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PROOF OF INSURANCE (2016) CLOSEDSOUTH-6 OP iii: KT "m (MMMY" CERTIFICATE OF LIABILITY INSURANCE 1 031231205 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 BETWEEM THE ISSUING INSURENS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pality(les) 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 endorsements ). PRODUCER Phone: 310-370-5000 COM"ACT PACIFIC UNIFIED INSURANCE P.O. Box 68 Fax: 310-370-545 PF- (AIC� NOV -awndale, CA 90260 Center Association, Inc. 410 So. Camino Real Redondo Beach, CA 90277 Co. COVERAGES CERTIFICATE NUMBER- 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. WWI LTR TYPE OF DURANCE ADDL SUSE POLICY Nwam POLICY EFF "www"M -"L-Cy 9XV Awm2m= LIM GENERAL UAStUTY EACH OCCURRENCE 3 1,000,000 A X COt CLAMS-MADE r-U-1 I A I OCCUR X 8502$8311218-7 03/31/2016 0313112016 PREMISES tea -004wor") 3 ea occurr4 NED EXP W-1 *ft E!Lsn) S PERSONAL& ADV KJURY S SEXUAL MJSCONDT-$ GENERAL AGGREGATE S 3,000,000 GENI AGGREGATE LVAIT APPLIES PM PRODUCTS -COMPIOPAGG S 310W.000 F-1 oOT - Loc 7 Poucy T F-1 - E mp Bon. 3 $1M1$3M AUTOMOSILE LIABILITY 9=R5E! La'T 1,000-am SWILYOWRY(perperson) s A ANYAuTo 8502SS311218-7 03131/2015 0313112016 ALLWNED AUTOS O worm NON-OWNED HMO AUTOS AUTOS SODRYINJURY(Peramiderd) S $ X UdBRELw LIAS X OCCUR EACH OCCURRENCE S 1,000,0oi AGGREGATE 6 1,000,000 A EXCESS LIAR CL VMS-MADS 6025$347908.5 03131/2015 0313112016 DED I X 1 sETENnoN$ 10,000 B -�Dc. WORKER$ COMPENSATION AND EMPLOVEW LIABILITY YIN OP ERMEMSEREXCLUDEW F ANY PROPRIFT ORVARTMEJUM-CUMF (14-da" wider imm InMJ w OPERATIONS below NIA 72WECPZ4112 1210112014 1210112015 E.L. EACH ACCIDENT S 1'000,000 DISEASE - EA EIAPLOYEE S '1100100 E.L. DISEASE - POLICY LWIT S 1,000, 000 A #11RapI Cost 8502SS311218-7 SPECIAL 0=112016 031311*6 BUILDING 359,400 A roe. #I/Repl Cost 8602SS311218.7 -SPECIAL 0313112015 0313IM16 CONTENTS 95,200 DESCRJPTM OF OPERATIONS I LOCATIM I VEHICLES (Mach ACORD 401, Additional Rentaft SchadWe, ff more space to roquhvd) Certificate Holder is included as Additional insured per the general liability extension form#14=42(03/14). RE:Counseling of abused children and their families who are referred to the South Bay Youth Project. SEE HOLDER. N=S FOR ADDITIONAL POLICY ]FORMS & CONDITXOKS. CITYOFE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN C4 of El Segundo CDBG Grant ACCORDANCE WrM THE POLICY PROVISIONS. Attn: Tina Gall 350 AUTHORMEDRePRESENTATIVE Main Street El Segundo, CA 90246 1 W taus -TUTU AUUKU CORPORATION. All rights reserved. ATTACHED TO AND FORMING PART OF COMMERCIAL GENERAL LIABILITY POLICY NUMBER: 3602SS311218-5 Markel Insurance Company LAI Various provisions in this endorsement modifil coverage, duties and what is and is not covered. 1;A I V "I -�, VItI'MAUNR PLUS Read the entire Policy carefully to determine rights, Throughout this endorsement the words 'you- and "your" refer to the Named Insured shown in the declarations. The words "we," "us" and "Our" refer to the company providing this insurance. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Unless specifically stated in this endorsement, all other terms, conditions and exclusions of the Policy remain unchanged, The following is a summary of the limits, additional coverages and extensions provided by this endorsement. For complete details on specific coverages, consult the policy contract wording. As respects any coverage provided by this endorsement, if higher limits are Provided on any other schedule, declarations, or endorsement attached to this policy, then the limits and coverage provided by this endorsement would not apply for that coverage. Medical Payments Supplementary Payments Boil Bonds Lon of Earnings Damage to Premises Rented to You Non-Owned Watercraft Non-Owned Aircraft Property Damage from Elevator Use Broadened Definition of Insured Mental Anguish Resulting from Bodily Injury Advertising Injury from Televised or Videotaped Material Broadened Definition of Mobile Equipment Per Location and Per Project Aggregates Additional Insured - Managers or Lessors of Premises Additional Insured - Vendors (Limited) Additional Insured-By Written Contract. Agreement or Permit Additional Insured-Mortgagee, Assignee, or Receiver Extended 'Property Damage" - Expected or Intended Injury Property Damage to Borrowed Equipment Property Damage to "Customers' Gonads", Medical Personnel Coverage Limited "Product Withdrawal" Expense Coverage Waiver of Transfer of Rights of Recovery Duties in the Event of "Occurrence'. Claim or -Suit" Unintentional Failure to Disclose Hazards Liberalization Increased to $10,000 per person (unless excluded) Up to $5000 Up to $500 a day UP to the General Liability Each Occurrence Limit Increased to 51 feet long If rented or loaned with a paid crew Included Included Included Included Included Included Included Included Included Included Included Up to $10.000 Per "occurrence. UP to $10,000 Per "occurrence" UP to $100,000 Per "Occurrence- if no other coverage form applies $10,000 per "Product Withdrawal' Included Included Included Included MGL232 105/091 COPYrOt, Markel Inwra"ce Company, 2009 Page 1 of 14 Includes c0p.Wighted material • ISO, Inc. with its permission L Medical Payments The following applies only if Medical Payments Coverage is not excluded from the Policy to which this endorsement Is attached; SECTION III - LIMITS OF INSURANCE, paragraph F. is deleted in its entirety and replaced by the following: 7. Subject to paragraph 6., Section III - Limits of Insurance, the Medical Expense Limit is equal to the Medical Expense Limit stated In the Declarations subject to a minimum of $10,000 and is the most we will pay under Coverage C for all medical expenses because of "bodily injury" sustained by any one person. H. SUPPLEMENTARY PAYMENTS - BAIL BONDS AND LOSS OF EARNINGS SUPPLEMENTARY PAYMENTS - COVERAGES A AND 9, paragraphs I.b. and I.d. are deleted in their entirety and replaced by the following: b. UP to $5000 for cost of ball bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which 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 d&y because of time off from work; 49; # A. When Damage To Premises Rented To You Limit is shown in the Declarations, Exclusion 1. of Coverage A. Section I is replaced by the following, J. Damage To Property "Property daniage" to; (1) Property you own, rent, or occupy, including any costs or expenses incurred by you, or any other person, organization or entity, for repair, replacement, enhancement, restoration or maintenance of such property for any reason, including prevention of injury to a person or damage to another's property; (2) Premises you sell, give away or abandon, if the "property damage" arises out of any part of those Premises; (3) Property loaned to you; (4) Personal property in the care, custody or control of the insured; (5) That particular part of real property on which you or any contractors or subcontractors working directly or indirectly on your behalf are performing operations, if the 'property damage' arises out of those operations; or (6) That particular part of any property that must be restored, repaired or replaced because "your work* was incorrectly performed on it. Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" (other than damage by fire) to premises, including the contents of such premises, rented to you. A separate limit of insurance applies to Damage To Premises Rented To You as described in Section III - Limits of Insurance. Paragraph (2) of this exclusion does not apply if the premises are "your work" and were never occupied, rented or held for rental by you. MGL232 (05109) Copyright Markel Insurance Company, 2009 Page 2 of 14 Includes copyrighted material of ISO. Inc. with its permission Paragraphs (3), (4), (5) and (6) of this exclusion do not aPPIY to liability assumed under a sidetrack agreement. Paragraph (6) Of this exclusion does not apply to "Property damage" # Products-completed operations hazard". included in the S. SECTION I - COVERAGE A.2. Exclusions is amended to delete the last paragraph and i replaced by the following! a 8 aced Exclusions c. through n, do not apply to damage by fire, lightning, explosion, Smoke or spfinkler leakage damage to Premises while rented to you or temporarily occupied by you with permission of the owner. A separate limit of insurance applies to this coverage as described in Section [if - Limits of Insurance. C. SECTION III - LIMITS OF INSURANCE, Paragraph 6. is replaced by the following: 6. SubJect to S. above, the Damage To Premises Rented To You Limit is the most we will Pay under Coverage A for damages because of "property damage* to any one promises while rented to you, or, In owe of damage by fire, lightning, explosion, smoke, or sprinkler leakage while rented to you or temporarily occupied by you with permission of the owner. The Damage To Premises Rented To You limit is the Each Occurrence Limit shown In the General Liability Declarations. D. COMMERCIAL GENERAL LIABILITY CONDITIONS SECTION, Paragraph 4.b.(I)(a)(11) or paragraph 4.b.0)(a1(111) is deleted and replaced by the following: That is fire, lightning, explosion, smoke or sprinkler leakage insurance for premises rented to you or temporarily occupied by You with permission of the owner; or E. DEFINITIONS SECTION , paragraph 9.a. Is deleted and replaced by the following: a. A contract for a Iowa Of Premises. However, that portion of the contract for a lease of premises that indernnifles any person or organization for damage by fire, lightning, explosion, smoke or sprinkler leakage to premises while rented to you or temporarily Occupied by You with permission. of the owner is not an "Insured contract'* IV. NON-OWNED WATERCRAFT AND NON-OWNED AIRCRAFT RENTED OR LOANED TO YOU WrM A CREW SECTION I - COVERAGES, COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Exclusion 9. - Aircraft, Auto or Watercraft, paragraph (1), is deleted in its entirety and replaced with the following. (2) A watercraft you do not own that is: (a) Less than 51 feet long; and (b) Not being used to carry Persons Or Property fol a charge. The following is added to g. (6) An aircraft not owned by any insured that is rented or loaned to You with a paid crew. If other insurance applies to a loss because of "property damage" non -awned watercraft ' described in (2)(a) and (b) or (6) above, the insurance provided te craft or aircraft as dad by this Coverage Form does not apply whether the other Insurance is primary, excess, contingent, or issued on any other basis. V- PROPERTY DAMAGE COVERAGE ARISING OUT OF ELEVATOR US- SECTION I - COVERAGES, COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Exclusion I. is amended to include the following: MGL232 (05109) COPYright Market Insurance Cornpany, 2009 Page 3 of 14 Includes CoMighted material of ISO, Inc. with its permission Paragraphs (3), (4) and (61 shall not apply to liability arising out of the uss of elevators. If other valid and collectible insurance applios to a loss because of "Property damage" arising out of the use of elevators, this Coverage Form shall apply excess of the other insurance, whether this other insurance is primary, excess, contingent, of Issued on any other basis. SECTION 11 -'MHO IS AN INSURED, is amended by the following; A. Paragraph 2. is amended to include the following as insureds: e. Any legally incorporated entity of which you own at least 51 % of the voting stock on the Inception date of this Coverage Form and on the date of any covered "occurrence", claim or "suit". This insurance shall not apply to any entity that is already an insured under any other insurance provided by any company or that would be an insured but for the exhaustion of Its limits of insurance. B. Newly Acquired or Formed Organizations Paragraph 3.a, is deleted In its entirety and replaced with: a. Coverage for your newly acquired or formed organization shalt be: 1. Effective on the date of acquisition or affirmation, and 2. Afforded until the end of the policy period of this Coverage Form. C. The following is added to Paragraph 2.