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PROOF OF INSURANCE (2015) CLOSEDCERTIFICATE OF LIABILITY INSURANCE °09/23/x'/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOUDER. 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 PDlicy(les) must be endorsed. If SUBROGATION IS WANED, s11b eet to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certif ete sloes not confer rbghts to the certificate holder in lieu of such endorsament(s 1,- 800 - 807 -0300 T rs services PRODUCER _ Artex Risk Solutions, Inc. PHONE r �,r 1- 3istiaa Broths "" ,. NAIaIE _ Christian 00 -807 -0300 INC, - 630 -378 (CB) � FAX NoI. -2598 Two Pierce Place _IY,bDREwi .............. Itasca, IL 60143 -3141 . ... __ ----. .....,. ..... _._— ...... .M.. ..., .. ... .... __... .,_. !NSUROk ....,., . ... A_._ G D RA GE I PRINCETON EXCESS & U US LINES INS .. _ .. 1078.._ 6 . ..— ..... . ,ee INSURED INSURER5 OLD REPUBLIC INS CO 24147 ., Brothers of the Christian Schools a Affiliates Including: INSURER Loc. #1177028 DAUGHTERS OF CHARITY OF ST VINCENT DEPAUL'S ..-....c ... ... - -... 1205 Windham Parkway !NSURERD_ _WW,.,.... Romeville, IL 60446 -1679 "PERE INSURER F COVERAGES CERTIFICATE NUMBER: 41532942 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 "PERMS„ D CLAIMS. rA .... - ----- ...... -TYPE OF ..... INSURANCE OF SUCH. 0t� LIMITS SHOWN VE BEEN REDUCED ku DYDFBY PAID i Y __..... .......,...�..... -- -- LIMITS ...... ........ ._ X...._ EXCLUSIONS AND CONDITIONS _ _ GENER AL LIABILITY E N2 -A3 -EE 0000008 -00 06/15/1 06/15/15 ,2,000,000 FACHQ�CC4,PRN'LFM�iCE; $ . ucluded X COMMERCIAL,. GENERAL LIABILITY .�' ..... ,. ,,,,, ...... ..... .. ,r CLAIMS -MADE E � OCCUR ..PERSONAL B�ADV INJURY $ 15, 000 MED ...,. - ....,,.,m .., Inc3udsd ...GENERAL A_G4'JRIi4+.�A'TF... ,......---._.... GENI_AGGREGATE "LIMIT APPLIES PER _PRODUCTS LOMPOPAGG - include d - POLICY IIL'Ql $ B AUTOMOBILE LIABILITY IsIN '8 21543 0 115 COMrIBNNED SINGLE UMIN � 1,000,00 0""" E...... ANY AUTO .....__ ) $ ..BODILY INJURY (Per person ..,. ._ ..... _ ......._... ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ ,...... AUTOS A.......... --- .. ............... E a � Ni ON OWNED 6 OPEf i'Y DAMAi C $ N HIRED AUTOS ..........� AUTOS alit 1n'dL ..... S UMBRELLA I.IAS OCCUR EACH OCCURRENCE,.,.,. E .... .............. _... TE EXCESS IJAB C LAIMS�AADE AGGREGA $ , ...... ..... tl Me( RVTE14nO1S $ WORKERS COMPENSATION WC'STKVIJ OIH- ANY P�O LOVERS II A BIL Mr'JL"..X4:CUTI'u'E YIN E L EACH ACCIDENT NN i H . . Q3FFiCE"CWLA EXCLUDED' NIA ,_E L EACH EA EMPLOyr ' $ .... ... . (Mandatory In III) N t S, dersCarhae µ�C'pY9�!¢ ....... ... ... __ - .... .._...... .... d.' F'F.,S"'CRIP V"ION OF OPERATION'S Wow I .. -E L DISEASE - POI LIMIT $' A Ltd. Prof. Healthcare N2 -A3 -EE 0000008 -00 06/15/1 06/15115 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is requlred) Only the General Liability coverage will apply on a Primary and Non - Contributory basis (per attached endorsement) if required by fully executed written contract. Certificate Holder is added as an Additional Insured (per the attached endorsement) for General Liability coverage solely, strictly, and specifically with regards to: Renewal of St Vincent Heals on Wheels Agreement to provide home areal delivery to E1 Segundo homebound residents frT October 1, 2014 through September 30, 2015. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANC'EL'LEO BEFORE pity of 161 Segundo its Officials nd Ilmp Des THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 350 fain Street Ili Segundo, ACID, 90245 -3813 ACORD 25 (210101'05) j kovascavich 41532942 AUTHORIZED REPRESENTATIVE ®1988 -2010 ACORD CORPORATIOK All rights reserved. The ACCORD name and logo are registered marks of ACORD PnInMon E&S The Princeton Excess and Surplus Lines Insurance Company 555 College Road East, Primcceton, New Jersey 08543-5241 Phone. (800) 305-4954 POLICY NUMBER: N2-A3-EX-0000008-00 GENERAL LIABILITY NAMED INSURED: The Religious and Charitable Risk Pooling Trust Of the Brothers of the Christian Schools and Affiliates COVERAGE TERM- 6/15/2014 to 06115/2015 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under SECTION 11 INSURING AGREEMENT C, GENERAL LIABILITY COVERAGE defined within the Coverage Agreement. SECTION 1: Schedule Name of Additional Insured Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION WHEN' YOU HAVE AGREED IN AWRITTEN CONTRACT FOR THAT PERSON OR ORGANIZATION TO BE ADDED AS AN ADDITIONAL INSURED ON YOUR POLICY Designated Location(s) Of Covered Operations: If no entry appears above, information required to complete this endorsement will be shown in the Certificate of Coverage as applicable to this endorsement. Section 11 Insuring Agreement C —Name of Insured Amended A. Who Is An Insured defined in the General Insurance Agreement is amended to Include as an Additional Insured the person(s) or