......... �yOafi'-" U ER MMIDDY IrFi.... """ EFF POLICY EXP LIMITS uTYPE OF INSURANCE POLICY NUMB MM /YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE '... $ UDw .................. '... $ _..__ CLAIMS-MADEI JOCCUR PR ICIE Ea oc�ore�.nryoY ................. MED EXP (Any on_e person) $ PERSONAL & ADV INJURY .�......................... ._,�. $ OEN'L. ._..........- AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PR POLICY JECT LOC PRODUCTS-COMP/OPAGG $ $ OTHER, COPBiNEDISINGLELIMIT $ AUTOMOBILE LIABILITY BODILY INJURY (Per person) $ ANY AUTO ............. ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON -OWNED J__ PROPERlY DA�,1.,AGE --•-- $ HIRED AUTOS AUTOS Aegr aucl40111. ,—,,, „„ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE .�... ...................... ._....DE AGGREGATE ......... $H.... E DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNERIEXECUTIVE E.L. EACH ACCIDENT ----------------' $ .......- OFFICER/MEMBER EXCLUDED? (Mandatory In NH) NIA A E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ A Professional Liability P100.094.137.10 02/10/2024 02/10/2025 Each Claim: $ 1,000,000 Aggregate: $ 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) CERTIFICATE HOLDER, CANCELLATION City of El Segundo 350 Main St, 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 j ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THE I HARTFORD HIRED AUTO AND NON -OWNED AUTO LIABILITY This endorsement modifies insurance provided under the following: BUSINESS LIABILITY COVERAGE FORM Except as otherwise stated in this endorsement, the terms and conditions of the Policy apply. A. Amended Coverage: The following is added to Section A. COVERAGES: Coverage is extended to "bodily injury" and "property damage" arising out of the use of a "hired auto" or "non -owned auto". B. The following changes are made to Section B. EXCLUSIONS: 1. Exclusion g. Aircraft, Auto Or Watercraft does not apply to a "hired auto" or a "non -owned auto". 2. Exclusion e. Employer's Liability does not apply to "bodily injury" to domestic "employees" not entitled to workers' compensation benefits or to liability assumed by the insured under an "insured contract". 3. Exclusion f. Pollution is deleted and replaced by the following: (1) "Bodily injury" or "property damage" arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of "pollutants": (a) That are, or that are contained in any property that is: (i) Being transported or towed by, handled, or handled for movement into, onto or from, the covered "auto"; (ii) Otherwise in the course of transit by or on behalf of the "insured"; or (iii) Being stored, disposed of, treated or processed in or upon the covered "auto". (b) Before the "pollutants" or any property in which the "pollutants" are contained are moved from the place where they are accepted by the insured for movement into or onto the covered "auto"; or (c) After the "pollutants" or any property in which the "pollutants" are contained are moved from the covered "auto" to the place where they are finally delivered, disposed of or abandoned by the insured. Paragraph (a) above does not apply to fuels, lubricants, fluids, exhaust gases or other similar "pollutants" that are needed for or result from the normal electrical, hydraulic or mechanical functioning of the covered "auto" or its parts, if: (i) The "pollutants" escape, seep, migrate, or are discharged or released directly from an "auto" part designed by its manufacturer to hold, store, receive, or dispose of such "pollutants"; and (ii) The "bodily injury" and "property damage" does not arise out of the operation of any equipment listed in Paragraphs 15.f.(2) and 15.f.(3) of the definition of "mobile equipment". Paragraphs (b) and (c) above do not apply to accidents that occur away from premises owned by or rented to an "insured" with respect to "pollutants" not in or upon a covered "auto" if: (i) The "pollutants" or any property in which the "pollutants" are contained are upset, overturned or damaged as a result of the maintenance or use of a covered "auto"; and (i I) The discharge, dispersal, seepage, migration, release or escape of the "pollutants" is caused directly by such upset, overturn or damage as a result of the maintenance or use of a covered "auto". 4. The following exclusion is added: Fellow employee Coverage does not apply to "bodily injury" to any fellow "employee" of the insured arising out of the operation of an "auto" owned by the insured in the course of the fellow "employee's" employment. Form SL 30 26 10 18 Page 1 of 3 © 2018, The Hartford (May include copyrighted material of Insurance Services Office, Inc., with its permission) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THE ', HARTFORD 5. The following exclusion is added: Care, Custody Or Control Coverage does not apply to "property damage" involving property owned or transported by the insured or in the insured's care, custody or control. C. With respect to "hired auto" and "non -owned auto" coverage, Section C. WHO IS AN INSURED is deleted and replaced by the following: 1. The following are insureds: a. You. b. Your "employee" while using with your permission: (1) An "auto" you hire or borrow; or (2) An "auto" you don't own, hire or borrow in your business or personal affairs; or (3) An "auto" hired or rented by your "employee" on your behalf and at your direction. c. Anyone else while using a "hired auto" or "non -owned auto" with your permission except: (1) The owner or anyone else from whom you hire or borrow an "auto". (2) Someone using an auto while he or she is working in a business of selling, servicing, repairing, parking or storing "autos" unless that business is yours. (3) Anyone other than your "employees", partners (if you are a partnership), members (if you are a limited liability company), or a lessee or borrower or any of their "employees", while moving property to or from an "auto". (4) A partner (if you are a partnership), or a member (if you are a limited liability company) for an "auto" owned by him or her or a member of his or her household. d. Anyone liable for the conduct of an insured described above but only to the extent of that liability. D. With respect to the operation of a "hired auto" or "non -owned auto" covered by this endorsement, the following changes are made to Section E. LIABILITY AND MEDICAL EXPENSES CONDITIONS: 1. The following condition is added: Other Insurance a. Except for any liability assumed under an "insured contract" the insurance provided by this endorsement is excess over any other collectible insurance. However, if your business is the selling, servicing, repairing, parking or storage of "autos", the insurance provided by this endorsement is primary when covered "bodily injury" or "property damage" arises out of the operation of a customer's "auto" by you or your "employee". b. When this endorsement and any other endorsement, coverage part, or policy covers on the same basis, either excess or primary, we will pay only our share. Our share is the proportion that the Limit of Insurance of our endorsement bears to the total of the limits of all the endorsements, coverage parts, and policies covering on the same basis. 2. The following condition is added: Two Or More Coverage Parts, Endorsements, Or Policies Issued By Us If this endorsement and any other endorsement, coverage part or policy issued to you by us or any company affiliated with us apply to the same accident, the aggregate maximum Limit of Insurance under all the endorsements, coverage parts, or policies shall not exceed the highest applicable Limit of Insurance under any one endorsement, coverage part, or policy. This condition does not apply to any endorsement, coverage part, or policy issued by us or an affiliated company specifically to apply as excess insurance over this endorsement. Form SL 30 26 10 18 © 2018, The Hartford (May include copyrighted material of Insurance Services Office, Inc., with its permission) Page 2 of 3 V THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THE HARTFORD 3. The following condition is added: Financial Responsibility Laws a. With respect to a "hired auto" or "non -owned auto" to which this insurance applies, when this endorsement is certified as proof of financial responsibility for the future under the provisions of any motor vehicle financial responsibility law, the insurance provided by this endorsement for "bodily injury" liability and "property damage" liability will comply with the provisions of the law to the extent of the coverage and limits of insurance required by that law. b. With respect to a "hired auto" or "non -owned auto" to which this insurance applies, we will provide any liability, uninsured motorists, underinsured motorists, no-fault or other coverage required by any motor vehicle law. We will provide the required limits for those coverages. E. The following changes are made to Section F. LIABILITY AND MEDICAL EXPENSES DEFINITIONS: 1. The following definition is added: "Hired auto" means any "auto" you lease, hire, rent or borrow. This does not include any auto you lease, hire, rent or borrow from any of your "employees", your partners (if you are a partnership), members (if you are a limited liability company)„ or your "executive officers" or members of their households. This does not include a long-term leased "auto" that you insure as an owned "auto" under any other auto liability insurance policy or a temporary substitute for an "auto" you own that is out of service because of its breakdown, repair, servicing or destruction. 2. The following definition is added: "Non -owned auto" means any "auto" you do not own, lease, hire, rent or borrow which is used in connection with your business. This includes: a. "Autos" owned by your "employees" your partners (if you are a partnership), members (if you are a limited liability company), or your "executive officers", or members of their households, but only while used in your business or your personal affairs. b. Customer's "auto" that is in your care, custody or control for service. Form SL 30 26 10 18 © 2018, The Hartford (May include copyrighted material of Insurance Services Office, Inc., with its permission) Page 3 of 3 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THE `' HARTFORD WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: BUSINESS LIABILITY COVERAGE FORM Except as otherwise stated in this endorsement, the terms and conditions of the Policy apply. The following is added to Section E. LIABILITY AND MEDICAL EXPENSES GENERAL CONDITIONS: We waive any right of recovery we may have against: a. Any person or organization shown in the Declarations, or b. Any person or organization with whom you have a contract that requires such waiver. Form SL 30 03 10 18 © 2018, The Hartford (May include copyrighted material of Insurance Services Office, Inc., with its permission) Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.