&.: Paragraph (1) does not apply to executive officers, or to managers at the Supervisory level or above. VII. MENTAL ANGUISH COVERAGE THAT RESULTS FROM BODILY INJURY DEFINITION$ SECTION, Item 3.. Bodily Injury, is deleted in its entirety and replaced with the following, 3. "Bodily injury" means: a. Bodily injury, sickness or disease sustained by a person, and also includes mental anguish or emotional distress provided such mental anguish or emotional distress results from any of these; and b. Death resulting from bodily injury, sickness or disease, A. DEFINITIONS SECTION, Item 14, Personal and Advertising Injury, paragraphs d. and a. are deleted in their entirety and replaced with the following: d. Oral, written or professionally produced televised or videotaped publication of material In any manner that slanders or libels a person or organization, or disparages a person's or organization's goods, products or services; a. Oral, written or professionally produced televised or videotaped publication of material in any manner that violates a person's right to privacy; B. SECTION I - COVERAGES, COVERAGE S. PERSONAL AND ADVER11SING INJURY LIABILITY, Exclusions b. and c. are deleted in their entirety and replaced with the following: b. "Personal and advertising injury" arising out of oral, written or professionally produced televised or videotaped publication of material in any manner, if done by you or at your direction with knowledge of Its falsity; MGL232 (05109) Copyright, Markel Insurance Company, 2009 Page 4 of 14 Includes copyrighted material of ISO, Inc. with its permission a. "Personal and advertising injury" arising out of oral, written or professionally Produced televised or videotaped publication of material whose first publication took place before the beginning of the policy period. DEFINITIONS SECTION, item 12., Mobile Equipment,. paragraph f.0) is amended to add the following: This shall not apply to self-propelled vehicles of less than 1000 pounds gross vehicle weight. X. PER LOCATION AND PER PROJECT AGGREGATES SECTION III - LIMITS OF INSURANCE, is amended to add the following: A. For all sums which the insured becomes legally obligated to pay as dame caused by "occurrences under COVERAGE A (SECTION 1),' gas 0 es and for all medical expenses caused by accidents under COVERAGE C (SECTION 1), which can be attributed only to operations at a covered "location" or covered construction project: 1, A separate Per Location or Per Project General Aggregate Limit to each covered applies e h covered construction project, and that limit is equal to the amount of the General Aggregate Limit 2. The Per Location or Per Project General Aggregate Limit is the most we will pay for the sum of all damages under COVERAGE A, except damages because of "bodily injury" or "property damage- included in the "products-completed operations hazard", and for medical expenses under COVERAGE C regardless of the number of: a. Insureds; b. Claims made or "Suits" brought; or c. Persons or organizations making claims or bringing "suits". S. Any payments made under COVERAGE A for damages or under COVERAGE C for medical expenses shall reduce the Per Location or Per Project General Aggregate Limit for each covered "location' or covered project for which payment is made. Such Payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other covered "location" or covered project's general aggregate. 4. The limits shown In the Declarations for Each Occurrence, Fire Damage and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit Shown In the Declarations. such limits will be subject to the applicable Per Location or Per Project General Aggregate Limit. B. For all sums which the insured becomes legally obligated to pay as damages caused by under COVERAGE A (SECTION 1), and for all medical expenses caused by accidents under occurrences" (SECTION 1), which cannot be attributed only to ongoing o COVERAGE C project: operations at a coveted "location" or covered 1. Any payments made under COVERAGE A for damages or under COVERAGE C for medical expenses shall reduce the amount available under the General Aggregate Limit or the PrOdum-Completed Operations Aggregate Limit, whichever Is applicable; and 2. Such payments shall not reduce any Per Location or Per Project General Aggregate Lima. MGL232 (05109) Copyright, Markel Insurance Company, 20M Includes copyrighted meterial of ISO, Irr_ with its pertnisston Page 5 of 14 C. When coverage for liability arising out of the "products-completed operations hazard" is provided, any payments for damages because of "bodily injury" or "property damage" included In the "products - completed operations hazard" will reduce the Produots-Completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the Per Location or Per Project General Aggregate Limit. D. For the purposes of this section of this endorsement, "Location" means promises Involving the same or connecting, lots, or premises whose connection is interrupted only by a street, roadway, waterway or right-of-way of a railroad. E. If the applicable covered construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. F. The provisions of Limits of Insurance (SECTION 111) not otherwise modified by this endorsement shall continue to apply as stipulated. WHO IS AN INSURED (SECTION 11) is amended to include as an additional insured any person or organization who lasses to you or manages property you rent or lease, but only with respect to liability for "bodily Injury", "prop" damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your b0lialf in connection with that part of the premises leased or rented to you and shown on the Declarations. The following additional exclusions apply- This insurance does not apply to 1. Any "occurrence- which takes Piece after you cease to be a tenant in that premises. 2. Structural alterations, new construction or demolition operations performed by or on behalf of the person or organization who leases to you or manages property you rent or lease. The following provision applies only if the policy to which this endorsement is attached provides insurance for "bodily injury" and "property damage" included in the "products-completed operations hazard ": WHO IS AN INSURED (SECTION 11) is amended to include as an additional insured any person or organization (referred to below as vendor) with whom you agree In a written contract or agreement to Provide insurance, but only with respect to "bodily injury" or "property damage" 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 reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contra ll 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, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; a. Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with e distribution or sale of the products; nect th MGI 932 (05109) Copyright, Markel Insurance Company, 2009 Page 6 of 14 Includes copyrighted material of ISO, Inc. with its permission f- Demonstration, Installation, servicing or repair operations, except such operations performed at the vendor's promises in connection with the sale of the product; 9. Products which, after distribution or sale by you, have been label or relabeled r u as container, part or Ingredient of any other thing or substance by r for t 00 a o used o r he vendor; h. Any failure to maintain the product in a merchantable condition; or 1. 'Bodily injury" or "property damage* arising out of the sole negligence of the vendor for its own acts or omissions or those Of its employees or anyone else acting on its behalf- However, this exclusion does not apply to: (1) The exceptions contained in subparagraphs d. or f.; or (2) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, In connection with the distribution or sale of the products. 2. This Insurance does not apply to any insured person of organization from whom you have acquired such products, or any ingredient, part or container entering into, accompanying or containing such products, X111. ADDITIONAL INSUREI) - BY WRITTEN CONTRACT, AGREEMENT, PERMIT OR AUTHORIZATION The following paragraph Is added to WHO IS AN INSURED (Section 11); 4. Any person or organization for whom you are required by written contract, agreement, permit or authorization to provide Insurance is an Insured, subject to the following additional provisions: a. The contract, agreement, Permit or authorization must be in effect during the Policy Period shown in the Declarations, and must have been executed prior to the " bodily ", " a", or .personal and advertising injury". bO injury ", "property damage ", b. The person or organization is an insured only to the extent you are held liable due to: (1) The ownership, maintenance or use of that part of premises You own, rent, Wase or occupy subject to the following additional provisions.- (a) This insurance does not apply to any "Occurrence" which takes place after you cease to be -a tenant in any promises leased to or rented to you; (b) This Insurance does not apply to any structural alterations, now construction or demolition operations performed by or on behalf of the person or organization ' : (2) Your ongoing operations for that insured, whether the work Is performed by you or for you; (3) The maintenance, operation or use by you of equipment leased to you by such person or organization, subject to the following additional provisions,-- (a) The insurance does not apply to any "occurrence" which takes place after the equipment lease expires; (b) This insurance does not apply to "bodily injury" or "property damage- arising out of the 6018 negligence of such person or organization! (4) Permits or authorizations issued by any state or political subdivision with respect to operations performed by you or on your behalf, subject to the following additional provision: This insurance does not apply to 'bodily injury", 'Property damage", or "personal and advertising injury' arising out of operations performed for that state or municipality.. w. (0 5109) CopyrkA, Markel Insurance Company, 2009 Page 7 of 14 lil'icludes Copyrighted material Of ISO, Inc. with its permission c. The Insurance with respect to any architect, engineer, or surveyor, added as an "Insured" by this coverage, does not apply to "bodily injury", "property damage", of "personal and advertising injury" arising out of the rendering or failure to render any professional services by or for you, including: (1) The preparing, approving or failure to prepare or approve maps, drawings, opinions, reports, surveys, change orders, designs or specifications; and (2) Supervisory, Inspection or engineering services. d. This insurance does not apply to "bodily injury" or "property damage" included within the 'products- completed operations hazard-. A person's or organization's status as an Insured under this endorsement ends when your operations for that insured are completed. No coverage will be provided if, in the absence of this endorsement, no liability will be imposed by law an You. Coverage will be limited to the extent of your negligence or fault according to the applicable principles of comparative fault. This Additional Insured provision does not apply to Managers or Lessors of Premises, Vendors, or Mortgagees, Assignees, or Receivers. For Managers or Lessors of Premises, refer to ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES. For Vendors, refer to ADDITIONAL INSURED - VENDORS. For Mortgagees, Assignees or Receivers, refer to ADDITIONAL INSURED - MORTGAGEE, ASSIGNEE, OR RECEIVER. WHO IS AN INSURED (Section 11) is amended to include as an Insured the person or organization with respect to their liability as mortgagee, assignee, or receiver and arising out of the ownership, maintenance, or use of promises by you. This insurance does not appiv to structural alterations, new construction and demolition operations performed by or for that person or organization. Exclusion 2.a. of SECTION I - COVERAGES, COVERAGE A is deleted in its entirety and replaced by the following: a. 'Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to 'bodily Injury" or "property damage" resulting from the use of reasonable force to protect persons or property. A. Paragraph f4) of Exclusion J. of SECTION I - COVERAGE% COVERAGE A does not apply to " property damage" to borrowed equipment while that equipment is: 1. Not being used to perform operations; and 2. Away from an insured's premises. B. The insurance afforded by this provision is excess over any valid and collectible Property insurance (including any deductible) available to the insured whether primary, excess, contingent or on any other basis: C. SECTION III - LIMITS OF INSURANCE is amended to add the following, Subject to the General Aggregate provision, the most we will pay under this provision for "property damage" to borrowed equipment is $10,000 per "occurrence -.. MGL232 (05109) CopyrQht, Market Insurance Company, 2W9 Page 8 of 14 Includes copyrighted material of ISO, Inc with its permission XVII, PROPERTY DAMAGE - -CUSTOMERS' GOODS" U apply A. Paragraphs (3). (4), and (6) of Exclusion J. of SECTION I - covERAGES, COVERAGE A does not p to Property damage" to "customers' goods* while