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PROOF OF INSURANCE (2017) CLOSEDr DRMAU -1 OP ID: C6 �y DATE (MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 06/20/2016 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 iELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED :EPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT. If the certiflcate 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 License #OK07568 PHONE _.. A PRODUCER Brakke Schafnitz Ins. Brokers Carole S Mitchell Ecaro e�mch 57 C.. a 949 -313-3323 100 Wilshire Blvd. # 940�l" Santa Monica, CA 90401 ADDRESS ellli us Darla Gray INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Westchester Surplus Lines Ins INSURED on r.aureen basso P O Box' 2028, ; �' INSURER B Palos Verdes Peninsula, CA 90274 INSURERC: INSURER D: ., mm� INSURER E : INSURER F COVERAGES CERTIFICATE NUMBER: 1 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. INS LTR ...,,..,,,,,. ., _........ b19L Usk ,m.m. �,, ...... P Ck"EFF - POIJCY'EX,p'.,..,. .... TYPE OF INSURANCE I V POLICY NUMBER M DAYYYY MWDDDYYYYI LIMITS A COMMERCIAL GENERAL LIABILITY ARA OCCURRENCE $ 1,000,000 A .. CLAIMS -MADE OCCUR X X 624270427005 07/01/2016 07101/2017 - MEDFP(Anyoneperson) $ 5,00 Add'Ilnsured m Prof. 8 POIIUt -CLM PERSONAL &ADVINJ RY $ 1 000,00 G EN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY E, T V 1 9.,oc PRODUCTS COMP/OP AGG $ 2,000,000 P PF'dOr . 01 HEIR I $ AUTOMOBILE LIABILITY ( tl i YMl $ Ea a de @ ANY AUTO BODILY INJURY (Per person) $ ..... ALL OWNED SCHEDULED Y ( BODILY INJURY Per accident $ AUTOS !AUTOS _ ) ®: NON -OWNED F O EA1Y't' A1MG5­`.. _ HIRED AUTOS AUTOS (Per a adl,nt) $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ .,,, D E D I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR /PARTNER /EXECUTIVE " "" OFFICER /MEMBER EXCLUDED? NIA ,E,L, EACH ACCIDENT $ (Mandatory in NH) E L DISEASE EA EMPLOYEE $ IF yes, describe under _ ®,,, �. -- DESCRIPTION OF OPERATIONS below E DISEASE - POLICY LIMIT $ • Professional Liab. G24270427005 07/01/2016 07/01/2017 Prof.Liab 1,000,000 • Contractors Poll. 624270427005 07101/2016 07/0112017 Pollution 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Policy Provides 30 days notice of cancellation except 10 days for nonpayment Applicable Endorsements Attached Where required by Written Contract CERTIFICATE HOLDER CANCELLATION C -ELSEG City of El Segundo Attn:Martha Dijkstra 350 Main Street El Segundo, CA 90245 ACORD 25 (2014/01) 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 ©1988 -2014 ACORD CORPORATION The ACORD name and loge :aie registered rnarks of ACORD All rights reserved. Named Insured Dr. Maureen Sassoon Number Policy tayrrubol Policy Number Policy Period Effective Date of Endorsement ECP 1 07f01/2016 to 07/01/2017 1 07/01/2016 Westchester Surplus Lines Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is Issued subsequent to the preparation of the. policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS POLLUTION LIABILITY COVERAGE PART SCHEDULE Name oY srsc Itl Rr fIt111brartF Any person or organization that is an owner of real property or personal property on which you are performing operations, or a contractor on whose behalf you are performing operations, and only at the specific written request of such person or organization to you, wherein such request is made prior to commencement of operations. (If no entry appears above, information required to complete this endorsement will be shown In the ueclaratlons as applicame to tnls endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or your work done under a contract with that person or organization and included in the products - completed operations hazard. This waiver applies only to the person or organization shown in the Schedule above. All other terms and conditions remain the same- ENV-3143 (03 -05) Includes copyrighted material of Insurance Services Office, Inc. with its permission Page 1 of 1 TRANSPORTATION POLLUTION LIABILITY COVERAGE ENDORSEMENT Narrmeri insured Endorsement Number 'Dr. Maureen Sassoon ECP _...._...._. _._ .. n F�olBcy aynaboi _ Policy Number Policy PePeriod Effective Date of Endorsement 07/01/201 6 to 07/01/2017 07/01/2016 Westchester Surplus Lines Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: CONTRACTORS POLLUTION LIABILITY