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PROOF OF INSURANCE (2015) CLOSEDC CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DDNYYY 10/31/2014 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), I PRODUCER Isk Strate les Company CONTACT T Risk .StrateQleS Company pp''.... � N,�..90; 949- 242 -9240 mmIT .... l Ia t ....... w 2040 Fain treet, Suite 450 PHONE Irvine, CA 926114 www.risk-strategies.com INSURED Lilley Planning Group, Inc. 564 S. Brea Blvd, Brea CA 92821 COVERAGES CA DOI License No. OF06675 CERTIFICATE NtIlY RF'R� 191AAn1A INSURER. D INSUREI"�. c INSURER D INSURER E INSURER F: RFVISIAN NI IMRFR• NAIC # 25674 22292 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. - .... -- ...TYPE OF INSURANCE MMlDD ���..... ..- .. ItdIS AD Ur3R' POLICY NUMBER .... _ POLICY EFF POLICY IEXJP LIMITS R /YYYY MMIDDIYYYY A w COMMERCIAL GENERAL LIABILITY v/ 6808337X973 9/19/2014 9119/2015 EACH OCCURRENCE $ $2,000,000 CLAIMS -MADE OCCUR pREM�GSEzrie) $ w $1,000,000 �. EXP,,,(Any „one person) .... $ $10,000 .............._.... PERSONAL & ADV INJURY _... $ $2,000,000 GrN L AGGREGATE LIMIT APPLIES PER: GENERAL A GGREGATE $ $4,000,000 POLICY ✓ PRO- LOC PRODUCTS - CO- COMP1pAGG $ 4,000,000 A Au roMOeaE uaelurY 6808337X973 9/19/2014 9/19/2015 �CF�OaD 6 �C beDtl'..I LE LIMIT $ $? 000 000 ANY AUTO ILY INJURY (Per person) $ ALL OWNED SCHEDULED _ AUTOS AUTOS BODILY INJURY (Per accident) $ NON -OWNED ✓ pROPCRt Y 17APJA4aE $ ✓ HIRED AUTOS AUTOS (P�rtta��Gtltarad' p UMBRELLA LIAB OCCUR EACH OCCURRENCE ............................._ $ EXCESS LIAB CLAIMS -MADE AGGREGATE. .. $.............................. .... _...,, DED RETENTION$ $ A WORKERS COMPENSATION ✓ UB4000T274 1/1/2014 1/1/2015 ER 07H AND EMPLOYERS' LIABILITY YIN ST4T TE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT 0 $ $1,000,000 OFFICER/MEMBER EXCLUDED? NIA ”' "" -�-- (Mandatory in NH) E.L., DISEASE EA EMPLOYEE $ $1,000,000 es. describe under 110, FSCRIPT'ION OF OPERATIONS beloow� E.L. DISEASE ICY POLICY LIMIT _ _ $ $1,000,000 B 'Professional Liability LH3A45833600 1011912014 1011912015 Per Claim: $2,000,000 Aggregate: $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Projects as on file with the insured. City of El Segundo„ Its officials and employees are named as addillonal Insureds and prit'nary/non- contributory clause applies to the general liability policy and a waiver of subrogation applies to the work comp policy -see attached endorsements. The above policies contain a 30 -day notice provision for non- renewal an Cancellation, 10 -day notice for non- payment of premium„ The non -owned and hired auto liability limit is subject to the general liability per occurrence limit. CERTIFICATE HOLDER CANCELLATION City of El Segundo', its officials and emloyee (w °I, Attn: City Clerk's o� �ice 850 Main St. El Segundo CA 90245 V' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Michael Christian ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD CERT NO.: 22184014 Sherry Young 10/31/2014 10:02:49 AM (PDT) Page 1 of 5 Insured: Lilley Planning Group, Inc. Policy No.: 6808337X973 Effective Date: 9/19/2014 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: w COMMERCIAL GENERAL LIABILITY COVERAGE PART " d �N SCHEDULE NAME OF PERSON(S) OR ORGANIZATION(S): City of El Segundo, its officials and employees PROJECT /LOCATION OF COVERED OPERATIONS: Projects as on file with the insured. PROVISIONS A. The following is added to WHO IS AN INSURED (Section II): The person or organization shown in the Schedule above is an additional insured on this Coverage Part, but only with respect to liability for "bodily injury", "property damage" or "personal injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: a. In the performance of your ongoing operations; b. In connection with premises owned by or rented to you; or c. In connection with "your work" and included within the "products- completed operations hazard ". Such person or organization does not qualify as an additional insured for "bodily injury", "property damage" or "personal injury" for which that person or organization has assumed liability in a contract or agreement. The insurance provided to such additional insured is limited as follows: d. This insurance does not apply to the rendering of or failure to render any .'professional services ". limits shown in the Declarations for this Coverage Part, whichever are less. This endorsement does not increase the limits of insurance stated in the LIMITS OF INSURANCE (Section III) for this Coverage Part. B. The following is added to Paragraph a. of 4. Other Insurance in COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): However, if