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PROOF OF INSURANCE (2010) CLOSEDY ® coRO CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. DRMAAU81 09/01/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Brakke Schafnitz West ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE License #0428915 TYPE OF INSURANCE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 840 Apollo Street, Suite 150 DATE (MMIDDIYYYY ) ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. E1 Segundo CA 90245 GENERAL LIABILITY Phone: 310 -524 -1340 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A. •echee[ surylua L Dr. Maureen Sassoon INSURER B A INSURERC X COMMERCIAL GENERAL LIABILITY P O Box 2098 02/17/09 INSBRERD PREMISES TEaacc'—.) Palos Verdes Peninsula CA 90274 I INSURER E'. COVERAGES IHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWI THSTANOING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUEDQR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OI- SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD'L I POLICY EFFECTIVE POLICY EXPIRATION LTR NERD TYPE OF INSURANCE POLICY NUMBER DATE (MMIDOIYYYY) DATE (MMIDDIYYYY ) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED A X COMMERCIAL GENERAL LIABILITY G24061814001 02/17/09 02/17/10 PREMISES TEaacc'—.) $ 50,000 ME D EXP(A,yane penoP) $ 5,000 CLAIMS MAD(: FX OCCUR PERSONAL& ADV INJURY $ 1,000,000 X $2,500 Ded /Occur GENERAL AGGREGATE $ 2,000,000 GEN -L AGGREGATE LIMIT APPLIES PER PRODUCTS- COMPIOPAGG $ 2,000,000 PRI- — X POLICY JECT LOU AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accitlenH $ ANY AUTO BODILY INJURY $ ALL OWNED ALTOS SCHEDULED AUTOS (Per Person( BODILY INJURY HIRED AUTOS $ NON OWNED autos (Pei a�crnem) PROPERTY DAMAGE (Per .—d—T) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT IS EA ACC OTHER THAN $ _ NI AI-1O b AU FD ONLY AGO EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ❑ CLAIMSMADE AGGREGATE IS S $ OEDUCTIBLIE $ RETENTION $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY VIN TORY LIMITS ER ANY PROPRIETORIPARTNERIEXECUTIVE L. L EACH ACCIDENT $ OFF ICERIMEMBER EXCLUDED'+ (Mandatory In NH) E L. DISEASE - EA EMPLOYEE S IT yes, d.—be antler SPECIAL PROVISIONS below E DISEASE - POLICY LIMIT $ OTHER A Professional Liabi G24061814001 02/17/09 02/17/10 Professio $lmm$2mmAgg Inclds Pollution & ASBESTOS I— VC—HSHAO& I I I Deductibl $5,000 /Clm DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS *Except 10 days IF cancelled for nonpayment of premium. The Certificate Holder is recognized as Additional Insured per endorsement ENV -3100 attached. SUPERSEDES & REPLACES CERTIFICATE DATED 2/24/09 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION C -ELSEG DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAILXXXXXXXXX 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL XXXXXX}OCX= City of El Segundo IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Attn City Clerks Offi 530 Main Street - REPRESENTATIVES. (t)� ATIVE El Segundo CA 90245 9°l Arr►wn 9s i7nnaroti co) 1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2009101) Named Insured Endorsement Number Dr. Maureen Sassoon Pollcy Symbol Policy Number Policy Period Effective Date of Endorsement EPW G24061814 001 02/17/2009 TO 02/17/2010 Issued By (Name of Insurance Company) Westchester Surplus Lines Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED ENDORSEMENT OWNERS, LESSEES OR CONTRACTORS — SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE CONTRACTOR'S POLLUTION LIABILITY COVERAGE SCHEDULE: Name of Person or Oroanization: Any person or organization that is an owner of real property or personal property on which you are performing operations, or a contractor on whose behalf you are performing operations, and only at the specific written request of such pe n or organization to you, wherein such request is made prior to commencement of operations. ,J� (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. SECTION II - WHO IS AN INSURED is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your ongoing operations performed for that insured. B. With respect to the insurance afforded to these additional insureds, the following exclusion is added: 2. Exclusions This insurance does not apply to bodily injury or property damage occurring after: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed; or (2) That portion of