`- THE HARTFORD ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following', BUSINESS LIABILITY COVERAGE FORM Except as otherwise stated in this endorsement, the terms and conditions of the Policy apply. A. The following is added to Section C. WHO IS AN INSURED: Additional Insured — State Or Governmental Agency Or Subdivision Or Political Subdivision - Permits Or Authorizations a. Any state or governmental agency or subdivision or political subdivision shown in the Declarations as an Additional Insured — State Or Governmental Agency Or Subdivision Or Political Subdivision — Permits Or Authorizations is also an additional insured, but 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 permit or authorization. b. If coverage provided to these additional insureds is required by a written contract or written agreement, or when required by a written permit or authorization issued by a state or governmental agency or subdivision or political subdivision, the insurance afforded to these additional insureds will not be broader than that which you are required by the contract, agreement, permit, or authorization to provide for these additional insureds. c. The insurance afforded to these additional insureds only applies to the extent permitted by law. B. With respect to the insurance afforded to such additional insured(s) by this endorsement, the following additional exclusion is added to Section B. EXCLUSIONS: This insurance does not apply to: a. 'Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the state or governmental agency or subdivision or political subdivision; or b. "Bodily injury" or "property damage" included in the "product -completed operations" hazard. Form SL 30 40 10 18 © 2018, The Hartford (May include copyrighted material of Insurance Services Office, Inc., with its permission) Page 1 of 1 Into H I SCOX PRO" Endors__ement..7 NAMED INSURED: Govinvest Inc. E8856.1„ Blanket Add)tionai,i,ne,4,red_End orsernent ( rttten. ntJa t) In consideration of the premium charged, and on the understanding this endorsement leaves all other terms, conditions, and exclusions unchanged, it is agreed the Cyber Coverage Part is amended as follows: I. The following definition is added to the end of Section III. Who is an insured: Additional insured means any person(s) or organization(s) the named insured has agreed in a written contract or agreement to add as an additional insured to a policy providing the type of coverage afforded by this Coverage Part, provided the contract or agreement: 1. is currently in effect or becomes effective during the policy period; and 2. was executed before the business operations from which the claim or event arises were performed. Coverage is available for additional insureds solely for their liability arising out of the named insured's negligence or of those acting on the named insured's behalf and not for any liability arising out of the sole negligence of the additional insured. II, In the preamble of Section III. Who is an insured, the words "additional insured," are added after "named insured,". III. In Section VII. Definitions, the definition of "You, your, or insured" is amended to add the words "additional insured," after "named insured.". Endorsement effective Endorsement No: Hiscox Inc. Authorized Representative Kevin Kerridge 09/28/2024 7 Certificate No. Processed Date: MPL2075241.24 07/03/2024 CYBCL-CYB E2013 CW (04/19) Page 1 of 1 HF.Lk:NALIREN I :`!5 GOVINVE-01 LVASUL A R CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 818/2024 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 rirthts to the certificate holder in lieu of such endorsements , PRODUCER Total Resources Ins Agy 39 Public Square Wilkes-Barre„ P.A 18702 800 969-5454 servi'cecert to rAv .Com 825-2990 INSURED..,VrV549,R,6i..'......._._—.-............ .-....� ,... .........___ Govinvest, Inc. 8605 Santa Monica Blvd INSURER ——r- —__ _ _ PMB 52465 ,rNs0tt.R:7_ West Hollywood, CA 90069 INSURER _ INSURER F COVERAGES CERTIFICATE NUMI�ER: REV S ON 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, H POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. EXCLUSIONS AND CONDITIONS._.....— ... ............. — INSR ADS9L -SUBR POLNCY EFP POLICY EXP LIMITS TYPE OF INSURANCE POLICY NUMBER .......�---yYY ' COMMERCIAL GENERAL... mgl DAMAGE TO RENTED s— ..._-.� 1`L LIABILITY _ EA4.I�I OCf URRENCE., _ CLAIMS -MADE "OCCUR PF.Q L19a1F 5 ..-.. MA D EXP_tA rrne.X?J eSa _— ._ ................. Pd RSLNI,mAC�V �NCtlY .... I gENLAGGREGATE LIMIT .,.,...._APPLIES PER. IwENEFtA1I.;. Af""GREC"aATE „• ...,,m,m,---- . Pf70.•XOY` I„' ,IECT LOC PROOUOTS COMPdOP AGG OTHER:. COMBINED, SINGLE LbMXT AUTOMOBILE LIABILITYANY AUTO OWNED i....�.. SCHEDULED AUTOS ONLY AUTOS BODRILY GAJItY{'+re. ryry FIB PROPE(t¢Y DAMAGE ARMS ONLY A JP0PSV }�MFL. r scci J nS) 5 UMBRELLA E ....�. — ......, L'..... __—. �..___ V �^ Y �M EXCESS LIAB�B COEACH OC£RE C�TURREN CLAIMS -MADE DED RETENTION $ ANY PROPRIETOR/PARTNER/EXECUTIVE X OWC*506198 8/2712024 8/27/2025 E L EACH AI��.aDEN I R� A WORKERS COMPENSATION X AND EMPLOYERS' LIABILITY 1,000„000 rqC EMM MBER EXCLUDED? NIA i, 00,000 l ..�� _AiSE , AFL i��A dF l C7YEE". _.. Wandalory n NH) E L OISE tllyycs daacribeunder 1,Oi10,000 DESCRIPTION OF OPERATIONS �liIow .._. .. ILL DXSE'ASE • POI, LtlMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Included Ted Price Excluded Jasmine Nachtigall-Fournier A waiver of subrogation in favor of the certificate holder has been included in the workers compensation policy (see attached endorsement). SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA 90245 '.. AUTHORIZED REPRESENTATIVE r' I ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 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 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 1_02 —% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Blanket Waiver - Any person or organization for whom the All CA Operations Named Insured has agreed by written contract to famish this waiver. 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 08/27/2024 Policy No. GOWC506198 Endorsement No. 0 Insured Insurance Company AmGUARD Insurance Company GovInvest, Inc. ®9998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved.