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PROOF OF INSURANCE (2025 - 2025) CLOSEDCERTIFICATE 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.
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ICY EXP"""
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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
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eluded
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( Y person)
EXP An one ers, ",;"""""".
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$ 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