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PROOF OF INSURANCE (2027 - 2027)ACC)RO CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY) 6/5/2026 .. 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(les) 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 PI,K7IE:�'� Emilia Edgewood Partners Insurance Center PHONE P.O Box 2110 L � — Rancho Cordova CA 95670 EhDES: elrlilh A: Federal INSURED INSURER B Shute Mihaly & Weinberger LLP ._...._ 550 California St Ste 1200 INSURER c San Francisco CA 94104-1054 11NSYPER D : rn�icowr_cc f'r-PTIFIf_ATE NUMBER: 2079755835 of London COVERAGE REVISION NUMBER: 85202 42552 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. IA"NSFt � �...--____ ...... ,...... OLI•CY•EFF POLICY E)4P.....-... ___ _. ,A,' kl ' $U'B1 ,,..... ........_POLICY LIMITS RANCE NUMBER TYPE OF INSU LpR... DD,PYYYIP' MM1DD A X COMMERCIAL GENERAL LIABILITY 36036940 2/27/2026 2/27/2027 EACH OCCURRENCE $1 000,000 X $1000000 CLAIMS -MADE OCCUR'I,hAISESaouaror�)„,-,•,„ MED EXP (Any ..one ..Person) _ $ 10.00,0................... ... PERSONAL $ A"JURY $ 1 000.,000 GENT AGGREGATE LIMIT APPLIES PER: E GENERALAGGREGATw yy $ 2,000 000 „^_ �m. POLICY JE O X... LOC PRODUCTS ,COMP/OP AGG $ 2,OOQ000 C9"HCRc6leml A AUTOMOBILE LIABILITY 73592954 2/27/2026 2/27/2027 i1 INEC1 INt LE LIMN"1 mm $1 00 0 .. 0.000 ANY AUTO BODILY INJURY (Per person) $ OWNED••• SCHEDULED BODILY INJURY (Per accident) $-••••_-��� AUTOS ONLY XAUTOS HIRED NON -OWNED PR .... .—_ ...� gPERTY DAMAI�E' - $ X,,,,,, AUTOS ONLY AUTOS ONLY A X UMBRELLA LIAR X OCCUR 78181273 2/27/2026 2/27/2027 EACH OCCURRENCE $ 3,000,000 EXCESS LIAB -.m CLAIMS -MADE GGREGATE w ..A...........,...-, .........................- $ 3,000,000 -_..............................., DED ^ I RETENTION$��� $ C WORKERS COMPENSATION BBWWK10000789 6/8/2026 6/8/2027 PER X OTH � •• AND EMPL� DYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNERIEXECUTIVE E.L. EACH ACCIDENT $ 1 000,000 .' ••���-- OFFICER/MEMBEREXCLUDED?••• (Mandatory in NH) N I A E.L. DISEASE - EA EMPLOYEE $ 1,000 000 If yes, describe under .DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,OOQ000 B Professional Liability NL2600102 3/1/2026 3/1/2027 Each Claim $2,000,000 Aggregalil $4,000,000 Claims Made Retro Date: 03/17/1980 Deduclibl,o $75,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: All Contracts/Written Agreements between the Certificate Holder and the Insured. When required by written contract, additional insured status with primary Coverage and waiver of subrogation apply to General Liability and Automobile Liability, all per the attached endorsements. CANCELLA 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 El Segundo Office of the City Clerk Jeff Stewart 350 Main Street AUTHORIZED REPRESENTATIVE El Segundo CA 90245 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD CH U B Bm Liability Insurance Endorsement Policy Period Effective Date Policy Number Insured Name of Company Date Issued This Endorsement applies to the following forms: GENERAL . LIABILITY Who Is An Insured Additional Insured - Scheduled Person Or Organization FEBRUARY 27, 2026 TO FEBRUARY 27, 2027 FEBRUARY 27, 2026 3603-69-40 WUC SHUTE MIHALY & WEINBERGER LLP m CO Na OLL X m m O FEDERAL INSURANCE COMPANY N N DECEMBER 17, 2025 Under Who Is An Insured, the following provision is added Persons or organizations shown in the Schedule are insureds; but they are insureds only if you are obligated pursuant to a contract or agreement to provide them with such insurance as is afforded, by this policy. However, the person or organization is an insured only: • if and then only to the extent the person or organization is described in the Schedule; • to the extent such contract or agreement requires the person or organization to be afforded status as an insured; • for activities that did not occur, in whole or in part, before the execution of the contract or agreement, and • with respect to damages, loss, cost or expense for injury or damage to which this insurance applies. No person or organization is an insured under this provision: • that is more specifically identified under any other provision of the Who Is An Insured section (regardless of any limitation applicable thereto). • with respect to any assumption of liability (of another person or organization) by them in a contract or agreement. This lirnitation does not apply to the liability for damages, loss, cost or expense for injury or damage, to which this insurance applies, that the person or organization would have in the absence of such contract or agreement. Liability Insurance Additional Insured - Scheduled Person Or Organization continued