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PROOF OF INSURANCE (2015) CLOSEDACCORV CERTIFICATE OF LIABILITY INSURANCE i /iMM /DDN ' PRODUCER (800) 955 -5578 FAX: (800) 530 -5725 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Palos Verdes Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 314 Vista Del Mar, PO Box 636 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 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 OFSUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS- ; wcwn TVaF nr 11JSIIRE1Jrr POLICY NUMBER �. V P ., POLICY ..nvw� naTF ruMm .. I EFFECTIVE POLICY EXP�RA��ON r LIMITS GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY A X CLAIMS MADE X OCCUR CBP1079676 GEN'L AGGREGATE LIMIT APPLIES PER X POLICY 1616- LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS CBP1079676 A X HIRED AUTOS X NON -OWNED AUTOS GARAGE LIABILITY ANY AUTO EXCESS / UMBRELLA LIABILITY OCCUR El CLAIMS MADE DEDUCTIBLE WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE I'"""""' OFFICER/MEMBER EXCLUDED? (Mandatory in NH) VH C±S, describe uMer S ECIAt, PROVISIONS bebw OTHER 1/2/2014 1/2/2015 1/2/2014 1/2/2015 Y EACH OCCURRENCE $ 2 r 000 DAMAGE TO RENTED PREMISES (Ea occurrence)_ S _000 100,000 MED EXP (Any one person) $ 5,0100 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 41 000,000 PRODUCTS .- COMPIOPAGG AUTO ONLY - EA ACCIDENT $ COMBINED SINGLE LIMIT 1,000,000 Ea accident) (n.,, �$ BODILY INJURY $ (Per person) BODILY INJURY $ (Per accident) PROPERTY DAMAGE ] $ i (Per accident) - AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EACH OCCURRENCE , $ GGREGATE $ S r$ m Wvv, orA6V- ' ,%daM..; UOfiY_LIMV l s: ER , E L. EACH ACCIDENT 1 $ EL. DISEASE -_EA ENPLOYEV. $ EL DISEASE - POLICY LIMIT { $ DESCRIPTION OF OPERATIONS 1 LOCATIONS /VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS The Certificate holder is hereby named as additional insured with respects to general liability per form #GECG602 (01 /11) Page 4 of 4 Paragraph B CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL A"XXMAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, "W)QXX0*XX %)QX City of E1 Segundo, Offioia an A6Do41�XE� Cd�)b)(i�I)6xX�kCdClsk Employees Attn: Administration Service ' 350 Main Street AUTHORIZED REPRESENTATIVE E1 Segundo, CA 90245 Denise Sutter /DENT ACORD 25 © 1988-2009 ACORD CORPORATION. All rights reserved. NSO 5(20090(2o09l01) The ACORD name and logo are registered marks of ACORD endorsement THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL UABIUTY GOLD ENDORSEMENT This modifies insurance v' under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SECTION I—COVERAGES COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY 2. Excklisllonil; Item 2.g. 2) is replaced with e following: watercraft o not own th is s than 50 feet long; and being b) Not s to carry persons or property for a charge. Itern 2. ) is added: 6) An aircraft in v ownership interest and that you have chartered crew. paragraph The last 2. ExcAusions is replaced following: Exclusions c.through n. do not apply to damage by fire, explosion, sprinkler leakage, or lightning td'premises while rented to you, temporarily occupied by you with the permission of the owner._, or managed:by ypu:und'or a written agreement with the owner. A separate limit of insurance applies to,-this oovefage as 'o pir bed in Section III—llrrfs of Instranoe. ,r SECTION I—COVERAGES COVERAGE C. MEDICAL PAYMENTS If Medical Payments Coverage is provided under this policy,the following is changed: 3. Lbft The medical expense limit provided by this policy shall be the greater of: a. $10,000; or b. The amount shown in the declarations. Coverage C. Medical Payments is primary and not contributing with any other insurance, even if that other insurance is also primary. The following is added; COVERAGE D.PRODUCT RECALL NOTIFICATION EXPENSES Insuring Agreement We will pay `product recall notification expenses" incurred by you for the withdrawal of your products,:.provided that a. Such withdrawal is required because of a determination by you during the policy period, that the use or consumption of your products could result in"bodily injury"or"property damage"; and b. The`product recall notification expenses" are incurred and reported to us during the policy period: The most we will pay for`product recall notification expenses"during the policy period is$100;000. SUPPLEMENTARY PAYMENTS—COVERAGES A AND B Item b. and d. are replaced with: b. The cost of bail bonds required because of accidents or traffic law violations arising out of.the.use;of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. d All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or`suit" including actual loss of earnings up to$500 a day because of time off from work. Includes copyrighted material of Insurance Services offices Inc.,with its permission. GECC,f602(01/11) . -., '.,r,.