your work out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. ENV -3100 (08 -04) Includes copyrighted material of Insurance Services Office, Inc. with its permission Page 1 of 1 — REPRINTEDFROM THEARCHME. THE ORIGINAL TRANSACTION MAY INCLUDE ADDITIONAL FORMS — Insurance,. j�M=tW4Ub.MM Wa—* POLICY NUMBER: A2074142 SAFECO INSURANCE COMPANY OF AMERICA AUTOMOBILE POLICY DECLARATIONS NAMED INSURED: RENEWAL MAUREEN SASSOON PO Box 2028 POLICY PERIOD FROM: SEPT 1 2009 PALOS VERDES PEN tCA9O -8028 TO: MAR. 1 2010 AGENT: NHC INSURANCE SERVICES INC 796 W 9TH ST SAN PEDRO CA 90731 -3602 at 12:01 A.M. standard time at the address of the insured as stated herein. AGENT TELEPHONE: (310) 221 -0917 RATED DRIVERS MS MAUREEN SASSOON 2008 BMW 3281 SULEV 4 DOOR SEDAN ID# WBAVC53578FZ84867 LOSS PAYEE BMW BANK OF NORTH AMERICA 1986 HONDA CIVIC 1500 4 DOOR SEDAN ID# INMAK7430GS007927 Insurance is afforded only for the coverages for which limits of liability or premium charges are indicated. COVERAGES 2008 BMW LIMITS I PREMIUMS 1 1986 HOMO LIMITS1 PREMIUMS LIABILITY: BODILY INJURY $500,000 S 110.30 SS00,000 S 79.80 Each Person 5500,000 Each Occurrence PROPERTY DAMAGE $100,000 Each Occurrence MEDICAL (EXCESS) PAYMENTS $5,000 UNINSURED AND UNDERINSURED MOTORISTS: BODILY INJURY $500,000 Each Person $500,000 Each Accident UNINSURED MOTORISTS: PROPERTY DAMAGE Each Person $500,000 Each Occurrence 70.60 $100,000 50.80 Each Occurrence 10.90 $5,000 9.80 50.10 COMPREHENSIVE Actual Cash Value 23.90 Less $250 Deductible COLLISION Actual Cash Value 201.50 Less $500 Deductible WAIVER OF COLLISION DEDUCTIBLE 13.10 ADDITIONAL COVERAGES: LOSS OF USE $50 Per Day /$1200 Max 18.40 AUTO LOAN /LEASE 6.20 ANTI FRAUD FEE .90 ROADSIDE ASSIST 2.50 TOTAL S 508.40 $500,000 53.40 Each Person $500,000 Each Accident $3,500 3.60 Each Accident .90 TOTAL S 198.30 -CONTINUED - P 0 BOX 515097, LOS ANGELES, CA 90051 SA 16971EP 9I90 Page 1 of 2 DATE PREPARED: JULY 28 2009 S,-, — REPRINTED FROM THE ARCHIVE. THE ORIGINAL TRANSACTION MAY INCLUDE ADDITIONAL FORMS — Insurance -, POLICY NUMBER: A2074142 SAFECO INSURANCE COMPANY OF AMERICA AUTOMOBILE POLICY DECLARATIONS (CONTINUED) TOTAL EACH VEHICLE: 2008 BMW S 508.40 1986 HOND 198.30 TOTAL PREMIUM FOR ALL VEHICLES .................. S 705.70 You can pay your premium in full or in installments. If you pay in installments using automatic deduction, no installment fee will apply to each installment. If you pay in installments without using automatic deduction, a $4.00 installment fee will apply to each installment. If there is more than one policy billed on the installment bill, only the highest fee amount would be applied to the bill. CONGRATULATIONS! YOUR PREMIUM INCLUDES DISCOUNTS AND ADJUSTMENTS FOR: Account, Anti - Theft, 4 -Door, Good Driver, Longevity, Multi -Car, Both Side Air Bag SA- 1698/EP 9M Page 2 of 2 r_. *REPRINTED FROM THE ARCHIVE THE ORIGINAL TRANSACTION MAY INCLUDE ADDITIONAL FORMS - InsuranCeTM b d max, c�c POLICY NUMBER: UA3442004 SAFECO INSURANCE COMPANY OF AMERICA PERSONAL UMBRELLA POLICY DECLARATIONS INSURED: AGENT: MAUREEN SASSOON NHC INSURANCE SERVICES INC PO BOX 2028 796 W 9TH ST PALOS VERDES PEN CA 90274 -8028 SAN PEDRO CA 90731 -3602 RESIDENCE PREMISES: 27056 SHOREWOOD RD RCH PALOS VRD CA 90275 -2228 RETAINED LIMIT: $ 2 50 LIMIT OF LIABILITY: $1,000,000 (310) 221 -0917 POLICY PERIOD FROM: JUNE 2 7 2009 TO: JUNE 27 2010 at 12:01 A.M. Standard time at the address of the insured as stated herein. SCHEDULE OF UNDERLYING INSURANCEU The insured agrees: 1) that insurance policies providing the coverages specified on the back of these declarations, if applicable, are in force and will be maintained in force as collectible insurance for at least the required minimum limits stated 2) to insure all motor vehicles owned, leased by or used by the insured 3) to insure all residence premises owned, leased by or leased to the insured 4) to insure all recreational vehicles owned, leased by or used by the insured 5) to insure all watercraft owned by the insured COVERAGES PREMIUM Basic premium - includes one automobile and primary residence $ 206.00 In Home Business Coverage $ 30.00 1 Additional automobile in the household $ 79.00 2 Rental units $ 26.00 TOTAL ANNUAL PREMIUM $ 341.00 You can pay your premium in full or in installments. If you pay in installments using automatic deduction, no installment fee