Form 80-02-2367 (Rev. 5-07) Endorsement Page I CHUBB® Liability Endorsement (continued) Under Conditions, the following provision is added to the condition titled Other Insurance. Conditions a Other Insurance — If you are obligated, pursuant to a contract or agreement, to provide the person or organization Primary, Noncontributory shown in the Schedule with primary insurance such as is afforded by this policy, then in such case Insurance — Scheduled this insurance is primary and we will not seek contribution from insurance available to such person Person Or Organization or organization. �a a� x� Schedule m N ' OOl N N PERSONS OR ORGANIZATIONS THAT YOU ARE OBLIGATED, PURSUANT TO A CONTRACT OR AGREEMENT, TO PROVIDE WITH SUCH INSURANCE AS IS AFFORDED BY THIS POLICY. All other terms and conditions remain unchanged Authorized Representative , Liability Insurance AdWtianal insured - Scheduled Person Or Organization last page Form 80-02-2367 (Rev. 5-07) Endorsemant Page 2 Conditions (continued) Transfer Or Waiver Of We will waive the right of recovery we would otherwise have had against another person or Rghts Of Aeoovery organization, for loss to which this insurance applies, provided the insured has waived their rights Against Others of recovery against such person or organi ration in a contract or agreement that is executed before such loss. To the extent that the ' redd's rights to recover all or part of any payment made under this insurance have not been waived, those rights are transferred to us. The insureds must do nothing after loss to impair them At our request, the insured will bring suit or transfer those rights to us and help us enforce them This condition does not apply to medical expenses. Lhdft Inswance Form 80-02-2 (Rev. 4-M) Contract Page 24 of 32 Policy Number: 73592954 COMMERCIAL AUTOMOBILE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL AUTOMOBILE BROAD FORM ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM This endorsement modifies the Business Auto Coverage Form 1. EXTENDED CANCELLATION CONDITION Paragraph A.2.b. — CANCELLATION - of the COMMON POLICY CONDITIONS form IL 00 17 is deleted and replaced with the following:, b. 60 days before the effective date of cancellation if we cancel for any other reason. 2. BROAD FORM INSURED A. Subsidiaries and Newly Acquired or Formed Organizations As Insureds The Named Insured shown in the Declarations is amended to include: 1. Any legally incorporated subsidiary in which you own more than 50% of the voting stock on the effective date of the Coverage Form. However, the Named Insured does not include any subsidiary that is an "insured" under any other automobile policy or would be an "insured" under such a policy but for its termination or the exhaustion of its Limit of Insurance. 2. Any organization that is acquired or firmed by you and over which you maintain majority ownership. However, the Named Insured does not include any newly formed or acquired organization: (a) That is an "insured" under any other automobile policy; (b) That has exhausted its Limit of Insurance under any other policy; or (c)180 days or more after its acquisition or formation by you, unless you have: given us written notice of the acquisition or formation. Coverage does not apply to "bodily injury" or "property damage" that results from an "accident" that occurred before you formed or acquired the organization. B. Employees as Insureds Paragraph A.1. —WHO IS AN INSURED, — of SECTION II — LIABILITY COVERAGE is amended to add the following: d. Any "employee" of yours while using a covered "auto" you don't own, hire or borrow in your business or your personal affairs. C. Lessors as Insureds Paragraph A.1. — WHO IS AN INSURED — of SECTION II — LIABILITY COVERAGE is amended to add the following: e. The lessor of a covered "auto" while the "auto" is leased to you under a written agreement if: (1) The agreement requires you to provide direct primary, insurance for the lessor; and (2) The "auto" is leased without a driver. Such leased 'auto" will be considered a covered "auto" you own and not a covered "'auto" you hire. However, the lessor is an "insured" only for "bodily injury" or "property damage" resulting from the acts or omissions by: 1. You; 2. Any of your "employees" or agents; or 3. Any person, except the lessor or any "employee or agent of the lessor" operating an "auto' with the permission of any of 1. and/or 2. above. D. Persons And Organizations As Insureds Under A Written Insured Contract Paragraph A.1 —WHO IS AN INSURED —of SECTION II — LIABILITY COVERAGE is amended to add the following: f. Any person or organization with respect to the