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PROOF OF INSURANCE (2010) CLOSEDCoverages This is to certify that the coverages listed below have been issued to the certificate holder named above for the certificate 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 coverage afforded described herein is subject to all the terms, exclusions and conditions of such coverage. Limits shown may have been reduced by paid claims. Type OfCoverago Certificate Number Coverage Effective Cover age Expiration Date Date Limits Property Real & Personal Prnnerty General Liability "MedExp omp /OP Agg Occurrence Adv Injury ® Claims Made 9061 7/1/200 9 7/1/2010 rrence 500,000 ge (Any one fire) Excess Liability ny one person) 9061 7/1/2009 7/1/2010 Each Occurrence 500,000 Other Description ofoporationa /Locatione/Vehiclog/9peeiat Items Coverage only extends for claims arising out of the Agreement for Consultant Services for the Community Development Block Grant Program for Home Delivered Meals with the City of El Segundo, for the term of the certificate. Holder of Certificate Additional Protected Person(s) City of El Segundo, its officials a d e loyee Office of the City Clerk 350 Main Street El Segundo, CA 90245 -3813 0771000016 Cancellation Should any of the above described coverages be cancelled before the expiration date thereof, the issuing company will endeavor to mail 30 days written notice to the holder of certificate named to the left, but- failure to ma such nonce shall impose no obligation or liability of any kind upon the company, its agents or repramtstiva. i Authorized Represontativs .i. ( {� 1 1 Certificate of Coverage Date: 4/28/2009 Certificste Holder This Certificate is issued as a matter of information only and Daughters of Charity of St, Vincent de Paul Province of the West confers no rights upon the holder of this certificate. This certificate 26000 Altamont Rd ext does not amend, end or alter the coverage afforded below. Los Altos Hills, CA 94022 Company Affording Covorage THE CATHOLIC MUTUAL RELIEF SOCIETY OF AMERICA Covered Location 10843 OLD MILL RD St. Vincent Senior Citizen Nutrition Program OMAHA, NE 68154 265 South Lake Los Angeles, CA 90057 Coverages This is to certify that the coverages listed below have been issued to the certificate holder named above for the certificate 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 coverage afforded described herein is subject to all the terms, exclusions and conditions of such coverage. Limits shown may have been reduced by paid claims. Type OfCoverago Certificate Number Coverage Effective Cover age Expiration Date Date Limits Property Real & Personal Prnnerty General Liability "MedExp omp /OP Agg Occurrence Adv Injury ® Claims Made 9061 7/1/200 9 7/1/2010 rrence 500,000 ge (Any one fire) Excess Liability ny one person) 9061 7/1/2009 7/1/2010 Each Occurrence 500,000 Other Description ofoporationa /Locatione/Vehiclog/9peeiat Items Coverage only extends for claims arising out of the Agreement for Consultant Services for the Community Development Block Grant Program for Home Delivered Meals with the City of El Segundo, for the term of the certificate. Holder of Certificate Additional Protected Person(s) City of El Segundo, its officials a d e loyee Office of the City Clerk 350 Main Street El Segundo, CA 90245 -3813 0771000016 Cancellation Should any of the above described coverages be cancelled before the expiration date thereof, the issuing company will endeavor to mail 30 days written notice to the holder of certificate named to the left, but- failure to ma such nonce shall impose no obligation or liability of any kind upon the company, its agents or repramtstiva. i Authorized Represontativs .i. ( {� 1 1 ENDORSEMENT (TO BE ATTACHED TO CERTIFICATE) Effective Date of Endorsement 7/1/2009 Charge Credit Cancellation Date of Endorsement Certificate Holder Daughters of Charity of St. Vincent de Paul Province of the West 26000 Altamont Rd Los Altos Hills, CA 94022 Certificate No. 9061 of The Catholic Mutual Relief Society is amended as follows: SECTION II - ADDITIONAL PROTECTED PERSON(S) It is understood and agreed that Section II - Liability (only with respect to Coverage D - General Liability, Coverage F - Medical Payments to Others and Coverage H - Counseling Errors and Omissions) is amended to include as an Additional Protected Person(s) members of the organizations shown in the schedule, but only with respect to their liability for the Protected Person(s) activities or activities they perform on behalf of the Protected Person(s). It is further understood and agreed that coverage extended under this endorsement is limited to and applies only with respect to liability assumed by contract or agreement; and this extension of coverage shall not enlarge the scope of coverage provided under this certificate or increase the limit of liability thereunder. Unless otherwise agreed by contract or agreement, coverage extended under this endorsement to the Additional Protected Person(s) will not precede the effective date of this certificate of coverage endorsement or extend beyond the cancellation date. Schedule - ADDITIONAL PROTECTED PERSON(S) City of El Segundo, its officials a mployees Office of the City Clerk 350 Main Street El Segundo, CA 90245 -3813 Remarks: Coverage only extends for claims arising out of