COVERAGE PART COVERAGES - CONTRACTORS POLLUTION LIABILITY, Section B., Exclusions, 16. Vehicles is deleted in its entirety and replaced with the following: 16. Vehicles Bodily injury or property damage arising from the use, maintenance, entrustment to others, or operation of any auto, aircraft, watercraft or other conveyance. However, this exclusion does not apply to: a. Bodily injury or property damage resulting from a pollution condition that commences during the transportation of your product by a carrier; or b. Bodily injury or property damage resulting from a pollution condition arising out of the ownership, maintenance or use of any autos or watercraft used in the operations performed by or on behalf of the insured. With respect to item b. above, the following Limits of Insurance apply: Limits of Insurance: $1,000,000 Each Occurrence $1,000,000 Transportation Pollution Aggregate Limit (serves to reduce the General Aggregate shown on the Declarations page) The Limits of Insurance are subject to the terms and conditions of the LIMITS OF INSURANCE section of the policy to which this endorsement is attached. All other terms and conditions remain the same. ENV -3146 (01 -14) copyright 2014 Page 1 of 1 GLOBAL PROGRAM SOLUTIONS AMENDATORY (Foreign Indemnity) ENDORSEMENT Named Irmured Dr. Maureen Sassoon ECP By 07/01/2016 to 07/01/2017 .... �...... lswad B Narve eP in ur nan a"mnpanyl Westchester Surplus Lines Insurance Company Number Effective Date of 07/01/2016 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTOR'S POLLUTION LIABILITY COVERAGE PART PROFESSIONAL LIABILITY COVERAGE PART THIRD -PARTY PREMISES POLLUTION LIABILITY COVERAGE PART ONSITE CLEANUP PREMISES POLLUTION LIABILITY COVERAGE PART SUDDEN AND ACCIDENTAL PREMISES POLLUTION LIAIBLITY COVERAGE PART PRODUCTS POLLUTION LIABILITY COVERAGE PART Notwithstanding anything in this policy that might be construed otherwise, including any definitions or provisions governing Defense and Claims Expense that discuss the geographic scope of coverage to be provided herein, the Coverage Territory of this policy shall include the following: 1. The United States of America, including its territories and possessions, and Puerto Rico; 2. International waters or airspace, but only if the injury or damage occurs in the course of travel or transportation between any of the places included in Item 1., above; and 3. All other parts of the world, except: a. The People's Republic of China; and b. Any of the former member states of the Union of Soviet Socialist Republics, including Armenia, Azerbaijan, Belarus, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Moldova, Russia, Tajikistan, Turkmenistan, Ukraine and Uzbekistan. This policy shall not afford coverage for any risk which would otherwise be in violation of the laws of the United States of America, including, but not limited to, economic or trade sanction laws or export control laws administered by the government of the United States of America. I. FOREIGN COVERAGE When a foreign occurrence arising out of one or more otherwise covered exposures of the insured or foreign entity causes injury or damage to which this insurance applies, rather than directly pay on behalf of the insured or foreign entity, we shall indemnify the insured for the foreign loss or foreign entity loss caused by a foreign occurrence subject to the following provisions. II. WHO IS AN INSURED The WHO IS AN INSURED provisions of this policy and any other associated definitions or schedules are hereby amended to confirm that foreign entities are not Lnsuq,,ds on whose behalf we have a direct duty to pay settlements or judgments or to whom we owe any duty to defend. ENV -3147 (10 -12) Copyright 2012 ," Page 1 of III. DEFENSE AND SUPPLEMENTARY PAYMENTS Rather than directly defend an insured or foreign entity, we shall indemnify the insured for defense costs incurred in defending a suit brought against it or its foreign entity, provided that the insured complies with Section V., ADDITIONAL CONDITIONS, of this Endorsement, below, and all other policy terms, conditions and limitations. IV. LIMITS OF INSURANCE The insurance provided by this Endorsement is subject to all applicable limits of insurance, limits of liability, deductibles and self- insured retentions (if any) identified in the