will apply to each installment. If you pay in installments without using automatic deduction, a $2.00 installment fee will apply to each installment. If there is more than one policy billed on the installment bill, only the highest fee amount would be applied to the bill. PLEASE SEE REVERSE ORIGINAL DATE PREPARED APR. 28 2009 P- 1075 /E P 9/06 G1 -' REPRINTED FROM THE ARCHIVE. THE ORIGINAL TRANSACTION MAY INCLUDE ADDITIONAL. FORMS " "' Type of Policy Required Minimum Limits Automobile /Motor Vehicle Liability Bodily Injury - 500,000 each person/ (including motor homes) and - 500,000 each occurrence Property Damage - 100,000 each occurrence OR Single Limit - 500,000 each occurrence Comprehensive Personal Liability Single Limit - 300,000 each occurrence Premises Liability Single Limit - 300,000 each occurrence Recreation Vehicle Liability Single Limits - 300,000 each occurrence Watercraft Liability 1. a. Powerboats 32 feet or more in length; or b. Sailing vessels (with or without auxiliary power) 26 feet or more in length Single Limits 500,000 each occurrence 2. All other watercraft Single Limits 300,000 each occurrence Incidental Farm Coverage Single Limits - 300,000 each occurrence ^' REPRINTED FROM THE ARCHIVE. THE ORIGINAL TRANSACTION MAY INCLUDE ADDITIONAL FORMS '*** 0 CALIFORNIA PERSONAL UMBRELLA POLICY S A F E C OV SAFECO INSURANCE COMPANY OF AMERICA Home Office: 4333 Brooklyn Ave. N.E., Seattle, Washington 98185 (A stock insurance company.) READY REFERENCE TO YOUR PERSONAL UMBRELLA POLICY Beginning On Page INSURING AGREEMENT DEFINITIONS 1 COVERAGES 2 Personal Liability Defense Coverage EXCLUSIONS 3 CONDITIONS 5 Limit of Liability Duties After Loss Payment of Loss Termination Maintenance of Underlying Insurance P- 9671CAFP 9199 0 a Registered Trademark of SAFECO Corporation -*REPRINTED FROM THE ARCHIVE THE ORIGINAL. TRANSACTION MAY INCLUDE ADDITIONAL FORMS ...`. * REPRINTED FROM THE ARCHIVE THE ORIGINAI TRANSACTION MAY INCLUDE ADDITIONAL FORMS "" INSURING AGREEMENT We agree to provide the insurance described in this policy in return for the premium and compliance with all applicable provisions of this policy. The limit of our liability and the premiums are shown in the Declarations, which becomes a part of this policy. DEFINITIONS Throughout this policy, "you" and "your" refer to the "named insured" shown in the Declarations and the spouse if a resident of the same household, and "we," "us" and 'bur' refer to the Company providing this insurance. In addition, certain words and phrases are defined as follows: 1. "Business" means any trade, profession or occupation. 2. "Insured" means you and also: a. any member of your household. But with respect to motor vehicles to which this policy applies, a member of your household is covered only as follows: (1) while using a motor vehicle owned by you or any member of your household; (2) while using a motor vehicle not owned by you or any member of your household provided such use is with the reasonable belief that the person using it is entitled to do so; b. any person while using a motor vehicle or watercraft owned by, loaned to or hired by you or on your behalf with your permission, c. any person or organization using or having custody of animals owned by you and with your permission; d. with respect to aircraft chartered with pilot by you or on your behalf, any person using such aircraft or legally responsible for its use. None of the following is an insured: a. the owner or lessor of a motor vehicle or watercraft loaned to or hired by you or on your behalf; b. any person (other than you) while employed or engaged in the business of selling, maintaining, storing, parking or mooring motor vehicles or watercraft. Also any person or organization (other than you) with respect to their liability for the acts or omissions of any such person; c. any person or organization (other than you, your employees or agents or a member of your household) loading or unloading motor vehicles or watercraft, d. the owner, pilot, crew member, or any person operating any aircraft chartered with pilot by you or on your behalf; e. any aircraft or aircraft part manufacturer, sales or maintenance organization, airport or hangar operator, their employees or agents with respect to any occurrence arising out of such operations. 