the Agreement for Consultant Services for the Community Development Block Grant Program for Home Delivered Meals with the City of El Segundo, for the term of the certificate. PKS -122 (I -99) CtAuthorized gepresentativc I ACCW EY CERTIFICATE OF LIABILITY INSURANCE C DATE /j /2005 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION C.M.G. AGENCY, INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 10843 Old Mill Rd ALTER THE COVERAGE AFFORDED BY THE POLICIES 81 Omaha, NE 68154 402-551-8765 INSURERS AFFORDING COVERAGE NAIC# INSURED St Vincent Senior Citizen Nutrition Program INSURER A: Preferred Professional Tna. Co 265 South Lake INSURER B: Los Angeles, CA 90057 INSURER C: INSURER D: (tnVW0Af_%=Q 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, NSR LTR 00DI El Segundo, CA 90245-3813 POLICY NUMBER POLICY EF C IVE POTS YDIRA ION LIMITS AUTHORIZED SENTATIVE ___ -- - --- - GENERAL LIABILITY EACH OCCURRENCE a PREMISES Ea rence $ COMMERCIAL GENERAL LIABILITY CLAIMS MADE F—] OCCUR MED EXP (Any one person) $ PERSONAL d ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG S POLICY PRO LOC AUTOMOBILE X LIABILITY ANYAUTO COMBINED SINGLE LIMIT (Ea accident) $ 500,000 BODILY INJURY (Per Pew) a ALL OWNED AUTOS SCHEDULED AUTOS A X HIRED AUTOS NON•OWNEDAUTOS MAU0027242 -00 7/1/09 7/1/10 BODILY INJURY (Par accident) a PROPERTY DAMAGE (Per accident) S GARAGE LIABILITY AUTO ONLY -EA ACCIDENT $ OTHER THAN EA ACC AUTOONLY: AGG $ ANYAUYD $ EXCESS /UMBRELLA LIABILITY OCCUR D CLAIMSMADE EACH OCCURRENCE $ AGGREGATE S a $ DEDUCTIBLE S RETENTION S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR&ARTHERIEXECUTIVE D OFFICERIAIEMBER EXCLUDED? (Mandatory In NH! If yes, describe under SPECIAL PROVISIONS below RY E.L. EACH ACCIDENT S E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT I S OTHER A Comprehensive HAU0027242 -00 7/1/09 7/1/10 $500 Deductible Collision I $500 Deductible DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Coverage only extends for claims arising out of the Agreement for Consultant Services for the Community Development Block Grant Program for Home Delivered Meals with the City of El Segundo, for the term of the certificate. Ca•It aPhICATF W"I n6w ^A\V.t•P P A ^Lt City of B1 Segundo, its ofiiciala and employees SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Office of the City Clerk DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL. 3 0 DAYS WRrrm" 350 Main St NOTICE TO THE CERTIFICATE HOLDER NAMEO TO THE LEFT, BUT FAILURE TO DO SO SNALL El Segundo, CA 90245-3813 IMPOSE NO OBLIGATION OR LIABILITY OF ANY IGNO UPON THE INSURER, RS AGENTS OR REPRESENTATIVES. AUTHORIZED SENTATIVE ___ -- - --- - ' .-.vv, w w lwva,v y -711 00ollb P W1VU0- LUUHAGVKUGVKYVKATIUN. Ail rIgntsreserved. The ACORD name and logo are registered marks of ACORD IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(les) 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 The Certificate of Insurance on the reverse side of this form 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. %. i ACORN►® (MM /DD /YYYY) CERTIFICATE OF LIABILITY INSURANCE DATE 09/30/2009 F PRODUCER Aon Risk services Central, Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY Milwaukee wI Office AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 330 E. Ki 1 bou rn Avenue CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE Suite 450 Milwaukee wi 53202 -3179 USA COVERAGE AFFORDED BY THE POLICIES BELOW. 'HONE- 866 283 -7122 FAX-(847) 953 -5390 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Old Republic Ins Co 24147 Daughters of Charity - Province of the west INSURER B: 26000 Altamont Road Los Altos Hills CA 94022 USA INSURER C: INSURER D: INSURER E: rnvF.uA�F.c 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. tNSR ADD LIMITS SHOWN ARE AS REQUESTED LTR INS TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION ATE MM /DDIVYYY DATE MM/DDI LIMITS ERAL LIABILITY EACH OCCURRENCE COMMERCIAL GENERAL LIABILITY CLAIMS MADE M OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) v one person PERSONAL & ADV INJURY NOW GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE PRODUCTS - COMP /OP AGG POLICY PRO- LOC ❑ ❑ 1ECT AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) ALL OWNED AUTOS BODILY INJURY ( Per person) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (Per accident) NON OWNED AUTOS PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT ANY AUTO OTHER THAN EA ACC AUTO ONLY: EXCESS I UMBRELLA LIABILITY AGO ❑ OCCUR ❑ CLAIMS MADE EACH OCCURRENCE AGGREGATE DEDUCTIBLE RETENTION X C STATU- OTH- RY LIMITS -FR A WORKERS COMPENSATION AND EMPLOYERS• LIABILITY MWC E.L. EACH ACCIDENT $1,000,000 ANY PROPRIETOR / PARTNER / EXECUTIVE (Mandatory in NH) EXCLUDED? (Mandatory In NH) E.L. DISEASE-EA EMPLOYEE $1,000,000 Yves, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 OTHER DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS Cancellation Provision shown herein is subject to shorter or longer time periods depending on the jurisdiction of, and reason for, the cancellation. CERTIFICATE HOLDER f A a d"LIT r .....�, To whom It May concern CA . USA 25 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE is The ACORD name and logo are registered marks of ACORD1988 -2009 ACORD CORPORATION. All rights reserve e u 'v L d 9 O x tr lN0 O� m rn rn O O n z w R w f d U J g