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PROOF OF INSURANCE (2025 - 2025)CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 5/28/2024 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 riohts to the certificate holder in lieu of such endorsement(s). PRODUCER N'-_Chrlstl an Brothers Artex Risk Solutions, Inc. (CB) PHONE - ----- 2850 Golf Road, 5th Floor E-MAi L Rolling Meadows IL 60008-4050 ADORR. (NSURED Brothers of the Christian Schools & Affiliates cHRIBRo-14 INSURER B: old LOC #1177028 DOC POW ST VINCENT SENIOR CITIZEN NTR-"sR�••• 1205 Windham Parkway IRS RERD„..'' Romeoville IL 60446-1679 ,,,.,,— nce,Comparly Insu anae Comoanv 3114143 ............. 3 COVERAGES CERTIFICATE NUMBER:4475695 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. ....... ....m, mm . "........m ................----............ ." ... _.___ ...... ...... ...... _. ._ ............. ��,��..... ..., -IT - ICY EXP""" .... ...... .TYPE ilt Iu I NPdL TSRR OF INSURANCE O IN POLICY NUMBER MO DRAdYY!" 1' MM7 OD/YYYY LIMITS B X COMMERCIAL GENERAL (ABILITY N N 822400 1325596 OCCURRENCE EACHO CI 6I1512024 6I15/2025 EREMISES $ 000 000 X _ _ CLAIMS -MADE OCCUR �a.or„�afPmesncgr] p,,,,ED eluded ------- ............. _. NACH ( Y person) EXP An one ers, ",;"""""". {{ $ 15,000 .. PERSONAL & ADV INJURY $ Inc_ luded G, Et'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ N Age r 1 _ POLICY �824,- LOC JEST PRODUCTS -CO- COMPIOP.AGG A� -- $„No OTHER AUTOMOBILE LIABILITY A AU. Y Y MWTB 21543 6/15/2024 6/15/2025 _ ) T $ 1,000,000 ..iC.'aA qN SepSINtaL �l.gMddl............. ,...,.............., ANY AUTO BODILYINJURY(Perperson) $ OWNED "X"" SCHEDULED 8- BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS , HIRED NON -OWNED C_X_,. mOPERTY DAIAAr'C AUTOS ONLY X., AUTOS ONLY (' I ¢ A�;iq mt $..... .........__ UMBRELLALIAB OCCUR OCCURRENCE $__","," , EXCESS LIAB CLAIMS MADE ..-EACH """"", """"""" . AGGREGATE 7 $ DER RETENTION $ $ WORKERS COMPENSATION [[ STaTL1TE I. AND EMPLOYERS' L AB L TY Y� ,µ E-RH ......,,, e E.L EACH ACCIDENT $ OFFICEANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? NIA " Mandatory in NH E DISEASE EA EMPLOYEE '— '"...........""" "" $ """" "" ""'... IF es, describe under under ' DESCRIPTION OPERATIONS below E"L .L DISEASE- POLICY LIMIT $ B Excess Automobile Liability Y Y 822400 1325596 6/15/2024 6/15/2025 Occ/No Agg $9.000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD101, Additional Remarks Schedule, may be attached if more space is required) Waiver of Subrogation (where allowed by law) per attached endorsement is provided under the Automobile Liability coverages per fully executed written contract. Certificate Holder is added as Additional Insured under Automobile Liability per agreement - per attached endorsements. solely, strictly and specifically with regards to: Consultant Services for the Community Development Block Grant Program for Home Delivered Meals. 11P City of El Segundo its Official and Employees Office of City Clerk 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 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM SCHEDULE Name of Person(s) or Organization(s): All persons or organizations as required by contract or agreement With respect to COVERED AUTOS LIABILITY COVERAGE, Who Is An Insured is changed with the addition of the following: Each person or organization shown in the Schedule for whom you are doing work is an "insured". But only for "bodily injury" or "property damage" that results from the ownership, maintenance or use of a covered "auto" by: 1. You; 2. an "employee" of yours; or 3. anyone who drives a covered "auto" with your permission or with the permission of one of your "employees". However, the insurance afforded to the person or organization shown in the Schedule shall not exceed the scope of coverage and/or limits of this policy. Not withstanding the foregoing sentence, in no event shall the insurance provided by this policy exceed the scope of coverage and/or limits required by the contract or agreement. PCA 001 10 13 MWTB 21543 Religious and Charitable Risk Pooling Trust 06/15/2024 - 06/15/2025 IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM SCHEDULE Name of Person or Organization: Only those persons or organizations for whom you are required to waive your rights of recovery under the terms of a written contract. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable. to this endorsement.) The Transfer Of Rights Of Recovery Against Others To Us Condition is changed by adding the following: We waive any right of recovery we may have against the person(s) or organization(s) shown in the Schedule because of payments we make for injury or damage. This waiver applies only to the person or organization shown in the Schedule. PCA 024 10 13 Page 1 of 1 MWTB 21543 Religious and Charitable Risk Pooling Trust 06/15/24 - 06/15/25 OLD REPUBLIC UNION INSURANCE ENDORSEMENT No 26 Attaching to and forming part of Policy No. 822400 1 325596 Named Insured: THE RELIGIOUS AND CHARITABLE RISK POOLING TRUST OF THE BROTHERS OF THE CHRISTIAN SCHOOLS AND AFFILIATES Effective date of this endorsement is June 15, 2024 ADDITIONAL INSURED ENDORSEMENT It is understood and agreed that the members as on file with Arthur J. Gallagher & Co. and/or ARTEX RISK SOLUTIONS, INC. (A DIVISION OF ARTHUR J. GALLAGHER & COMPANY) are added as Additional Insureds in respect of the coverage as afforded under this Policy. It is further understood and noted that Brothers of the Christian Schools may issue written confirmation where the Insured or the Insured's members are obligated to provide proof of the cover provided by this Policy to Additional Insured's, Loss Payees and Mortgagors who have an insurable interest in the property or operations of the Insured. Except as amended in this Endorsement, this insurance is subject to all coverage terms, clauses and conditions in the policy to which this Endorsement is attached. Page 58 of 87 OLD REPUBLIC UNION INSURANCE COMPANY Attaching to and forming part of Policy No. 822400 1325596 Named Insured: THE RELIGIOUS AND CHARITABLE RISK POOLING TRUST OF THE BROTHERS OF THE CHRISTIAN SCHOOLS AND AFFILIATES Effective date of this endorsement is June 15, 2024 COMBINED PROPERTY AND CASUALTY AND CRIME PACKAGE THE FOLLOWING WORDING HAS BEEN EXTRACTED FROM THE ABOVE MENTIONED POLICY FORM TO PROVIDE PROOF OF COVERAGE. PLEASE READ IT CAREFULLY. SECTION IV - GENERAL CONDITIONS 15. WAIVER OF SUBROGATION: This Insurance shall not be invalidated if the Insured by written agreement has waived or shall waive its right of recovery from any party for loss or damage covered hereunder; provided, that any such waiver is made prior to the occurrence of said loss or damage. '4" CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/7/2023 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 Artex Risk Solutions, Inc. (CB) 2850 Golf Road, 5th Floor Rolling Meadows IL 60008-4050 Christian Brothers Services ,tr 800-807-0300... 147 INSURED Vni Brothers of the Christian Schools & Affiliates Loc #1177028 DOC POW ST VINCENT SENIOR CITIZEN NTR 1205 Windham Parkway Romeoville IL 60446-1679 E; F: COVERAGES CERTIFICATE NUMBER:483607842 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' - -- ADDL.f U I` obugY Fu�F'I" POLVCY EXP k n ' LTR TYPE OF INSURANCE POLICY NUMBER MM DDr1 YYY MMID_ LIMITS D/VYVY COMMERCIAL GENERAL LIABILITY OCCURRENCE $ Ai Ar G9 rO t Fr-.0tt`J ... .... CLAIMS -MADE OCCUR ........ .� i ...... d EACH PW 9C �.„�M9IaE�v_t�"a o�F,I a� $............. ..w.. MED EXP (Any one person) $ ... .......... I PERSONAL & ADV INJURY $ GEN'LAGGREGATEP LIMIT APPLIES PER: GENERAL AGGREGATE POLICY 130- LOC ECT PRODUCTS COMP/OPAGG __ $ �......,., OTHER:: �,...... $ AUTOMOBILE LIABILITY COMBINCO S INGtEUMIT $ tw-a �cr id?rnt ..... ....... .......... ........................ .. ANY AUTO BODILYINJU. RY (P...... on) $ OWNED SCHEDULED AUTOS ONLY 4 AUTOS BODILY INJURY Per accident) $ HIRED NON -OWNED !dent) PRO$ AUTOS ONLY „. AUTOS ONLY Kidd )ttAl»hACiE� UMBRELLA LIAB RRENCE $ COCCURLAIMS-MADE EXCESS LIAB AGGREGATE, — DED RETENTION $ $ A WORKERS COMPENSATION Y MWC 11722612 1/1/2024 1/1/2025 X PER w TH A AND EMPLOYERS' LIABILITY Y / N MWC 305311 09 1l1/2024 1l1/2025 ANYPROPRIETOR/PARTNER/EXECUTIVE NYPROFFI EL. EACH AC CID 000 ER/MEMBEREXCLUDED N/A A _ (Mandatory m NH ( I EL DISEASE EMPLOYEE. $1,000,000'000 If es, describe under . DESCRIPTION OF OPERATIONS below I E.L, DISEASE- POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedute, may be ifmore space Is required) Waiver of Subrogation, per the attached endorsement, (where allowed by law) is provided under the Workers' Compensation coverage when required by fully executed, written contract. Consultant Services for the Community Development Block Grant Program for Home Delivered Meals. CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo its Official and Employees Office of City ACCORDANCE WITH THE POLICY PROVISIONS. Clerk 350 Main Street AUTHORIXEDREPRESENTAT°'IVE El Segundo CA 90245 44ie 401& ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) POLICY NUMBER: MWC 117226 12 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule ALL PERSONS OR ORGANIZATIONS WHERE REQUIRED BY WRITTEN CONTRACT DATE OF ISSUE: 01/01/2024 WC 00 03 13 (Ed. 4-84) © 1983 National Council on Compensation Insurance. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 43 03 05 POLICY NUMBER: MWC 117226 12 UTAH WAIVER OF SUBROGATION ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Utah is shown in Item 3.A. of the Information Page. 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.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Our waiver of rights does not release your employees' rights against third parties and does not release our authority as trustee of claims against third parties. Schedule ALL PERSONS OR ORGANIZATIONS WHERE REQUIRED BY WRITTEN CONTRACT DATE OF ISSUE: 01/01/2024 © 2000 National Council on Compensation Insurance, Inc. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 42 03 04 B (Ed. 6-14) TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Texas is shown in Item 3.A. of the Information Page. 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 un the Schedule, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule where you are required by a written contract to obtain this waiver from us. This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. The premium for this endorsement is shown in the Schedule. Schedule 1. ( ) Specific Waiver Name of person or organization ( X ) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver,. 2. Operations: ALL TEXAS OPERATIONS 3. Premium: The premium charge for this endorsement shall be — 0 percent of the premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described 4. Advance Premium: INCLUDED 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 01-01-2024 Policy No. MWC 117226 12 Endorsement No. Insured RELIGIOUS AND CHARITABLE RISK Insurance Company OLD REPUBLIC INSURANCE COMPANY WC420304B © Copyright 2014 National Council on Compensation Insurance, Inc. All Rights Reserved. Premium $ INCL. Countersigned By , /,00� 10R) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE WC 04 03 06 (Ed. 04-84) 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 0 % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE PERSON OR ORGANIZATION ALL PERSONS OR ORGANIZATIONS WHERE REQUIRED BY WRITTEN CONTRACT DATE OF ISSUE: 01-01-24 JOB DESCRIPTION ©1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB's California Workers' Compensation Insurance Forms Manual © 1999. INSURED COPY