operation, maintenance or use of a covered "auto% provided that you and such person or organization have agreed under an express provision in a written "insured contract", written agreement or a written permit issued to you by a governmental or public authority to add such person or organization to this policy as an "insured". However, such person or organization is an "insured" only: Form: 16-02-0292 (Rev. 11-16) Page 1 of 3 "Includes copyrighted material of Insurance Services Office, Inc. with its permission" Policy Number: 73592954 (1) with respect to the operation, d. Rental Expense maintenance or use of a covered We will pay the following expenses that you or "auto"; and any of your "employees" are legally obligated (2) for "bodily injury" or "property damage" to pay because of a written contract or caused by an "accident" which takes agreement entered into for use of a rental place after: vehicle in the conduct of your business: (a) You executed the "insured MAXIMUM WE WILL PAY FOR ANY ONE contract" or written agreement; or CONTRACT OR AGREEMENT: (b) The permit has been issued to 1. $2,500 for loss of income incurred by the you. rental agency during the period of time that 3. FELLOW EMPLOYEE COVERAGE vehicle is out of use because of actual EXCLUSION B.5. - FELLOW EMPLOYEE — of damage to, or "loss" of, that vehicle, including SECTION II — LIABILITY COVERAGE does not apply. income lost due to absence of that vehicle for 4. PHYSICAL DAMAGE — ADDITIONAL TEMPORARY use as a replacement; TRANSPORTATION EXPENSE COVERAGE Paragraph A.4.a. — TRANSPORTATION EXPENSES 2. $2,600 for decrease in trade-in value of the — of SECTION III — PHYSICAL DAMAGE rental vehicle because of actual damage to COVERAGE is amended to provide a limit of $50 per that vehicle arising out of a covered "loss'; and day for temporary transportation expense, subject to a 3. $2,500 for administrative expenses incurred maximum limit of $1,000. by the rental agency, as stated in the contract 5. AUTO LOAN/LEASE GAP COVERAGE or agreement. Paragraph A. 4. — COVERAGE EXTENSIONS - of 4. $7,500 maximum total amount for paragraphs SECTION III — PHYSICAL DAMAGE COVERAGE is 1., 2. and 3. combined. amended to add the following: 7. EXTRA EXPENSE — BROADENED COVERAGE c. Unpaid Loan or Lease Amounts Paragraph A.4. — COVERAGE EXTENSIONS —of In the event of a total "loss" to a covered "auto", we will SECTION III — PHYSICAL DAMAGE COVERAGE pay any unpaid amount due on the loan or lease for a is amended to add the following: covered "auto" minus: e. Recovery Expense 1. The amount paid under the Physical Damage We will pay for the expense of returning a Coverage Section of the policy; and stolen covered "auto" to you. 2. Any: 8. AIRBAG COVERAGE a. Overdue Ioanilease payments at the time of Paragraph B.3.a. -EXCLUSIONS —of SECTION the "loss"; III — PHYSICAL DAMAGE COVERAGE does not b. Financial penalties imposed under a lease for apply to the accidental or unintended discharge of excessive use, abnormal wear and tear or an airbag. Coverage is excess over any other high mileage; collectible insurance or warranty specifically c. Security deposits not returned by the lessor: designed to provide this coverage. d. Costs for extended warranties, Credit Life 9. AUDIO, VISUAL AND DATA ELECTRONIC Insurance, Health, Accident or Disability EQUIPMENT - BROADENED COVERAGE Insurance purchased with the loan or lease; Paragraph CA.b. — LIMIT OF INSURANCE - of and SECTION III - PHYSICAL DAMAGE is deleted e. Carry-over balances from previous loans or and replaced with the following: leases. b. $2,000 is the most we will pay for "loss" in any We will pay for any unpaid amount due on the loan or one "accident" to all electronic equipment that lease if caused by: reproduces, receives or transmits audio, visual 1. Other than Collision Coverage only if the or data signals which, at the time of "loss", is: Declarations indicate that Comprehensive (1) Permanently installed in or upon the Coverage is provided for any covered "auto"; covered "auto" in a housing, opening or 2. Specified Causes of Loss Coverage only if the other location that is not normally used by Declarations indicate that Specified Causes of the "auto" manufacturer for the installation Loss Coverage is provided for any covered "auto"; of such equipment; or 3. Collision Coverage only if the Declarations indicate (2) Removable from a permanently installed that Collision Coverage is provided for any housing unit as described in Paragraph covered "auto. 2.a. above or is an integral part of that B. RENTAL AGENCY EXPENSE equipment; or Paragraph A. 4. — COVERAGE EXTENSIONS — of (3) An integral part of such equipment. SECTION III — PHYSICAL DAMAGE COVERAGE is amended to add the following: 10. GLASSREPAIR— I I L Form: 16-02-0292 (Rev. 11-16) Page 2 of 3 "Includes copyrighted material of Insurance Services Office, Inc. with its permission" ra- Policy Number: 73592954 Under Paragraph D. - DEDUCTIBLE — of SECTION III — PHYSICAL DAMAGE COVERAGE the following is added: No deductible applies to glass damage if the glass is repaired rather than replaced. 