3. "Member of your household" means any person whose principal place of residence is the same as yours and who is: a. related to you by blood, marriage or adoption; or b. a ward or foster child. 4. "Motor vehicle" means a land motor vehicle, trailer or semi - trailer, including farm tractors, trailers and implements: a. designed for use principally on public roads; b. while being used on public roads, if subject to the motor vehicle registration law or financial responsibility law of the state of principal garaging. 5. "Personal injury" means: P- 9671CAEP W99 - -- 1 _ - -- a. bodily injury, sickness or disease, disability or shock including required care, loss of services and death resulting therefrom; b. mental anguish or mental injury; c. injury arising out of one or more of the following offenses: (1) false arrest, detention or imprisonment, or malicious prosecution or humiliation; (2) libel, slander or defamation of character; or (3) invasion of privacy, wrongful eviction or wrongful entry. 6. 7 8. " * REPRINTED FROM THE ARCHIVE THE ORIGINAL TRANSACTION MAY INCLUDE ADDITIONAL FORMS " * "Property damage" means physical injury to or destruction of tangible property including loss of its use. "Retained limit" means either: a. the limit of liability specified in the Schedule of Underlying Insurance of the Declarations for each underlying policy, plus the limit of any other underlying insurance collectible by the insured; or b. the amount shown under Retained Limit in the Declarations, as the result of an occurrence not covered by underlying policies of insurance. "Ultimate net loss" means the amount paid or payable in settlement of the loss for which any insured is held liable by: a. court judgment; or b. compromise involving our written consent. All recoveries and salvage collected will be deducted from this amount. "Ultimate net loss" does not include: a. loss expense or legal expenses (such as attorney's fees and court costs); b. salaries of employees; or c. office expenses incurred by any insured, us, or any underlying carrier. 9. "Occurrence" means: a. an accident, including continuous or repeated exposure to substantially the same general harmful conditions, which results, during the coverage period, in: (1) personal injury; or (2) property damage; b. an offense, committed during the coverage period, which results in personal injury. 10. "Residence premises" means: a. for a condominium or cooperative unit - owner or apartment resident: the unit where you reside shown as the residence premises in the Declarations of this contract; b. for all others: any of the following premises shown in the Declarations as the residence premises: (1) the one to four family dwelling, other structures and grounds where you reside in at least one of the family units; or (2) that part of any other building where you reside. COVERAGES PERSONAL LIABILITY 2. We will pay on behalf of the insured for the ultimate net loss in excess of the retained limit which the insured is legally obligated to pay as damages because of covered personal injury or property damage caused by an occurrence. DEFENSE COVERAGE 3. When a claim covered by this policy is made against any insured and such claim is not covered by the insured's underlying policies stated in the Declarations or by any other underlying insurance available for the insured, we will, subject to the retained limits: 1. Defend any suit against any insured, even if it is groundless or fraudulent. And we will investi- gate, negotiate and settle on behalf of the 4. insured any claim or suit as we deem appro- priate. P- 9671CAEP 9/99 Pay premiums for: a. bonds to release attachments; b. appeal bonds; and c. bail bonds; up to the limits of the policy. We will not apply for or furnish any such bonds. Pay all. a. our expenses; b. costs taxed against any insured in any suit we defend; c. interest accruing after entry of judgment until we have paid, tendered or deposited in court such part of the judgment which does not exceed our limit of liability. Pay reasonable expenses incurred by any in- sured at our request, including loss of earnings (but not loss of other income), up to $100 a day. —'REPRINTED FROM THE ARCHIVE THE ORIGINAL TRANSACTION MAY INCLUDE ADDITIONAL FORMS ***' We will pay for these expenses (except for claim or this agreement, we will pay any expense incurred suit settlement payments we make) in addition to with our written