you specifically agree in a "contract or agreement requiring insurance" that, for the additional insured shown in the Schedule, the insurance provided to that additional insured under this Coverage Part must apply on a primary basis, or a primary and non - contributory basis, this insurance is primary to other insurance that is available to such additional insured which covers such additional insured as a named insured, and we will not share with the other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought occurs; and (2) The "personal injury" for which coverage is sought arises out of an offense committed; after you have entered into that "contract or e. The limits of insurance afforded to the agreement requiring insurance" for such additional insured shall be the limits additional insured. But this insurance still is which you agreed in that "contract or excess over valid and collectible other agreement requiring insurance" to insurance, whether primary, excess, provide for that additional insured, or the contingent or on any other basis, that is CG D3 82 09 07 © 2007 The Travelers Companies, Inc. Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CERT NO.: 22184014 Sherry Young 10/31/2014 10:02:49 AM (PDT) Page 2 of 5 available to the additional insured when the additional insured is also an additional insured under any other insurance. C. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us in COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): We waive any rights of recovery we may have against the additional insured shown in the Schedule above because of payments we make for "bodily injury", "property damage" or "personal injury" arising out of "your work" on or for the project, or at the location, shown in the Schedule above, performed by you, or on your behalf, under a "contract or agreement requiring insurance" with that additional insured. We waive these rights only where you have agreed to do so as part of the ,.contract or agreement requiring insurance" with that additional insured entered into by you before, and in effect when, the "bodily injury" or "property damage" occurs, or the "personal injury" offense is committed. D. The following definition is added to DEFINITIONS (Section V): "Contract or agreement requiring insurance" means that part of any contract or agreement under which you are required to include the person or organization shown in the Schedule as an additional insured on this Coverage Part, provided that the "bodily injury" and "property damage" occurs, and the "personal injury" is caused by an offense committed: a. After you have entered into that contract or agreement; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. CG D3 82 09 07 © 2007 The Travelers Companies, Inc. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CEKT NO.: 22184014 Sherry Young 10/31/2014 10:02:49 AM (PDT) Page 3 of 5 Page 2 of 2 41 TRAVELERS Insured: Lilley Planning Group, Inc.�,� Policy No.: UB4000T274 � , Effective Date: 1/1/2014°� � WORKERS COMPENSATION AND EMPLOYERS LIABILITY ENDORSEMENT WC 99 03 76 (00) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT — CALIFORNIA (BLANKET WAIVER) 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. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 5.000% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization City of El Segundo, its officials and employees Job Description: Projects as on file with the insured Authorized Representative CERT NO.: 22184014 Sherry Young 10/31/2014 10:02:49 AM (PDT) Page 4 of 5 POLICY NUMBER: 6808337X973 UB4000T274 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED ENTITY - NOTICE OF CANCELLATION PROVIDED BY US This endorsement modifies insurance provided under the following:. ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: Number of Days Notice of Cancellation: 30 PERSON OR City of El Segundo, ORGANIZATION: its officials and employees Attn: City Clerk's office ADDRESS: 350 Main St. El Segundo CA 90245 PROVISIONS: If we cancel this policy for any statutorily permitted reason other than nonpayment of premium, and a number of days is shown for cancellation in the schedule above, we will mail notice of cancellation to the person or organization shown in the schedule above. We will mail such notice to the address shown in the schedule above at least the number of days shown for cancellation in the schedule above before the effective date of cancellation. IL T4 05 03 11 © 2011 The Travelers Indemnity Company. All rights reserved. CERT MG.: 221.8401.4 sherry Young 1.0(31./201.4 1.0:02:49 AM (PDT) Page 5 of 5 Page 1 of 1