11. TWO OR MORE DEDUCTIBLES Paragraph D.- DEDUCTIBLE — of SECTION II I — PHYSICAL DAMAGE COVERAGE is amended to add the following: If this Coverage Form and any other Coverage Form or policy issued to you by us, that is not an automobile policy or Coverage Form applies to the same 'accident", the following applies: 1. If the deductible under this Business Auto Coverage Form is the smaller (or smallest) deductible, it will be waived; or 2. If the deductible under this Business Auto Coverage Form is not the smaller (or smallest) deductible, it will be reduced by the amount of the smaller (or smallest) deductible. 12. AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS Paragraph A.2.a. - DUTIES IN THE EVENT OF AN ACCIDENT, CLAIM, SUIT OR LOSS of SECTION IV - BUSINESS AUTO CONDITIONS is deleted and replaced with the following: a. In the event of "accident", claim, 'suit" or "loss", you must promptly notify us when the .accidenf is known to: (1) You or your authorized representative, if you are an individual-, (2) A partner, or any authorized representative, if you are a partnership; (3) A member, if you are a limited liability company; or (4) An executive officer, insurance manager, or authorized representative, if you are an organization other than a partnership or limited liability company. Knowledge of an "accident", claim, "suif or "loss" by other persons does not imply that the persons listed above have such knowledge. Notice to us should include: (1) How, when and where the 'accident" or "loss" occurred; (2) The " insured's" name and address; and (3) To the extent possible, the names and addresses of any injured persons or witnesses. 13. WAIVER OF SUBROGATION Paragraph A.5. - TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US of SECTION IV — BUSINESS AUTO CONDITIONS Is deleted and replaced with the following: 5. We will waive the right of recovery we would otherwise have against another person or organization for "loss" to which this insurance applies, provided the "insured" has waived their rights of recovery against such person or organization under a contract or agreement that is entered into before such 'loss". To the extent that the "Insured's" rights to recover damages for all or part of any payment made under this insurance has not been waived,, those rights are transferred to us,. That person or organization must do everything necessary to secure our rights and must do nothing after "accident' or "loss" to impair them. At our request, the insured Will bring suit or transfer those rights to us and help us enforce them. 14. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS Paragraph B.2, — CONCEALMENT, MISREPRESENTATION or FRAUD of SECTION IV — BUSINESS AUTO CONDITIONS - is deleted and replaced with the following-, If you unintentionally fail to disclose any hazards existing at the inception date of your policy, we will not void coverage under this Coverage Forrn because of such failure. 15. AUTOS RENTED BY EMPLOYEES Paragraph 13.5. - OTHER INSURANCE of SECTION IV — BUSINESS AUTO CONDITIONS - is amended to add the following: e. Any "auto"hired or rented by your "employee" on your behalf and at your direction will be considered an "auto" you hire. If an "employee's" personal insurance also applies on an excess basis to a covered "auto" hired or rented by Your "employee" on your behalf and at your direction, this Insurance will be primary to the "employees" personal insurance. 16. HIRED AUTO — COVERAGE TERRITORY Paragraph 13-7.b.(5). - POLICY PERIOD, COVERAGE TERRITORY of SECTION IV — BUSINESS AUTO CONDITIONS is deleted and replaced with the following: (5) A covered 'auto" of the private passenger type is leased, hired, rented or borrowed without a driver for a period of 45 days or less; and 17, RESULTANT MENTAL ANGUISH COVERAGE Paragraph C. of - SECTION V — DEFINITIONS is deleted and replaced by the following, "Bodily injury" means bodily injury, sickness or disease sustained by any person, including mental anguish or death as a result of the "bodily injury" sustained by that person. Form: 16-02-0292 (Rev. 11-16) Page 3 of 3 "Includes copyrighted material of insurance Services office, Inc. with its permission" N Policy Number: 73592954 4. Loss Payment — Physical Damage Coverages At our option, we may: a. Pay for, repair or replace damaged or stolen property; b. Return the stolen property, at our expense. We will pay for any damage that results to the "auto" from the theft; or c. Take all or any part of the damaged or stolen property at an agreed or appraised value. If we pay for the "loss", our payment will include the applicable sales tax for the damaged or stolen property. 