=., INSURED COPY ___., _.....,.--- .L__ SECTION N—WHO IS AN INSURED Item 4. is replaced with: 4. Any subsidiaries, companies, corporations, firms, or organizations you acquire or form during the policy period over which you maintain a controlling interest of greater than 50% of the stock or assets,will qualify as a Named Insured if: a) you have the responsibility of placing insurance for such entity; and b) coverage for the entity is not otherwise more specifically provided;and C) the entity is incorporated or organized under the laws of the United States of America. However, coverage under this provision does not apply to "bodily injury' or'property damage'tat:oocgurred before you acquired or formed the entity, or 'personal injury" or 'advertising injury" arising out of an offense committed before you acquired or formed the entity. Coverage under this provision is afforded only until the end of the policy period, or the twelve°(12) month anniversary of the policy inception date whichever is earlier. SECTION NI—LIMITS OF INSURANCE Paragraph 2 is amended to include: The General Aggregate Limit of Insurance applies separately to each 'location' owned by you, rented to you, or occupied by you with the permission of the owner. Paragraph 6. is replaced with the following: 6. Subject to 5. above,the Fire Damage Limit is the most we will pay under Coverage A for damages because of 'property damage'to premises while rented to you,temporarily occupied by you with permission of4he owner, or managed by you under a written agreement with the owner, arising out of any one free ezplosivn or sprinkler leakage incident. The Fire Damage Umit provided by this policy shall be the greater of: a $500,000; or b. The amount shown in the Declarations. SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS Item 2. a. is replaced with: 2 Dubies in The Event of Occurerme,Offense, Clain or Suit a. You must promptly notify us. Your duty to promptly notify us is effective when .any.of,your,}executive officers, partners, members,or legal representatives is aware of the'occurrence',offense;:olaim ;"ult". Knowledge of an'occurrence',offense,claim or'suit'by other employee(s) does not.imply you also.�have such knowledge. To the extent possible; notice to us should include: 1) How,when and where the'occurrence'or offense took place; 2) The names and addresses of any injured persons and witnesses;and 3) The nature and location of any injury or damage arising out of the 'occurrence', offense, claim or 'suir. Item 4. b. 1) b) is replaced with: b. Exoess Insurance 1) b) That is Fire, Explosion or Sprinkler Leakage insurance for premises .while rented to you, temporarily occupied by you with permission of the owner, or managed by you u fmder a written agreement with the owner, or Item 6. is amended to include: 6. Reprowntallons d If you unintentionalty fail to disclose any hazards existing at the inception date of your policy, we will not deny coverage under this Coverage Part because of such failure. Homer, this pf ^ls rl, oe 'not"Offect our right to oollect additional premium or exercise our right of cancellation or non-ren wal.` k"Kw copyrioted material of Insurance Services Offices Inc.,with Its pertninion. GECG 602(01111) IKIJQ1 tRFn r`npv Rem 8. is replaced with: 8. Transfer of Rights Of Recovery Against Others To Us a. If the insured has rights to recover all or part of any payment we have made under-this-Cbverage Part, those rights are transferred to us. The insured 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. b, if required by a written insured contract", we waive any right of recovery we may have against.any person or organization because of payments we mare for injury or damage,:arising,at�t of your ongoing operations or "your wore" done under that written "Insured contract" for that person or organization and included in the"produott's-completed operations hazard". Item 10. and Item 11. are added: 10. Cancelation Concition If we cancel this policy for any reason other than nonpayment of-premium we will mail or deliver-written notice of cancellation to the first Named Insured at least 60 days prior to the effective date of cancellation. 