Declarations of, or elsewhere in, this policy, including any aggregate limits and sublimits (collectively 'limits "). Any foreign loss or foreign entity loss for which we pay indemnity shall erode and be counted against such limits. Such limits apply on the same basis (e.g., per occurrence, per claim, in the aggregate etc.) with respect to the insureds as would apply if the foreign occurrence had taken place within the United States of America, including its territories and possessions, or Puerto Rico. The applicability of limits to Supplementary Payments or allocated loss adjustment expense applies on the same basis (pursuant to the applicable coverage part) as would apply if the foreign occurrence had taken place directly with respect to an insured within the United States of America, including its territories and possessions, or Puerto Rico. V. ADDITIONAL CONDITIONS The following conditions apply in addition to the conditions and limitations provided elsewhere in this policy. A. Claims Made and/or Reported Coverage (to the extent applicable) Any requirements in this policy that a claim be first made and /or reported, or deemed made and/or reported, during the policy period, or any discovery or extended reporting period, shall also apply to all claims made against a foreign entity for which an insured seeks indemnification. Any provisions regarding notice of circumstances which may become a claim pursuant to this policy shall apply to circumstances known or which reasonably should have been known by the insured. B. Additional Duties of the Insured 1. With respect to a foreign occurrence which may result in a claim to which this insurance applies, the insured assumes the duty to notify us, and must notify us in accordance with the conditions in the applicable coverage part or endorsement of this policy. 2. The insured shall, when directed by us: a. Retain in its own name, but, subject to any relevant retention or deductible obligations herein, a loss adjusting expert approved by us that is authorized in the jurisdiction in which the foreign loss or foreign entity loss occurred; b. Where permitted by applicable law, grant us the full right to collaborate with such loss adjusting expert; c. Grant us full access to any records produced by such loss adjusting expert; and d. Obtain the right to control the investigation, adjustment, defense and settlement of the foreign loss or foreign entity loss using experts approved by us, including access to books, records, bills, invoices, vouchers and other information. C. Payment as Discharge of Liability With respect to any foreign loss or foreign entity loss, payment to the insured shall, in all circumstances, to the extent of such payment, discharge us from any liability or alleged liability to any other person or entity, whether or not such person or entity is named as an insured pursuant to this policy. D. Truthfulness and Accuracy of Information 1. The insured shall make a good faith effort to provide truthful and accurate information to us with respect to the applicable foreign entity, foreign occurrence, claim, suit, foreign loss or foreign entity loss; and 2. The insured shall not, at any time, intentionally conceal or misrepresent facts concerning any foreign entity; any foreign loss; any foreign entity loss; any claim or suit; or any foreign occurrence. ENV -3147 (10 -12) copyright2012 0 Page 2 of 3 VI. Additional Definitions The following definitions apply to this Endorsement in addition to definitions set forth elsewhere in this policy: A. Allocated loss adjustment expense means any: 1. Expenses, costs and interest provided for pursuant to this policy that responds to a loss, claim, suit or demand; and 2. Other expenses, costs, or interest incurred in connection with the investigation, administration, adjustment, settlement or defense of any loss, claim, suit or demand arising pursuant to this policy that we directly allocate to a particular claim, whether or not a payment indemnifying the claimant(s) is made by any person or entity. Such expenses shall include: subrogation; all court costs, fees and expenses; fees for service of process; fees and expenses to attorneys for legal services; the cost of services of undercover operations and detectives; fees to obtain medical cost containment services; the