5. Transfer Of Rights Of Recovery Against Others To Us If any person or organization to or for whom we make payment under this Coverage Form has rights to recover damages from another, those rights are transferred to us, That person or organization must do everything necessary to secure our rights and must do nothing after "accident" or "loss" to impair them. B. General Conditions 1. Bankruptcy Bankruptcy or insolvency of the "insured" or the "insured"s"' estate will not relieve us of any obligations under this Coverage Form. 2. Concealment, Misrepresentation Or Fraud This Coverage Form Is void in any case of fraud by you at any time as it relates to this Coverage Form. it is also void if you or any other "insured"" at any time, intentionally conceals or misrepresents a material fact concerning: a. This Coverage Form; b. The covered "auto"; c. Your interest in the covered "auto"; or d. A claim under this Coverage Form. 3. Liberalization If we revise this Coverage Form to provide more coverage without additional premium charge, your policy will automatically provide the additional coverage as of the day the revision is effective in your state. 4. No Benefit To Bailee — Physical Damage Coverages We will not recognize any assignment or grant any coverage for the benefit of any person or organization holding„ storing or transporting property for a fee regardless of any other provision of this Coverage Form,: 5. Other insurance a. For any covered "auto"" you own, this Coverage Form provides primary insurance. For any covered "auto"" you don't own, the insurance provided by this Coverage Form is excess over any other collectible insurance. However, while a, covered "auto" which is a "trailer" is connected to another vehicle, the Covered Autos Liability Coverage this Coverage Form provides for the "trailer" is: (1) Excess, while it is connected to a motor vehicle you do not own; or (2) Primary while it is connected to a covered "auto" you own. b. For Hired Auto Physical Damage Coverage,. any covered "auto" you lease, hire, rent or borrow is deemed to be a covered "auto"' you own. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". c. Regardless of the provisions of Paragraph a. above, this Coverage Form's Covered Autos Liability Coverage is primary for any liability assumed under an insured contract". d. When this Coverage Form ,and any other Coverage Form 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 Coverage Form bears to the total of the limits of all the Coverage Forms and policies covering on the same basis. 6. Premium Audit a. The estimated premium for this Coverage Form is based on the exposures you told us you would have when this policy began. We will compute the final premium due when we determine your actual exposures. The estimated total premium will be credited against the final premium due and the first Named Insured will be billed for the balance, if any. The due date for the final premium or retrospective premium is the date shown as the due date on the bill. If the estimated total premium exceeds the final premium due, the first Named Insured will get a refund. b. If this policy is issued for more than one year, the premium for this Coverage Form will be computed annually based on our rates or premiums In effect at the beginning of each year of the policy. CA 00 01 10 13 © Insurance Services Office, Inc., 2011 Page 9 of 12 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. ") WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORH'IA P1 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.) min Nd You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the oLL work described in the Schedule. m� N GOl N N 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 THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER PRIOR TO A LOSS 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 06-08-26 Policy No. BBW—WK-10000789-05 Endorsement No. Insured SHUTE MIHALY & WEINBERGER LLP Premium $ INCL . Insurance Company NOVA Casualty Company Countersigned By © IM by the Workers' Compensation Insurance Ratlng Bureau of Callfomla. All rlgMs reserved. From the WCIRB's California Workers' Compensation Insurance Forms Manual ©1999. INSURED