on your premises. B. The insurance afforded by this provision is excess over any valid and collectible Property insurance (including any deductible) available to the insured whether pri me , e ry, basis. xcess, contingent or on any other C. SECTION III - LlMrM OF: INSURANCE is amended to add the following: Subject to the General Aggregate provision, the most we will pay under this provision for "property damage" to "customers' goods* is $10,000 per "occurrence-, XVIII. MEDICAL PERSONNEL The following applies only if no other similar coverage is included an or added to the policy to which this endorsement is attached: The following is added to SECTION I - COVERAGES, COVERAGE A - Bodily Injury Inj and P Damage Liability - Insuring Agreement- roperty A. We will pay those sums the insured becomes legally obligated to pay as a result of an "occurrence" arising out of your employed registered nurse, licensed practical nurse, certified emergency medical technician or certified paramedic Performing professional health care services. This applies only to those professional health care services arising out of duties related to the conduct of your business. The registered nurse, licensed practical nurse, certified emergency medical technician Or certified paramedic must be your "employee". B. SECTION If - WHO IS AN INSURED Is amended to include the above designated "employees" for acts within the scope of their employment by you while performing duties related to the conduct of your business including duties arising out of his or her providing or failure to provide professional health services. C. SECTION III - LIMITS OF INSURANCE is amended to add the following,- Subject to the General Aggregate provision, the most we will Pay under Medical Personnel coverage is $100,000 for all professional health services sustained by any one person. XIX- LIMITED PRODUCT WITHDRAWAL EXPENSE COVERAGE THIS COVERAGE ONLY PROVIDES REIMBURSEMENT TO YOU FOR EXPENSES INCURRED BECAUSE OF A COVERED "PRODUCT WITHDRAWAL". THIS COVERAGE DOES NOT PROVIDE ANY LIABILITY COVERAGE OR COVERAGE FOR THE COST OR EXPENSE OF DEFENDING ANY CLAIM OR SUIT. A. The following is added to section I - Coverages: , 1, 11 - 1i ' 1;1-411T'Z,-U EXPENSE COVERAGE 1. Insuring Agreement (a) We will reimburse you for 'Product withdrawal expense" incurred by You because of a "product withdrawal" to which this insurance applies. The amount of such reimbursement is limited as described in Section In - Limfts of Insurance. NO other obligation or liability to pay sums or perform acts or services is covered. (b) This Insurance applies to a "Product withdrawal" only if the "product withdrawal' is Initiated in the "coverage territory" during the policy period because. (1) You determine that the "Product withdrawal" is necessary, or (c) We will reimburse 'product withdrawal expenses" only if: (1) The expenses are incurred within one Year Of the date the "product withdrawal" was Initiated; (2) The expenses are reported to us within one year of the date the expenses were incurred; and (3) The product that is the subject of the "Product withdrawal" was produced after the inception date of this policy or the date this endorsement was added, whichever is earlier, (d) The initiation of a 'product withdrawal" will be deemed to have been made only at the earliest of the following times: (1) When you first announced, in any manner, to the general public. your vendors, or to your employees (other than those directly Involved in making the determination) your decision to conduct or participate in a "product withdrawal". TNS applies regardless of whether the determination to conduct a "product withdrawal" is made by you or Is requested by a third party; or 12) When you first received, either orally or In writing, notification of an order from an authorized government entity to conduct a "product withdrawal". (a) "Product withdrawal expenses, incurred to withdraw "your products" which contain the same or substantially similar 'defects" will be deemed to have arisen out of the same "product withdrawal". 2. Exclusions This insurance does not apply to "product withdrawal expenses" arising out of: (a) Breach Of Warranty And Failure To Conform To Intended Purpose Any "Product withdrawal" initiated due to the failure of 'Your product" to accomplish their Intended purpose, Including any breach of warranty of fitness, whether written or implied. This exclusion does not apply if such failure is reasonably expected to cause "bodily injury" or "physical damage" to tangible property other than "your product". (b) Infringement Of Copyright, Patent, Trade Secret, Trade Dress Or Trademark Any "product withdrawal" initiated due to copyright. patent, trade secret, trade dress or trademark infringements. (c) Deterioration, Decomposition Or Chemical Transformation Any "product withdrawal" initiated due to transformation of a chemical nature, deterioration or decomposition of "your product". This exclusion does not apply if it is caused by; £1) An error in manufacturing, design or processing; (2) Transportation of "your product"; or (3) "Product tampering". (d) Goodwill, Market Share, Revenue, Profit Or Redesign The costs of goodwill, market share, revenue or "profit" or the costs of redesigning 'your product". [e) Expiration Of Shelf Life Any "Product withdrawal" initiated due to expiration of the designated shelf life of "your product-, MGL232 (05/091 Copyright, Markel Insurance Company, 2009 . Inc with its permission Includes copyrighted material of ISO. P899 10 of 14 (fl Known Defect A "product withdrawal" Initiated because of a "defect" in 'Your product" known to exist by the Named Insured or the Named Insured's "executive officers', prior to the date when this Coverage Part was first issued to You or prior to the time "Yourproduct' leaves your control or possession. (9) Otherwise Excluded Products A recall of any specific products for which "bodily Injury" or "property damage" is excluded under Coverage A - Bodily Injury and Property Damage Uability by endorsement. (h) Governmental Ban A recall when "your product' or 8 component contained within "your product" has been!. (II Banned from the market by an authorized government entity prior to the policy period, or (2) Distributed or sold by you subsequent to any governmental