consent. the applicable limit of liability of this policy. In any The insured shall promptly reimburse us for any county where we are prevented from carrying out amount of ultimate net loss paid on behalf of the insured within the retained limit of liability. EXCLUSIONS This policy does not apply to: Any liability that is payable or must be provided for under a workers' compensation, occupational disease, unemployment compensation or disability benefits law. This exclusion does not apply with respect to workers' compensation coverage for domestic employees in the course of their duties related to the maintenance of residence premises. Any liability arising out of the ownership, maintenance or use, including loading or unloading of: a. any aircraft, except aircraft chartered with crew by you or on your behalf. This exclu- sion does not apply to model aircraft. Any aircraft designed for carrying persons or cargo is not a model aircraft; b. any motorcycle, moped, motor scooter, motorized bicycle or similar vehicle: (1) licensed for road use; or (2) subject to the financial responsibility laws of the garaging state. We will, however, cover any insured while operating a borrowed or rented motorcycle, as long as it is with the owner's permission, used for the purpose intended and not provided for the regular use of any insured; c. any watercraft while away from the premises that is owned by any insured if the watercraft is: (1) powered by an inboard or inboard - outboard motor; (2) a sailing vessel (with or without auxiliary power) of 26 feet or more in overall length; or (3) powered by one or more outboard motors with more than 25 total horsepower; (4) a personal watercraft. Personal watercraft means jet skis, wet bikes or other craft using a water jet pump powered by an internal combustion engine as the primary source of propulsion. unless, with respect to (1) -(4) above: (1) the watercraft is covered by an underlying policy and stated in the Declarations; and (2) notice is given to us within forty -five days after acquisition of any new watercraft and additional premium is charged. We will, however, cover any insured while operating a borrowed or rented watercraft regardless of size or horsepower, as long as it is with the owner's permission and used for the purpose intended. 3. Any liability arising out of: P- 967)CAEP 9199 3 � � any business pursuits or business property of any insured, except for: (1) the business use of a private pas- senger automobile or owned water- craft, unless used to carry persons or property for a charge; (2) the occasional or part-time self - employed business pursuits of any insured who is under 23 years of age; b. the rendering of any professional service or the omission of such service by any insured. 4. Any liability arising out of the maintenance or use, including loading or unloading, of any non -owned motor vehicle regularly used or available for use by you or any member of your household, if the motor vehicle is not covered by an underlying policy. 5. Any liability arising out of any insured's parti- cipation in, or preparation or practice for any racing or speed contest or similar competition involving a motorized land vehicle or motorized watercraft including personal watercraft, regardless of whether such contest is spontaneous, prearranged or organized. This exclusion does not apply to a sailing vessel less than 25 feet in overall length with or without auxiliary power. "" REPRINTED FROM THE ARCHIVE THE ORIGINAL TRANSACTION MAY INCLUDE ABC) TIONAL FORMS - 6. Any liability assumed by any insured under 15. any contract or agreement except any indemnity obligation assumed by the insured under a written contract directly relating to the ownership, maintenance or use of the premises. 7. Any personal injury or property damage of any insured providing home care services to any person on a regular basis by or at the direction of: any insured; b. any employee of any insured; c. any other person actually or apparently acting on behalf of any insured. Regular basis means more than 20 hours per week. This exclusion does not apply to: a. home care services provided to the relatives of any insured; b. occasional or part-time home care services provided by any insured under 23 years of age. 8. Any liability arising out of the transmission of a communicable disease by an insured. 