11. Liberafvation If we adopt a change in our forms or rules which would broaden your coverage without an extra charge, the broader coverage will apply to this policy. This extension is effective upon the approval of such- broader coverage in your state. SECTION V—DEFINITIONS The following definitions are added or changed: 9. `Insured contract" a. Is changed to: a. A contract for a lease of premises. However, that portion of the contract for ai lease of premises that indemnifies any person or organization for damage by fire, explosion or sprinkler leakage to;pttmises while rented to you, or temporarily occupied by you with permission of the owner,or manag6d.by you under a written agreement with the owner is not an"insured contract". 23 and 24 are added: 23. 'Location' means premises involving the same or connecting lots, or premises whose ,co.Ctnection is interrupted only by a street, roadway, waterway or right-of-way of a railroad. 24. `Product recall notification expenses" means the reasonable.additional expenses (including,.but.not limited to, cost of correspondence, newspaper and magazine advertising,. radio or.1elevision announcements and transportation cost), necessarily incurred in arranging for the return of products, but excluding costs of the replacement products and the cash value of the damaged products. The following Provisions are also added to this Coverage Part: A. ADDITIONAL INSUREDS—BY CONTRACT,AGREEMENT�OR PERMIT 1. Paragraph 2. under SECTION II — WHO IS AN INSURED is amended to include.:as :.an,insured any person or organization when you and such person or organization have agreed in writing in a contract, agreement or permit that such person or organization be added as an additional insured on your..policy to provide insurance such as is afforded under this Coverage Part. Such person or organization is not entitled to any notices that we are required to send to the Named Insured and is an additional insured only with respect to liability arising out of: a. Your ongoing operations performed for that person or organization; or b. Premises or facilities owned or used by you. With respect to provision 1.a. above, a person's or organization's status as an insured under this endorsement ends when your operations for that person or organization are completed. With respect to provision 1.b. above, a person's or organization's status as an insured under this endorsement ends when their contract or agreement with you for such premises or facilities ends. cf-:C,G-so2(01111) Includes copyrighted material of Insurance Services Offices Inc.,with its permission. ! � :^ user io=n r_n0V 2. This endorsement provision A.does not apply: a. Unless the written contrail or agreement has been executed, or permit has been issued, prior to the 'bodily iryury','property damage"or'personal and advertising injury'; b. To"bodily injury'or'p Dperty damage'occurring after. (1) All worts, trxluding materials, parts or equipment furnished In connection with such work' in the project (other than service, maintenance or repairs) to be performed by or on behad df the additional insured(s)at the site of the covered operations has been completed;or (2) TW portion of"your " 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 perkwming operatkm for a principal as a part of the same project; c. To the rendering of or failure to render any professional services including, but not limited`tio; any professional architectural, engineering or surveying services such as: (1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports,surveys,field orders, change orders or drawings and specifications;and (2) Supervisory, Inspection,architectural or engineering activities; d To "bodly injury', "property damage' or'personal and advertising injury' arising,out of anyact.ielror or omission that results from the additional insured's sole negligence or wrongdoing; e. To any person or organization included as an insured under provision EL of this endorsement, ` L To any person or organization specifically designated