cost of employing experts for the purpose of preparing maps, photographs, diagrams, or chemical or physical analysis, or for expert advice or opinion; the cost of obtaining copies of any public records; and the cost of obtaining depositions and court reporters or recorded statements. However, allocated loss adjustment expense does not include: 1. The salaries of the employees of any foreign entity or of the insured; 2. Fees, expenses and interest for legal services not provided to or for the benefit of the insured; and 3. Amounts otherwise reimbursed to the insured or foreign entity. B. Foreign entity means any person or entity which would otherwise qualify as an insured or additional insured as defined in or identified in any coverage part, endorsement or schedule attached to this policy, but for the fact that such person or entity is domiciled or its principal place of business is located within a jurisdiction outside of the United States of America, including its territories and possessions, or Puerto Rico. C. Foreign loss means: 1. Damages or other amounts to which this insurance applies, that an insured has incurred or becomes legally obligated to pay within a jurisdiction outside of the United States of America, including its territories and possessions, or Puerto Rico, as the result of injury, damage, loss, or liability to which this insurance would apply if the foreign occurrence had taken place within the United States of America, including its territories and possessions, or Puerto Rico; and 2. Any reasonable and necessary expenses or costs incurred by the insured to which this insurance would apply if we defended the claim or suit, which have not been paid, indemnified or reimbursed pursuant to any other insurance. D. Foreign entity loss means: 1. Damages, or other amounts to which this insurance applies, that a foreign entity has incurred or becomes legally obligated to pay because of injury„ damage, loss, or liability to which this insurance would apply if the insured were directly liable for such amounts with respect to covered exposures located within the 'United States of America, including its territories and possessions, or Puerto Rico; and 2. Any reasonable and necessary expenses or costs incurred by a foreign entity to which this insurance would apply if we defended the claim or suit, which have not been paid, indemnified or reimbursed pursuant to any other insurance. E. Foreign occurrence means an accident, occurrence, pollution condition, loss, act, error or omission (as any of these terms may be defined in the applicable coverage parts), which may result in a foreign loss or foreign entity loss. All other terms and conditions of this policy remain unchanged. ENV -3147 (10 -12) copyright2012 Q Page 3 of 3 MOLD COVERAGE ENDORSEMENT — CLAIMS MADE CONTRACTORS POLLUTION LIABILITY Named Insured! Endorsement Number Dr. Maureen Sassoon y m......., _._.�.. i ;W �. _. y ber Polic Period Effective Date of Endorsement 07/01/2016 to 07/0112017 07101 /2016 rtPsuod k tN.Ame or Insurance Company) Westchester Surplus Lines Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: CONTRACTORS POLLUTION LIABILITY COVERAGE PART THIS IS A CLAIMS -MADE ENDORSEMENT WHICH COVERS ONLY CLAIMS FIRST MADE AGAINST THE INSURED AND REPORTED TO THE INSURER, IN WRITING, DURING THE POLICY PERIOD. PLEASE READ THIS ENDORSEMENT CAREFULLY. SOME OF THE PROVISIONS CONTAINED IN THIS ENDORSEMENT RESTRICT COVERAGE, SPECIFY WHAT IS AND IS NOT COVERED AND DESIGNATE RIGHTS AND DUTIES. LEGAL DEFENSE EXPENSES ARE SUBJECT TO AND WILL ERODE THE LIMITS OF INSURANCE AND ANY APPLICABLE DEDUCTIBLES. Limits of Insurance: $1,000,000 $1,000,000 Deductible: $10,000 Retroactive Date: 2/17/2009 SCHEDULE Each Claim Mold Aggregate Limit (serves to reduce the General Aggregate Limit shown on the Declarations page) Each Claim Coverage then applies only for the Limits of Insurance specifically listed in the SCHEDULE set forth above. A. For the purpose of this endorsement, CONTRACTORS POLLUTION LIABILITY COVERAGE PART, COVERAGES, A. Insuring Agreement is deleted In its entirety and replaced by the following: COVERAGES - MOLD LIABILITY Insuring Agreement We will pay those sums in excess of the deductible shown in the SCHEDULE contained in this endorsement that the Insured (becomes legally