9. Any injury caused by a violation of a penal law or ordinance committed by or with the knowledge or consent of any insured, except those caused by violation of a motor vehicle law. 10. Any personal injury arising out of sexual molestation or sexual harassment or physical or mental abuse. 11. Any personal injury or property damage arising out of the use, sale, manufacture, delivery, transfer or possession by any person of a controlled substance. Controlled sub- stances include but are not limited to cocaine, LSD, marijuana, PCP and all narcotic drugs. However, this exclusion does not apply to the legitimate use of prescription drugs by a person following the orders of a licensed physician. 12. Any injury sustained by any person as a result of an offense directly or indirectly related to the employment of this person by any insured, except domestic employees in the course of their duties related to the maintenance of the residence premises. 13. Any personal injury or property damage for any insured who is also covered under any nuclear energy liability policy. This exclusion applies even if the limits of liability of that policy have been exhausted. 14. Any personal injury to you or a member of your household. Any act or damage which is expected or intended by any insured, or which is the foreseeable result of an act or omission intended by any insured, which causes personal injury or property damage. But this exclusion does not apply to personal injury resulting from a reasonable action by any insured in: a. preventing or eliminating danger in the operation of motor vehicles or aircraft; or b. protecting persons or property. 16. Any act or omission of any insured as an officer or member of the board of directors of any corporation or organization except a nonprofit corporation or organization. 17. Any amounts payable under any Uninsured Motorists, Underinsured Motorists or Uninsured Watercraft Bodily Injury coverage. 18. Any property damage to: a. property owned by any insured; or b. aircraft rented to, used by or in the care of any insured; or c. any property rented to, used or occupied by or in the care of any insured except to the extent that we have agreed to provide insurance by special endorsement. 19. Any civic or public activities performed for pay by any insured. 20. Any loss caused directly or indirectly by war, including undeclared war, civil war, insurrection, rebellion, revolution, warlike act by a military force or military personnel, destruction or seizure or use for a military purpose, and including any consequence of any of these. Discharge of a nuclear weapon shall be deemed a warlike act even if accidental, 21. Any punitive damages awarded against an insured. 22. Any liability arising, in whole or in part, out of the actual, alleged, or threatened discharge, dispersal, seepage, migration, release, escape, emission, transmission, absorption, ingestion or inhalation of pollutants at any time. This includes any loss, cost or expense arising out of any: P- 967 1CAEP9 /99 a. request, demand or order that any insured or others test for, monitor, abate, clean up, remove, contain, treat, detoxify, neutralize, or in any way respond to, or assess, the effects of pollutants; b. claim or suit by or on behalf of a govern- mental authority for damages because of testing for, monitoring, cleaning up, *REPRINTED FROM THE ARCHIVF THE ORIGINAL TRANSACTION MAY INCLUDE ADDITIONAL. FORMS - removing, containing, treating, detoxifying, neutralizing, or in any way responding to, or assessing, the effects of pollutants. "Pollutants" means: a. liquid fuels; b. lead or any materials containing lead; c. asbestos or any materials containing asbestos; d. radon; e. formaldehyde or any materials containing formaldehyde; f. electric fields, magnetic fields, electromagnetic fields, power frequency fields, electromagnetic radiation or any other electric or magnetic energy of any frequency; g. carbon monoxide; or h. any other irritant or contaminant, including vapor, fumes, acids, alkalis, chemicals, radioactive substances and waste. CONDITIONS 1. Limit of Liability. Our liability shall be only for the ultimate net loss in excess of the insured's retained limit. Regardless of the number of insureds, claims made or persons injured, our total liability for all damages resulting from any one occurrence shall not exceed the limit of liability stated in the Declarations. All personal injury and property damage resulting from any one accident or from contin- uous or repeated exposure to substantially the same general conditions shall be considered to be the result of one occurrence. There is no limit to the number of occurrences during the policy period for which claim may be made. 2. Severability of Insurance. This insurance applies separately to each insured. This condition shall not increase our limit of liability for any one occurrence. 