ban. (1) Defense Of Claim The defame of a claim or "suit" against you for liability arlsing out of a "product withdrawal". (j) Third Party Damages. Fines And Penalties Any compensatory damages, flnes, penalties, punitive or exemplary or other non-compensatory damages imposed upon the insured. (k) PolkWon-Related Expenses Any loss, cost, or expense due to any: (1) Request, demand, order, statutory or regulatory requirement that any insured or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of, "pollutants", or (2) Claim or suit by or on behalf of a governmental authority for damages because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing, or In any way responding to or assessing the effects of, "pollutants". B. For purposes of this endorsement, section III - LIMITS OF INSURANCE is replaced by the following: SECTION III - LIMITS OF INSURANCE The most that we will reimburse you for under this coverage is $ 10,000 regardless of the number of: (a) Insureds; (Is) "Product withdrawals" initiated; or (c) Number of "your products" withdrawn. The $10,000 limit is the most that we will reimburse you for the sum of all "product withdrawal expenses' incurred for all "product withdrawals" initiated during the policy period. MGL232 (05109) Copyrigift, Markel Insurance Company, 20M Page I I of 14 InclWles copyrighted material of ISO, Inc. With its permission C. For the purposes of this coverage, the Duties In The Event Of Occurrence, claim Or Suit Condition under Section IV - Conditions is replaced by the following: 2. Duties In The Event Of A "Defect" Or A 'Product Withdrawal- a. You must see to it that we are notified as soon as practicable of any actual, suspected or threatened "defect" in "your product", or any governmental investigation, that may result in a "product withdrawal". To the extent possible, notice should include: (1) How, when and where the "defect" was disrovered; (2) The names and addresses of any injured persons and witnesses; and (3) The nature, location and circumstances of any injury or damage arising out of use or consumption of "your product". b. If a "product withdrawal" is initiated, you must: (1) Immediately record the specifies of the "product withdrawal" and the date where it was initiated; and (2) Notify us as soon as practicable. You must see to It that we receive written notice of the "product withdrawal" as soon as practicable. c. You must promptly take all reasonable steps to mitigate the expenses associated with a "product withdrawal". Any "profit" that you receive from mitigating the expenses will be deducted from the amount of reimbursement that you will receive for 'product withdrawal expenses". d. You and any other involved Insured must: (1) Immediately send us copies of pertinent correspondence received In connection with the .'product withdrawal"; (21 Authorize us to obtain records and other information; and (3) Cooperate with us in our investigation of the "product withdrawal'. D. For the purposes of this coverage, the following is added to Section IV - Conditions: Concealment Or Fraud We will not provide coverage under Section I to you, or any other insured, who at any time: 1. Engaged in fraudulent conduct; or 2. Intentionally concealed or misrepresented a material fact concerning a 'product withdrawal" or "product withdrawal expenses" incurred by you under Section I of thi,,4 coverage. XX- WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Item 8., Transfer of Rights of Recovery Against Others to Us of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS is amended by the addition of the following: We agree to wave any right of recovery we may have against any person or organization with whom you have agreed by contract prior to an 'occurrence" to waive such rights because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a wntract with that person or organization and included in the "products-completed operations hazard". The waiver applies only to the person or organization with whom you have agreed in a contract prior to an "occurrence" to waive such rights. MGL232 (061091 Copyright, Market Insurance Company, 2009 Page 12 of 14 Includes copyrighted material of ISO, Ine- with Its permission XXI. DUTIES IN THE EVENT • OCCURRENCE, OFFENSE, CLAIM OR SUrl SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, Item 2., Duties In the Event Of Occurrence, Claim or Suit, is amended to include the following; a, Your obligation to notify us as Soon as practicable of an "Occurrence", Offense, claim or "Suit' is satisfied If you send us written notice as soon as practicable after any of Your "executive officers', directors, partners, insurance managers or legal representatives becomes awale of or should have become aware of such -occurrence", offense, claim or Suit". SECTION III/ - COMMERCIAL GENERAL LIABILITY CONDITIONS, is amended to include the following: Based on our reliance on your representations as to existing hazards, If you unintentionally fail to disclose all such hazards prior to the beginning of the policy period of the Coverage Part, we shall not deny coverage under this Coverage Part because of such failure. SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, is amended to include the following: if we revise this Coverage Form to provide more coverage without additional premium charge. your Policy Will automatically provide the additional coverage as of the day the revision is effective In your state. ►. ,� =1 7 The following definitions are added: 1. "Customers' goods' mean tangible personal property belonging to your customers and left with you for storage, service or repair. "Customers' goods" do not include: a. Accounts, bills, currency, deeds, food stamps or other evidences of debt, money, notes or securities. Lottery tickets held for sale are not securities; b. Animals; c. Contraband, or property in the course of illegal transportation or trade, d. Personal property while airborne or waterborne; a. Property that is covered under another coverage form of this or any Other policy In which it is more spwficafly described, except for the excess of the amount due (whether you can collect on it or not) from that other insurance,-, f. Vehicles or self-propelled machines (including aircraft or watercraft) that are licensed for use on public roads. This paragraph does not apply to: (1) Vehicles or self-propelled machines, other then 'autos', you hold for sale, or (2) Rowboats or canoes out of water at the described premises; g. The following property while outside of buildings: (1) Grain, hay, straw or other crops; (2) Fences, radio or television antennas (including satellite dishes) and their lead-in wiring, masts or towers, signs iother than signs attached to buildings), tress, shrubs or plants (other than trees, shrubs or plants held for sale). MGL232 (051 09) Copyright, Markel Insurance Company. 