obligated to pay as damages because of bodily injury or property damage to which this insurance applies. We shall have the right and duty to defend the Insured against any claim or suit seeping those damages. However, we shall have no duty to defend the Insured against any claim or suit seeking damages for bodily injury or property damage to which this insurance does not apply. We may, at our discretion, investigate any loss and settle any claim(s) or suit(s) that may result. But the amount we will pay for damages is limited as described in the SCHEDULE set forth above; and our right and duty to defend ends when the applicable limit of insurance has been exhausted in the payment of ENV -3211 (05 -12) Includes copyrighted material of Insurance Services Office, Inc, with its permission Page 1 of 4 Copyright 2012 judgments, settlements or supplementary payments under this and/or any other attached Coverage Parks and all Supplementary Payments which reduce the Limit of Insurance. 2. This insurance applies to a loss only if The loss arises out of your work and results in mold condition that takes place in the coverage territory; and b. Your work did not occur before the Retroactive Date, if any, shown in the SCHEDULE set forth above or after the end of the policy period; and C. The claim(s) or suit(s) is first made against any Insured and reported to the Insurer, in writing during the policy period or any Extended Reporting Period we provide under the EXTENDED REPORTING PERIOD Section of this endorsement. 3. A claim or suit by a person or organization seeking damages will be deemed to have been made at the earlier of the following times: When notice of such claim or suit is received and recorded by any Insured or by us, whichever comes first; or b. When we make a settlement in accordance with Paragraph 1. above. All claim(s) or suit(s) for damages because of a loss to the same person, including damages claimed by any person or organization for care, loss of services, or death resulting at any time from the loss, will be deemed to have been made at the time the first of those claim(s) or suit($) is made against any Insured. & For the purpose of this endorsement, CONTRACTORS POLLUTION LIABILITY COVERAGE PART, LIMITS OF INSURANCE is amended to include the following: The Each Claim Limit shown in the SCHEDULE set forth above is the most we will pay for the sum of all damages because of a loss arising out of any one mold condition under this endorsement. The most we will pay with respect to any rnold condition that continues during the policy periods of more than one Mold Liability Coverage Part is the Each Claim Limit shown in the SCHEDULE set forth above applicable to the first policy period during which the mold condition commenced. The Contractors Pollution Liability Limit shown in the Declarations is amended to include damages and Supplementary Payments under the Mold Liability Coverage Part. The Mold Aggregate Limit shown in the SCHEDULE set forth above is the most we will pay for the sum of clamagps under all Coverage Parts and Supplementary Payments afforded by this endorsement. The General Aggregate Limit shown in the Declarations is amended to include damages and Supplementary Payments under the Mold Liability Coverage Part. The deductible amount stated in the SCHEDULE set forth above is applicable to each claim and applies once to each claim and applies to defense expenses, investigation, settlement, compromise, or indemnification. C. For the purpose of this endorsement, CONTRACTORS POLLUTION LIABILITY COVERAGE PART, DEFINITIONS, is amended to include the following additional DEFINITION: Mold condition means the discharge, dispersal, seepage, migration, release or escape of mold, bacteria, or viruses provided such conditions are not naturally occurring in the environment in the amounts and concentrations discovered. ENV -3211 (05 -12) Includes copyrighted material of Insurance Services Office, Inc. with its permission Page 2 of 4 Copyright 2012 D. For the purpose of this endorsement, the following Extended Reporting Period Provisions are added: EXTENDED REPORTING PERIOD In the event that the coverage provided by this endorsement is deleted or the policy is cancelled or non - renewed by the insured or the Company, for any reason, except for non - payment