3. Duties After Loss. a. Upon the happening of an occurrence likely to involve us, written notice shall be given as soon as practicable to us or any of our authorized agents. Such notice shall contain: (1) particulars sufficient to identify the insured; (2) reasonably obtainable information regarding the time, place and circumstances of the occurrence or injury; (3) the names and addresses of the claimants and available witnesses. b. If a claim is made or suit is brought against the insured, the insured shall immediately notify us in writing. Also, forward to the underlying insurers and to us every demand, summons or other process received by the insured. c. The insured shall cooperate with the un- derlying insurers as required by the terms of the underlying policies. The insured shall cooperate with us and, upon our request, assist in: (1) making settlements; (2) conducting of suits; (3) enforcing any right of contribution or indemnity against any person or organization who may be liable to the insured because of loss covered by this policy or the underlying policies; (4) attending hearings and trials; (5) securing and giving evidence; and (6) obtaining the attendance of witnesses. 4. Appeals. If the insured or the underlying insurers elect not to appeal a judgment in excess of the underlying limits, we: a. may elect to make such appeal at our cost and expense; and b. shall be liable for the taxable costs and disbursements and incidental interest. P- 9671CAEP9199 . -__ 5 _.._ In no event shall our liability for ultimate net loss exceed the amount set forth in Condition 1, Limit of Liability, and in addition, the cost and expense of such appeal. 5. Suit Against Us. No action shall be brought against us unless there has been compliance with the policy pro- visions. No one shall have any right to join us as a party to any action against any insured. Further, no action shall be brought against us ^" REPRINTED FROM THE ARCHIVE. THE ORIGINAL. TRANSACTION MAY INCLUDE ADDITIONAL FORMS "" until the obligation of the insured has been 12. Waiver or Change of Policy Provisions. determined by final judgment or agreement A waiver or change of any provision of this signed by us. policy must be in writing by us to be valid. 6. Bankruptcy or Death. The insured's bankruptcy or insolvency shall not relieve us of any of our obligations. If, how- ever, the insured dies or becomes bankrupt or insolvent within the policy period, this policy, unless canceled, shall cover your legal repre- sentative for the unexpired term. 7. Payment of Loss. The insured may pay the amount of ultimate net loss to the claimant with our written consent to effect settlement and, upon submission of proof, we shall indemnify the insured for that part of such payment which is in excess of the retained limit. Or, we will, upon the insured's request, make such payment to the claimant on the insured's behalf. 8. Other Insurance. If other valid and collectible insurance is available to the insured covering.a loss also covered by this policy, other than insurance that is in excess of the insurance afforded by this policy, the insurance afforded by this policy shall be in excess of and shall not contribute with such other insurance. Nothing shall make this policy subject to the terms, conditions, and limitations of such other insurance. 9. Underlying Insurance Exhausted. If the limits of liability on any underlying policies of insurance are exhausted by any occurrence, we will assume charge of the settlement or defense of any claim against the insured resulting from the same occurrence. The provisions of Defense Coverage shall apply. 10. Policy Period and Territory. This policy applies to occurrences happening anywhere during the policy period which is stated in the Declarations. The policy may be renewed for successive policy periods if the required premium is paid and accepted by us on or before the expiration of the current policy period. The premium will be computed at our then current rate for coverage then offered. 