2009 Page 13 of 14 Includes copyrighted material of ISO, Inc. with its permission 2. "Defect" means a defect, deficiency- or inadequacy that creates a dangerous condition. 3. "Product tempering" is an act of intentional alteration of 'your product" which has caused or is reasonably expected to cause "bodily injury" or physical injury to tangible property other than "your product". When "product tampering" is known, suspected or threatened, a "product withdrawal" will be limited to those batches of "your product" which are known or suspected to have been tampered with. For purposes of this insurance, electronic data is not tangible property. As used in this definition, electronic deta means information, facts or programs stored as or on, created or used on, or transmitted to or from computer software, Including systems and application software, hard or floppy disks, CD-ROMs, tapes, drives, cells, data processing devices or any other media which are used with electronically controlled equipment. 4. "Product withdrawal" means the recall or withdrawal: a. From the market, or b. From use by any other person or organization; of "your products" or products which contain "your products", because of known or suspected "Product tampering", which has caused or Is reasonably expected to cause "bodily injury" or physical Injury to tangible property other than "your product". For purposes of this insurance, electronic data is not tangible property. As used in this definition, electronic data means information, facts or programs stored as or on, created or used on, or transmitted to or from computer software, including systems and applications software, hard or floppy disks, CD-ROMs, tapes, drives, calls, data processing devices, or any other media which are used with electronically controlled equipment, 5. "Product withdrawal expenses" means those reasonable and necessary extra expenses, listed below, paid and directly related to a "product withdrawal",-. a. Costs of notification; b. Costs of stationery, envelopes, production of announcements and postage or facsimiles; 0. Costs of overtime paid to your regular non-salary employees and costs incurred by your employees, including costs of transportation and accommodations; d. Costs of computer time; a. Costs of hiring independent contractors and other temporary employees; f. Costs of transportation, shipping or packaging; 9. Costs of warehouse or storage space; or h. Costs of proper disposal of "your products" or products that contain "your products" that can not be reused, not exceeding your purchase price or your cost to produce the products. 6. "Profit" means the positive gain from business operation after subtracting for all expenses. All other terms and conditions remain the same. MOL232 (05109) Copyright, Markel insurance Company, 2009 Page 14 of 14 Includes copyrighted material of ISO, Inc, with its permission MUM ii�ililill, , � ljjjji�l 11111' ljl� 'T 1 WORKERS' COMPENSATION BROAD FORM E14DORSEMENT EXTENDED OPTIONS Policy Number: 72 WEC PZ4112 Endorsement Number: Effective Date: 12/01/14 Effective hour Is the same as stated on the InformaUon page of the policy. Named Insured and Address: SOUTH BAY CHILDREN I s HEALTH CENTER ASSOCIATION, INC. 410 CAMINO REAL RMONDO BEACH, CA 90277 Section I of this endorsement expands coverage provided under WC 00 00 00. Section If ♦ this endorsement provides additional coverage usually only provided ♦ endorsement. Section III of this endorsement Is a Schedule of Covered States. You may use the index to locate these coverage features quickly. SUBJECT E&G-9 I SIUBJEC PAGE SECTION 1 2 B. Part One Does Not Apply 3 PARTS ONE and TWO 2 C. Application of Coverage 3 01 We Will Also Pay 2 D. Additional Exclusions 3 PART-THREE 2 E. West Virginia 3 02 How This Insurance Works 2 EXTENDED OPTIONS 4 PART - SIX 2 01 Employers' I-Jability Insurance 4 03 Transfer of Your Rights and Dudes 2 02 Unintentional Failure to Disclose 4 04 Liberalization 2 Hazards SECTION 11 2 03 Waiver of Our Right to Recover from 4 VOLUNTARY COMPENSATION INSURANCE 2 Others 05 Voluntary Compensation Insurance 04 Foreign Voluntary Compensation 4 A. How This Insurance Applies 2 A. How This Reimbursement Applies 4 a. We Will Pay 2 B. We Will Reimburse 4 C. Exclusions 3 C. Exclusions 4 D. Before We Pay 3 D. Before We Pay 5 E. Recovery From Others 3 E. Recovery From Others 5 F. Employers' Liability Insurance 3 F. Reimbursement For Actual Loss 5 EMPLOYERS' LIABILITY STOP GAP 3 Sustained ENDORSEMENT 3 G. Repatriation 5 06 Employers' UabHfty Stop Gap H. Endernic Disease 5 3 05 Longshore and Harbor Workers' 5 A. Stop Gap Coverage Limited to Compensation Act Coverage Wntana, North Dakota, Ohio, 3 Endorsement •Coverage Washington, West VWJnla and SECTION 111 6 VVyoming 01 Schedule of Covered States 6 Form VX 99 03 03 B Printed In U.S.A. (Ed. 8/00) Fero baste: 10/22/14 Page I of 6 Policy Expiration Date: 12/01/15 1 . reasonable expenses Incurred at our request INCLUDING loss of earnings; 2. premiums for bonds to release attachments and for appeal bonds In bond amounts up to the limit of our liability under this insurance; 3. litigation costs taxed against you; 4. interest an a judgment as required by law until we offer the amount due under this law:, and 5. expenses we incur, Ems • fff WAY LIABILITY COVERAGE T. Voluntary Compensation Insurance A- How This Insurance Applies This Insurance applies to bodily injury by accident or bodily injury by disease. Bodily injury Includes resulting death. 