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PROOF OF INSURANCE (2025 - 2026)DIYYYY A� ° "" CERTIFICATE OF LIABILITY INSURANCE ED4ATE`MMI2024' /O1/2024 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 polic,y(ies) must be endorsed.. It 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 License# 0751768 CON C BOB HADZOR NAME. Robert Hadzor Insurance Services PHONE (925) 372-9000 l8X 1C (925) 372-9003 No E-MAIL 3755 Alhambra Ave. Suite 7 ADDRESS, bob@ hadzorinsurance.com Martinez, CA 94553- INSURED The El Segundo Nursery School Group P.O. Box 73 300 E. Pine Avenue. E1 Segundo CA 90245- rn11C0Ar-=c rFRTIFICATE NUMBER, �INSURERLS) AFFORDING COVERAGE NAIC # A•Non rofits Insurance Allance O B' c kIarkel Insurance Com an D: E: .-....... F: REVISION NUMBER: ER:. 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 LTR TYPE OF INSURANCE I POLICY NUMBER POLICY EFF MW DIYYYY POLICY EXP IDD1YYYY LIMITS A GENERAL LIABILITY 024-20766-NPO 4/01/2024 4/01/2025 EACH OCCURRENCE _ $ 1,000,000 X COMMERCIAL GENERAL LIABILITY / / / / pREI iSES IFa 111,111MIL $ 100, 000 CLAIMS -MADE ExI OCCUR / / / / MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 / / / / GENERAL AGGREGATE $ 3,000,0010 / / / / PRODUCTS -COMPiO'P'AGG Is 3,000,000 GEN'LAGGREGATE LIMIT APPLIES PER. POLICY PT 1-1 LOC LIQUOR LIAB $ 1,000,000 A AUTOMOBILE LIABILITY 024-20766-NPO ' 4/01 2024 4/01/2025 M BINEDSINGLE LII $100Eaa0,000 / / BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED / / / / BODILY INJURY (Per accident) $ AUTOS AUTOS NON -OWNED X X / / / / PROPERTY DAMAGE Peu accdddnl $ HIRED AUTOS AUTOS $ / / / / UMBRELLA LIAB OCCUR / / EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE / / / / AGGREGATE $ / / / / S DED RETENTION $ C WORKERS COMPENSATION 00023768-13 2,✓01J2024 2/01/2025 WC STAT X OIfR AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN E,L,. EACH ACCIDENT $ 1 000 000 OFFICER/MEMBER EXCLUDED? My�NIA (Mandatory in NHJ / / / / E L DISEASE - EA EMPLOYEE $_ l)00 , 000 p 4c Iraq, desuioe untaer DESCRIPTION OF OPERATIONS below / / / / • E,.L, DISEASE -POLICY LIMIT $ 1., 000, 000 A PERSONAL PROPERTY 024-20766-Prop 4/01/2024 4/01/2025 SPECIAL FORM RC 5,000 A D&O INSURANCE 024-20766-NPO-D&O 4/01/2029 4/01/2025 SPECIAL FORM RC 3,000,000'' DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of E1 Segundo its Officers, Officials, Directors, Employees and Volunteers are named as additional insured and Also attached is the Waiver of subrogation for Work Comp policy through Markel Insurance Company. Re: Landlord of The El Segundo Nursery School Group CERTIFICATE I ( ) - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of E1 Segundo its Official and ­,. Employees c/o City Clerk AUTHORIZED REPRESENTATIVE 350 Main Street RM 5 El Segundo CA 90245-3813, ACORD 25 (2010105) ©1988-2010 ACORD INS025 (201005) 01 The ACORD name and logo are registered marks of ACORD All rights reserved. �J�����»R����]-� � f ���N� /\ ���—� 0�«'����"�'^'"~~� Policy Number: 2D24-287OO-NPO THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ |TCAREFULLY lh/sendorsement modifies insurance provided under the following, COMMERCIAL GENERAL. L|AB|L|TYCOVERAGE PART Section ||— WHO |SANINSURED isamended bzindudo� 4. Any public entity as an additional insured, and the officers, officials, employees, agents and/or volunteers of that public entity, as applicable, who may be named in the Schedule above, when You have agreed in a written contract or written agreernent presently in effect or becoming effective during the term of this policy, that such public en\ityand/or its officers, officials, employees, agents ondbnvolunteers headdeoosan, additional �na|\nsuved(s)onyourpo|i�bu|on|yw0hrespect toUobUi\yfor "bodily irju�/,^pmpahydammge or 'panaone| and advertising injury" caused, inwhole orm pad, by s. Your negligent acts cxemissions, or b� The negligent acts oromissions ofthose acting onYour behalf, in \he performance o[your ongoing operations No such public entity or individual is an additional insured for liability arising out of the sole negligence by that public entity orits designated individuals The additional insured status will not beafforded wiih respect to liability arising Out oior related to your activities aa a real estate manager for that person or organization B, Section III — LIMITS 0FINSURANCE /samendmdho/ndwde� 8, The limits of insurance applicable to the public entity and applicable individuals identified as an additional insured(s) purSLIFInt to Provision A 4. above, are those specified in the written contract between You and that public entity, orthe limits available under this policy, whichever are less These limits are part ofand riot inaddition \nthe limits nfinsuranomLinder this policy C� With respect iothe insurance provided kothe additional inaued(a). Condition 4,Other Insurance of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is replaced by the following: 4. Other Insurance a. Primary Insurance !'his insurance is primary if You have agreed in a written comracl or written agreenieni (1) That this insurance be primary U other insurance /s also pnmary, we will share widn all that Other insurance as described in c. below, or MIACE51 02 19 pwgu 1 of �]����PR(���]_� N SN R & hJ(`E to, wv"�"y/ POLICY NUMBER: 2O232O7GG (2) The coverage afforded by this insurance is primary and non-contributory with the additional mounad(u)'own insurance Paragraphs (1 ) and (2) do not apply to other insurance to which the additional insured(s) has beer! added as an additional insured or to other insurance described in paragraph b, below, b. Excess Insurance This insurance ioexcess over: 1 Any of the other insurance, whether primary. excess, contingent or on ally other basis: (a) That is Fire, Extended Cc*ensge, Builder's Risk. |nake||eUon Risk orsimilar coverage for ` "your wor ^� (b) [hat is fire, lightning, or explosion insurance for prenliSeS rented to you or temporarily Occupied 0yyou with permission ofthe owner, (c) Thai/omsurancepurohasedbyyou\000veryourhabi|i\yaaaienanthrr^propertydamage" topremises temporarily occupied byyou with permission oYthe owner�o, (d) If the loss arises out of the maintenance or use of aircraft, ^autoa^ orwatercraft io the exten1 not subject k»Exclusion g.ofSECTION I —COVERAGE A—BQD|LY|NJURYAND PROPERTY DAMAGE. (o) Any other insurance available to an additional insured(s) under this EndorsenlenIt covering liability for damages which are subject to this endorsement and for which the additional inaura0(s)has been added ayanadditional insured bythat other insurance (1) When this insurance icexcess, wewill have noduty Under Coverages AorB todefend the additional insurad(a)against any ^aui['i[any other insurer has adutyiodefend file additional insumd(s)against that "aui\^ |fnuother insurer defends, wewill undertake kzdoso, Uu\weww| be entitled to the additional inSUred(s)' rights against all those other insurers (2) When this insurance is excess over other insurance, we will pay only our share of the aniount of the loss, i|any, that exceeds the sum of: (a) I he total amount that all such other insurance would pay for the loss in the absence of this insurance, and (b) The total of all deductible and self -insured amounts Under all that other inSUrance (3) We will share the remaining loss, if any, with any other insurance ihoi is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown inthe Declarations ofUhiaCoverage Part o Methods mfSharing If all o[the o\herinsurance available to [he additional inaumd(s) permits contribution by equal shares` we will ioUmw\h|a method also Under this approach each insurer contributes equal amounts until it has paid its applicable limit ofinsurance or none o[the loss nymaina, whichever comes first, Oanymther\hoo(herinsunancoewsi|ab|eWtheeddhiona|msu/eU(s)doeonoiponnUuonihbuUonby equal shares, wewill contribute bylimits Under this method, each insurer's share iobased onthe ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers, N|SC'E81 021Q Page 2of2 MARKEL INSURANCE COMPANY gig A STOCK COMPANY 10275 West Higgins Road, Suite 750 Rosemont, IL 60018 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY .......I ........................... _ _. �._... INFORMATION PAGE NCCI No. 22616 Policy No. MWC0023768-14 New No. Renewal of Policy Number MWC0023768-13 State Unemployment I.D. No. or Identifying Number as Required: FEIN: 956001076 1. Insured: EL SEGUNDO CO-OP NURSERY Producer: Robert Hadzor Insurance Services Mailing SCHOOL(NONPROFIT) Mailing 3755 Alahambra Ave., Suite 7 Address: PO Box 73 Address: Martinez, CA, 94553 El Segundo, CA, 90245-0073 Email Address: ❑ Individual ❑ Partnership ❑ Corporation or ® Nonprofit Other workplace not shown above: See Attached Location Schedule 2. Policy Period: The policy is from 02/01/2025 to 02/01/2026 [12.01 AM Standard Time] at the insured's mailing address. 