organizabon(s) shown in the Schedule above, but only with respect to liability in the performance of the Named Insured's ongoing operations for the Additional Insured(s) at the Location(s) designated in the Schedule above for 'bodily injury" or "property damage", caused in whole or in part, by the Named Insured's acts or omissions which takes place after the execution of a written agreement with the Additional Insured(s). B. For the coverage provided by this endorsement: the following paragraph is added to Section IV — General Conditions, Section 11, Insuring Agreement C - General Liability. This insurance is primai'y insurance as respects to this coverage to the additional insured person or organization, where the written contract or written agreement requires that this insurance be primary and noncontributory. In that event, we will not seek contribution from any other insurance policy available to the additional insured on which the additional insured person or organization is a Named Insured. C. Who Is An Insured is also amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, with respect to liability for 'bodily injury' or "property damage" caused, in whole or in part, by the "Named Insured's work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". D. The insurance provided to the additional insured person or organization does not apply to Bodily injury, Property Damage or Personal or Advertising Injury arising out of the rendering or failure to render any professional architectural, engineering or surveying services including: 1. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; 2. Supervisory, inspection, architectural or engineering activities. Section IV All Other terms and conditions of the Insuring Agreement remain unchanged. CERTIFICATE OF LIABILITY INSURANCE OATE(MMIODTTY%Yy 1 211112 01 4 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. IAAYUK I IN I: IT ino cernTacate Romer as an At the terms and conditions of the policy, certain certificate holder in lieu of such andorsementl PRODUCER Aon Risk services central, Inc. Milwaukee wi office 10700 Research Drive Suite 450 Milwaukee WI 53226 USA INSURED Dauqhters of charity - Province of the west 26000 Altamont Road LOS Altos Hills CA 94022 USA may require an endorsement. A statement on this certificate does not confer rights to the 1 ie i ii c. . (866) 283 -7122 1 r.V a,, ,.. (800) 363 - 0105 1) INSURER B: INSURER C: INSURER D: INSURER E: INSURER F: INSURER(S) AFFORDING COVERAGE NAIL # d Republic Insurance Comoanv 124147 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTW'ITHS'TANDING 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. Limits shown are as recauesh TYPE OF INSURANCE POLICY NUMBER LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS -MADE [:]OCCUR DMA E R:. TEU MED EXP (Any one person) PERSONAL& ADV INJURY GENILAGGREGATE LIMITAPPLIES PER: POLICY F-1....P�T El LOC GENERALAGGREGATE PRODUCTS- COMPIOPAGG OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO BODILY INJURY ( Per person) '. BODILY INJURY (Per accident) ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS P� OePERDAMAGE UMBRELLA LIAB OCCUR EACH OCCURRENCE AGGREGATE '.. EXCESS LAAB A DE WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETOR I PARTNERI EXECUTIVE OFFICERMEMBER EXCLUDED? N NIA (Mantlatoty In NH) n ve.s. desalbe under X TE A OTH• ER.,., ... E, L, EACH ACCIDENT �. 51,000,0 0 EL, DISEASE -EA EMPLOYEE $1,000,000 EL, DISEASE - POLICY LIMIT $1.000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) A waiver of subrogation is granted in favor of certificate Holder in accordance with the policy provisions of the wC policy. should any of the above described policies be cancelled before the expiration date thereof, the policy provisions will govern how notice of cancellation may be delivered to certificate holders in accordance with the policy provisions of each policy. CERTIFICATE HOLDER CANCELLATION 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, a AUTHORIZED REPRESENTATIVE 350 Main street E1 Segundo CA 90245 -31113 USA 01988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD w Jr c m 'O m a 0 2 E M 0 0 °n O Z 2 tti dl v WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 POLICY NUMBER: MWC 302585 00 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CAUFORNIA ft 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.) 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 INCL % of the California workers' compensation premium otherwise due on such remuneration. PERSON OR ORGANIZATION City of El Segundo 350 Main Street El Segundo, CA 90245 -3813 DATE OF ISSUE: 07 -31 -14 SCHEDULE JOB DESCRIPTION ON FILE WITH COMPANY 01998 by the Workers' Comp m allon Insurance ReUng Bureau of Calkxria. All fights remrved. From the WCIRB's CaHorMa Worksm' Compensadon Insurance Forms Mhnual ©1999. INSURED CCPY