an additional insured for ongoing operations by a separate ADDITIONAL INSURED — OWNERS, LESSEES OR CONTRACTQR6,,,erdemoment Issued by us and made a part of this policy. B. ADDITIONAL INSURED—VENDORS Paragraph 2. under SECTION U—WHO IS AN INSURED is amended to include as an-insured-any person or organization (referred below as "v ) with whom you agreed, in a written contro Pr-agreement to provide insurance such as is afforded under this policy, but only with respect to "bodily.injury: or "property d " arising out of "your products" which are distributed or sold in the regular course of the vendor's business,subject to the following additional exclusions: 1. The insurance afforded the vendor does not apply to: a. 'Bodily Injury` or *property damage" for which the vendor is obligated to pay damages by reayson of the assumption of liability In a contract or agreement. This exclusion does not apply to`liabi)'ity for damages that the vendor would have to the absence of the contract or agreement; b. Any express warranty unauthorized by you; c. Any physical or chemical change in the product made intentionally by the vendor;. d Repackaging, unless unpacked solely for the purpose of inspection, dem onstrat rh,�testing, or substitution of parts under instructions from the manufacturer, and then repackaged in the origglnal container, e. Any failure to make such inspections, adjustments, tests or servicing. as the vendor hps agreed to make or normally undertakes to make in the course of business, in connection.with the distribution or sale of the products; L Demonstration, installation, servicing or repair operations, except such operations performed at the vendoes premises in connection with the sale of the product; g. Products which, after distribution or sale by you, have been labeled or relabeled or used as a container,part or ingredient of any other thing iDr substance by or for the vendor;or h. To 'bodily injury' or 'property damage' arising out of any act, error or omission-,that results from the additional insured's sole negligence or wrongdoing. 2. This insurance does not apply to any insured person or organization,from whom,yopvhave,acquired such products,or any ingredient, part or container, entering into,accompanying or containing such products. IncNides copyrighted material of Insurance Services offices Inc.,with Its permission. GECG 602(01111) page°4 olf4 u101 10Cn r%nDv E79(MMIDDIYYYY) '� "' '" CERTIFICATE OF LIABILITY INSURANCE /2014 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(ies) must 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 cON-rnCT Shannon Bailey Michael Ehrenfeld Company PHONE (619)683-9990 FAX .(619)683-9999 2655 Camino Del Rio North &MAIL shannonb@ehrenfeldinsurance.com #200 INSURER S AFFORDING COVERAGE NAIC# San Diego CA 92108 INSURERA:Preferred Em to ers Insurance••••_ 10900 INSURED INSURER B: Westchester Medical Group INSURERC: 360 N. Sepulveda Blvd INSURER D: Suite 3000 INSURERE: El Segundo CA 90245 INSURER F: COVERAGES CERTIFICATE NUMBER:14/15 REVISION NUMBER: 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. T .� POLICY EXP LIMITS INSR TYPE OF INSURANCE ADDL BR POLICY NUMBER tDICDY EFF PO MMIDDIYYYYI i GENERAL LIABILITY EACH OCCURRENCE $ D MArX , R N k. COMMERCIAL GENERAL LIABILITY PREMISE," f t r tort tar $ _.—..._ CLAIMS-MADE E]OCCUR MED EX one ipmmrson) $ I PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY El M LOC $ AUTOMOBILE LIABILITY tJf)MBtlP9ED SINfLt:I.tlMW'T` „j to as gclenl ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOSPer J ELLA LIAB OCCUR EACH OCCURRENCE $ S LIAB CLAIMS-MADE AGGREGATE $ RETENTION$ $ A WORKERS COMPENSATION X WC 8TATU-J 0TH- AND EMPLOYERS'LIABILITY '• ANY PROPRIETORIPARTNER/EXECUTIVE YIN E L.EACH ACCIDENT $ 10,000 OFFICERIMEMBER EXCLUDED? N/'4 6/1/2014 6/1/2015 (Mandatory in NH) N1410625 E L DISEASE-EA EMPLOYE $ 11000,000 if yes,describe under DESCRIPTION OF OPERATIONS below ®', _ E,L..DISEASE-POLICY LIMIT $ 1 000 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE HOLDER' CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of E1 Segundo City Cle ACCORDANCE WITH THE POLICY PROVISIONS. Admin Services Director 350 Main Street Room 5 AUTHORIZED REPRESENTATIVE E1 Segundo, CA 90245-3813 Gabe Erle/SB �- ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005)01 The ACORD name and logo are registered marks of ACORD