PROOF OF INSURANCE (2025 - 2026)Certificate Of Insurance ra u4v4J , xc .Jc r rvi
DATE (MM/DD/YYYY)
ACCR" CERTIFICATE OF LIABILITY INSURANCE 7/21/2025
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 pollcy(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 endorsements .
PRODUCER �.
Techlnsurance, Division of Specialty Program Group LLC •• • ---• -
NE
203 N. LaSalle St., 20th Floor, Chicago, IL 60601 CONTACT 00� 688-1984 FAX farsL_ITm 312 690-4123 _
............. ._.._.... ...--
INSURER A
INSURED
INSURER...._
B;
Peregrine Technologies
INSURER C
71 Stevenson St Ste 700, San Francisco, CA, 94105-2984
11N ER D
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w THIS IS TO CERTIFY THAT THE POLIO T .__
IES 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.
'SR _ rI$5L U1 ....._ t'OL9CY EFF' PU0.TCY' EP .�.--..-.,,,. _
L' TYPE OF INSURANCE POLICY NUMBER MMtDOfYYYY Mmot)(YYYY LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 2,000,000
P''CPrnq
1,000000
CLAIMS -MADE F OCCUR
$ .-n......m.�,
RED EXP (An)one person)
$ 10,000
g
Yes
46SBABF4FW2
3/29/2025
3/29/2026
PERSONAL & ADV INJURY
$ 2,000,000
GENERAL AGGREGATE ....
$ 4,000 o00
.
GEN'L
AGGREGATE... LIMIT APPLIES PER;
✓
PRO-
POLICY LOC
JEO'T
.........
ODUCTS - COMP/OP AG G
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,00 00
4,000,000
$ 4,000,000
_-- ,.....
OTHER:
$
AUTOMOBILE
LIABILITY
CONNED SING I" LIMIT
$ 2,000 000
ANY AUTO
BODILY INJURY (Per person)
.........._---
$
...'
ALL OWNED .. . SCHEDULED
Yes
4656ABF4FW2
3I29/2025
3/29/2026
(Per accident)
BODILY INJURYTDAMAGE
$
B
_
✓
AUTOS AUTOS
✓ NON -OWNED
$
HIRED AUTOS TOS
✓ UMBRELLA LIAB ✓ 'OCCUR
EACH OCCURRENCE
$ 3,000,000
E
EXCESS LIAB '..CLAIMS -MADE
Yes
46SBABF4FW2
3129/2025
3/29/2026
AGGREGATE
$ 3 000 000
DED f ✓ RETENTION $ 10,000
$ mm
WORKERS COMPENSATION
✓ �TARTUTE ER i-
AND EMPLOYERS• LIABILITY
YIN
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46WECAC3TVE
12/4/2024
1 025
12/4I2025
E L. EACH ACCIDENT
S 1 0®0 Q00
OFFICERIMEMBE
(Mandatory In NH EXCLUDED?
E L. DISEASE - EA EMPLOYEE
�-
$ 1 000 µ000
If yos, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
C
Professional Liability (Errors and Omisslons)
VG00006652AA
3/6/2025
3/8/2026
Occurrence/Aggregate $2.000,000 / $2,000,000
D
Cyber Liability
VG00006652AA
3/6/2025
3/812026
'... Aggregate Limit $ 2,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
Excess Professional Liability EO - Underwriters at Lloyd's - 03/08/2025 to 03/08/2026 - CANCXS00063-01 - Occurrence/Aggregate $5,000,0001$5,000,000
Excess Professional Liability EO - Scottsdale Indemnity Company - 03/08/2025 to 03/08/2026 - EKS3565008 - Occurrence/Aggregate $3,000,000/
$3,000,000
The City of El Segundo, its elected and appointed officials, employees, and volunteers are Additional Insured as their Interests may appear in regards to
General, Auto, Umbrella Liability when required by written contract. This Insurance Is primary and non-contributory to any other insurance provided as respects
general liability coverage. 30 Day Notice of Cancellation In favor of The City of El Segundo, Its elected and appointed officials, employees, and volunteers.
The City of El Segundo
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
U 19HS-ZO14 AGUKU GUKF'UKA I IUIN. All rlgnTs reservoir.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF OUR RIGHT TO RECOVER
FROM OTHERS ENDORSEMENT
Policy Number: 46 WEC AC3TVE Endorsement Number:
Effective Date: 12/04/24 Effective hour is the same as stated on the Information Page of the policy.
Named Insured and Address: Peregrine Technologies
71 STEVENSON ST STE 700
SAN FRANCISCO CA 94105
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 shall not operate directly or indirectly to benefit anyone not named in the Schedule.
SCHEDULE
Any person or organization for whom you are required by contract or agreement to obtain this waiver from us.
Endorsement is not applicable in KY, NH, NJ or for any MO construction risk
Countersigned by
Authorized Representative
Form WC 00 03 13 Printed in U.S.A.
Process Date: 10/24/24 Policy Expiration Date: 12/04/25
n-]
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF OUR RIGHT TO RECOVER FROM
OTHERS ENDORSEMENT - CALIFORNIA
Policy Number: 46 WEC AC3TVE Endorsement Number:
Effective Date: 12/04/24 Effective hour is the same as stated on the Information Page of the policy.
Named Insured and Address: Peregrine Technologies
71 STEVENSON ST STE 700
SAN FRANCISCO CA 94105
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 2 % of the California workers' compensation premium otherwise due
on such remuneration.
SCHEDULE
Person or Organization
Job Description
Any person or organization for whom you are required by written contract or agreement to obtain this waiver of rights from
us
Countersigned by
Authorized Representative
Form WC 04 03 06 (1) Printed in U.S.A.
Process Date: 10/24/24 Policy Expiration Date: 12/04/25