3. A. Workers Compensation Insurance: Part One of this policy applies to the Workers Compensation Law of the states listed here: CALIFORNIA B. Employers liability Insurance: Part Two of this policy applies to work in each state listed in Item 3A . The limits of our liability under Part Two are: Bodily Injury by Accident: $1,000,000 each accident Bodily Injury by disease: $1,000,000 policy limit Bodily Injury by disease: $1,000,000 each employee C. Other States Insurance: Part Three of this policy applies to the states, if any, listed here: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MT, MO, NE, NV, NH, NJ, NM, NY, NC, OK, OR, PA, RI, SC, SD, TN, TX, LIT, VT, VA, WV and WI D. This Policy includes these endorsements and schedules: MDWC1000B, WC040002, WC040003, WC040004, WC040005, MWC12000510, WCOOOOOOC, WC000419, WC000422C, WC040301 D, WC040306, WC04036013, WC040601 B, WC040604A, MWC14030510, MWC14040510, PN0499011, PN049902B, PN049904, MPWC10000510, MPIL 1157-CA 05 23, MJWC1000B, MWC 1202-CA, MPIL 1083, MPIL 1007 01 20 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Premium Basis Total Rate Per Classification Code Estimated Annual $100 of Estimated Annual Premium No. Remuneration Remuneration See WC 04 00 05 Extension of Information Page MINIMUM PREMIUM $350.00 TOTAL ESTIMATED ANNUAL PREMIUM $1,318.00 EXPERIENCE MODIFICATION TAXES & ASSESSMENTS $63.00 IF INDICATED BELOW, INTERIM ADJUSTMENTS OF PREMUIM SHALL BE MADE: ® Annually ❑ Semi -Annually ❑ Quarterly ❑ Monthly $1,318.00 Deposit Premium $Per Installment Endr Issuing Office: Omaha, Nebraska Countersigned by: MDWC 1000B (02/20) Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY EXTENSION OF INFORMATION PAGE Schedule of Name Insured ITEM 1 Policy No. MWC0023768-14 Name Insured FEIN EL SEGUNDO CO-OP NURSERY SCHOOL(NONPROFIT), 956001076 WC 04 00 02 ©1998 by the Workers' Compensation Insurance Rating Bureau of California. (Ed. 7-98) All rights reserved. From the WCIRB's California Workers' Compensation Insurance Forms Manual ©2001 WC 04 00 02 (Ed. 7-98) Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY Location EXTENSION OF INFORMATION PAGE Schedule of Locations ITEM 1 FEIN 300 E Pine Ave 956001076 El Segundo, CA 90245-3056 WC 04 00 03 (Ed. 7-98) Policy No. MWC0023768-14 PHONE SIC ENTITY CODE TYPE 714-330-3991 8351 Nonprofit WC 04 00 03 ©1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. From the Page 1 of 1 (Ed. 7-98) WCIRB's California Workers' Compensation Insurance Forms Manual © 2001 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY EXTENSION OF INFORMATION PAGE Schedule of Forms ITEM 3D Form Numbers MDWC1000B, WC040002, WC040003, WC040004, WC040005, MWC12000510, WCOOOOOOC, WC000419, WC000422C, WC040301 D, WC040306, WC040360B, WC040601B, WC040604A, MWC14030510, MWC14040510, PN0499011, PN04990213, PN049904, MPWC10000510, MPIL 1157-CA 05 23, MJWC100013, MWC 1202-CA, MPIL 1083, MPIL 1007 01 20 WC 04 00 04 (Ed. 7-98) Policy No. MWC0023768-14 --am-gam CALIFORNIA WC 04 00 04 © 1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. Page 'I of 1 (Ed. 7-98) From the WCIRB's California Workers' Compensation Insurance Forms Manual 0 2001 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY 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 5 % of the California workers' compensation premium otherwise due on such remuneration. Work performed by EL SEGUNDO CO-OP NURSERY SCHOOL(NONPROFIT) at: PO Box 73 El Segundo, CA, 90245-0073 Schedule Subrogant Information Class Code Description Payroll City of El Segundo its officials & 8868 Colleges/Schools-private- Employees c/o City Clerk professionals 350 Main Street Room 5 El Segundo, CA, 90245 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: 02/01/2025 Policy No. MWC0023768-14 Endorsement No. Insured: EL SEGUNDO CO-OP NURSERY SCHOOL(NONPROFIT) Insurance Company: Markel Insurance Company Countersigned by Premium $(See Attached) WC 04 03 06 ©1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. From the Page 1 of 2 (Ed. 04-84) WCIRB's California Workers' Compensation Insurance Forms Manual © 2001 WC 04 03 06 © 1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. From the page 2 of 2 (Ed. 04-84) WCIRB's California Workers' Compensation Insurance Forms Manual © 2001