11. Our Right to Recover Payment. After making payment under this policy, we will have the right to recover from anyone held responsible. The insured will sign papers and do whatever is required to transfer the right to us, and do nothing to harm this right. P- 9671CAF.P 9/99 13. Termination. This policy may be canceled as follows: a. You may cancel by: (1) returning this policy to us; or (2) giving us advance written notice of the date cancellation is to take effect. We will return the prorated unused share of your premium. b. We may cancel: (1) at any time for nonpayment of premium, whether payable to us or to our agent or under any finance or credit plan, by mailing at least 20 days in advance a notice to you at the address shown in this policy; or (2) for any reason during the first 60 days that this policy is in effect, by mailing at least 31 days in advance, a notice to you at the address shown in this policy; or (3) when this policy has been in effect for 60 days or more, or at any time if it is a renewal with us, if there has been a material misrepresentation of fact which if known to us would have caused us not to issue the policy. This can be done by notifying you at least 31 days before the date cancellation takes effect. c. We may elect not to renew this policy, We may do so by mailing at least 45 days in advance, a notice to you at the address shown in this policy, indicating the expiration date of this policy. d. We may deliver any notice instead of mailing it. Proof of mailing of any notice shall be sufficient proof of notice. e. We will return the prorated unused share of your premium within 25 days of the date cancellation takes effect. 14. Assignment. Assignment of this policy shall not be valid unless we give our written consent. 15. Conflicting Statutes. If any of the terms of this policy should conflict with state or local law, the insured can enforce them as if the terms had been changed to conform. ' " REPRINTED FROM THE ARCHIVE THE ORIGINAL TRANSACTION MAY INCLUDE ADDITIONAL FORMS '- 16. Maintenance of Underlying Insurance. Each policy, when applicable, as specified in the Schedule of Underlying Insurance of the Declarations, shall be maintained in full effect, without alteration, during the policy period, except for any reduction of the aggregate limit or limits due to payment of claims with respect to occurrences that take place during the policy period. If you fail to do so, this policy will not be invalid, but we shall only be liable to the extent that we would have been had you complied with this condition. If there is no recovery available to you as a result of insolvency of the underlying insurer or by reason of your having breached the contract of underlying insurance, the coverage of this policy shall apply in excess of the applicable limit of liability specified in the Schedule of Underlying Insurance of the Declarations. 17. Concealment or Fraud. This policy will be void if any insured has, before or after a loss: a. intentionally concealed or misrepresented any material fact or circumstances; or b. made false statements or engaged in fraudulent conduct relating to this insur- ance. 18. Liberalization Clause. P- 967lCAEP 9/99 ..___ 7 _..__ If we make a change which broadens coverage under this edition of our policy without additional premium charge, that change will automatically apply to your insurance as of the date we implement the change in your state. This liberalization clause does not apply to changes implemented in the underlying coverage. oe9/19/2999 15:15 3195440752 DR SASSOOPJ rmll 1P -1 0;('1111 is "3' U')Il11 ms, mph, cih providing management, health & safety services Lorraine Ward Human Resources Department City of El Segundo 350 Main Street El Segundo; California 90245 RE: Workers' Compensation lnsurwice Dear Ms. Ward: August 18, 2009 Due to the fact that Dr. Maureen Sassoon is self - employed and does not have any employees, Workers' Compensation insurance is not warranted and has not been obtained. Dr. Sassoon does maintain personal medical insurance through Kaiser Permanente. Cordially, Maureen Sassoon PAGE 01 p.o, box 2028 palos verdes peninsula ca, 9027`4