1. The bodily injury must be sustained by any officer or employee not subject to the workers' compensation law of any state shown in Item 3.A. of the Information Page. 2. The bodily Injury must arise out of and in the course of employment or Incidental to work In a state shown In Item 3A. of the Information Page. PARTTHREE 2. How This InsumnceApplies 193 If we adopt a change in his form that would broaden the coverage of this form without extra charge, the broader coverage will apply to this Policy. It will apply when the change becomes of eclive in your state. 3. The bodily injury must occur in the United States of America, its territories or possessions, or Canada, and may occur elsewhere if the employee Is a United States or Canadian citizen, or otherwise legal resident and legally employed, In the United States or Canada and temporarily away from those places. 4. Bodily Injury by accident must occur during the policy period. 5. Bodily injury by disease must be caused or aggravated by the conditions of the Form WC 99 03 03 B Printed In U.S.A. (Ed. 8/00) Pap 2 of 6 ifficer's • employee's employment The ,MG&S or employee's last day of last zxp•sure to the conditions causing • aggravating such bodily injury by disease must occur during the poky period. We will pay an amount equal to the benefits that would be required of you as if you and your employees were subject to the workers' compensation law of any state shown In stern 3A of the Information Page. We will pay those amounts to the persons who would be entitled to them under the law. rvlm�� 1. any obilgiation imposed by workers' compensation oroccupationat disease law or any sknilar law. 2. bodily Injury intentionally caused • aggravated by you. 3. officers or employees who have elected not to be subject to the state workers' compensation law. 4. partners or sole proprietors not covered under the Standard Sole Proprietors, Partners, Officers and Others Caverage Endorsement D. Before We Pay Before we pay benefits to the persons entitled to them, they must 1. Release you and us, In writing, of all responsibility for the injury or death. 2. Transfer • us their right to recover from others who may be responsible for the Injury or death. 3. Cooperate with us and do everything necessary ♦ enable us to enforce the right to recover from others. If the persons entitled to the benefits of this Insurance fall to do those things, our duty to pay ends at once. If they claim damages from you or from us for the Injury or death, our duty to pay ends at once. E. Recovery From Others If we make a recovery from others, we will keep an amount equal to our expenses of recovery and the benefits we paid. We will pay the balance to the persons entitled to IL P. Part One (Workew Compensation insurance) does • apply to work In states shown in Paragraph A above. C. Part Two (Employers' Liabft Insurance) applies In the states, shown In Paragraph A, as though " were shown In Item 3A of the Information Page. D. Part Two, Section C. Exclusions is changed by adding ftse exclusions. This insurance does not cover; S. bodily injury Intentionally caused • agigravated by you or In Ohio bodily injury resulting from an act which is determined by an Ohio court of law to have been comrrdtted • you with the belief than an injury is substantially certain to occur. However, the cost of defending such claims • suits in Ohio is ocnered. 13. bodily injury sustained by any member of the flying crew of any aircraft 14, any claim for bodily Injury with respect to which you are deprived of any defense or defenses or are otherwise subject to penalty because of default In premium under the provisions of the workers' compensation law or Lams of a state shown In Paragraph A. E. This Insurance applies to damages for which you are liable under West Virginia Code Annot S23-4-2. Form WC 99 03 03 B Printed in U.SA (Ed. 8100) Page 3 3 f 6 4A114 MAN Form WC 99 03 03 B Pdrited In U.S.A. (Ed. OW) Page 4 of 6 4. liability for any consequence. whether direct or lndlrec� of war, Invasion, act of Foreign enemy, hostilities (Whether war be declared or not), civil war, rebellion, revolution, Insurrection or military or usurped power. No endorsement now or subsequently attached to this policy shall be construed as overriding or waiving this limitation unless specific reference is made thereto. D. BefbM We Pay Before we reimburse you for the benefits to the persons entitled to them, you must have them: 1. release you and us, in writing, of aff responsibility for the injury or death, 2. transfer to us thek right to recover from others who may be responsible for their injury or death, 3. cooperate with us and do everything necessary to enable us to enforce the right to recover from others. If the persons entitled to the benefits paid fail to do these things, our duty to reimburse ends at once. If they claim damages from us for the injury or death, our duty to reimburse ends at once. If we make a recovery from others, we will keep an amount equal to our expenses of recovery and the benefits we reimbursed. We will pay the balance to the persons entitled to ft. If persons entitled to the benefits make a recovery from others, they must repay us for the amounts that we have reimbursed you, F. Relmibmemerit: for Actual Loss Sustained This endorsement provides only for reimbursement for the loss you actually sustain. In order for you to recover loss or expenses under this reimbursement you must 1. actually sustain and pay the loss or expense In money after trial, or 2- secure our consent for the payrnent of the loss or expense. G. Repatriation Our reimbursement Includes the additional expenses of repatriation to the United States H. Endemic Disem The word "disease" Includes any endemic Aseases. Part Two (Employers' Liability Insurance), C. Exclusions, exclusion 8, does riot apply to work subject to the Longshore and Harbor Workers' Compensation Art This coverage does not apply to work subject • the Defense Base Act the Outer Continental Shelf Lards Act or the Nonappropriated Fund Instrumentalities Act. Form WC 99 03 03 B Printed In U.S.A. (Ed. 8100) page a Of 6 MA"I HMF► A. This endorsement only applies in the states listed In this Schedule of Covered States. C. Schedule of Covered States: WO B. If a state, shmn In Item 3A. of the Information Page, approves this endorsement after the effective date of this policy, this endorsement Will apply bo this policy. The coverage will apply in the new state on the effective date of the state approval. Authorized Representative Form WC 99 03 03 B Printed in U.SA (Ed. B=) Page 6 of T,