of premium or deductible amounts, the following shall apply: A. Automatic Extended Reporting Period We shall provide the insured at no additional premium an Automatic Extended Reporting Period of sixty (60) days for any claim(s) or suit(s) first made against the insured during this automatic extended reporting period provided: a. The claim(s) or suit(s) arises out of a loss to which this insurance applies; and b. The loss commenced on or after the Retroactive Date shown in the SCHEDULE set forth above and before the expiration of the policy or cancellation date of this endorsement; and C. The claim(s) or suit(s) are reported in writing to us within sixty (60) days immediately following the expiration of the policy or cancellation date of this endorsement in accordance with GENERAL CONDITIONS, B. Duties in the Event of a Claim or Suit, Item 2. The Automatic Extended Reporting Period shall become effective on the expiration of the policy or cancellation date of this endorsement. The Automatic Extended Reporting Period shall not reinstate or increase the Limits of Insurance, nor shall it extend the policy period or change the scope of the coverage provided. 4. The Automatic Extended Reporting Period shall not be provided if the insured has purchased other insurance to replace the coverage provided under this endorsement. B. Optional Extended Reporting Period The Named Insured, upon payment of a maximum additional premium of 200% of the annual policy premium, shall be entitled to purchase an Optional Extended Reporting Period of thirty-four (34) months for any claim(s) or suit(s) first made against the insured during this optional extended reporting period or the automatic extended reporting period provided: a. The claim(s) or sult(s) arises out of a loss to which this insurance applies; and b. The loss commenced on or after the Retroactive Date shown in the SCHEDULE set forth above and before the expiration of the policy or cancellation date of this endorsement; and C. The claim(s) or suit(s) are reported in writing to us within the thirty -six (36) months immediately following the expiration of the policy or cancellation date of this endorsement in accordance with GENERAL CONDITIONS, B. Duties in the Event of a Claim or Suit, item 2. 2. A written request for the Optional Extended Reporting Period must be received by us within thirty (30) days immediately following the expiration of the policy or cancellation date of this endorsement. ENV -3211 (05 -12) Includes copyrighted material of Insurance Services Office, Inc. with its permission Page 3 of 4 Copyright 2012 3. Upon payment of the additional premium, the Optional Extended Reporting Period may not be cancelled and no return premiums will be provided. 4. The Optional Extended Reporting Period shall become effective on the expiration date of the Automatic Extended Reporting Period. 5. The Optional Extended Reporting Period shall not reinstate or increase the Limits of Insurance, nor shall it extend the policy period or change the scope of the coverage provided. All other terms and conditions remain the same. ENV -3211 (05 -12) Includes copyrighted material of Insurance Services Office, Inc. with Its permission Page 4 of 4 Copyright2012 POLLUTION CONDITION AMENDATORY ENDORSEMENT wimtxat ua rrt r9. Encorsement Nk Dr. Maureen Sassoon t5aVic s rnt;oi =P@Z3� ber 07/ 01/2016 to 07101 y y y eriod Effective Date of /2017 07/01/2016 ECP..... �............. �..... — --------- �_ _ __ �.....rw essaaeQ 6y tNarno of Insurance Corratranyl Westchester Surplus Lines Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: CONTRACTORS POLLUTION LIABILITY COVERAGE PART For the purpose of this endorsement, CONTRACTORS POLLUTION LIABILITY COVERAGE PART, DEFINITIONS, Pollution Condition, is deleted in its entirety and replaced with the following: Pollution condition mearts the discharge, dispersal, release, escape„ migration, or seepage of any solid, liquid, gaseous or thermal, material matter, irritant or contaminant, including smoke, soot, vapors, fumes, acids, alkalis, chemicals, hazardous substances, hazardous materials, low level radiological material, or waste materials including medical, infectious, or pathological wastes, on, in, into, or upon land and structures thereupon, the atmosphere, surface water or groundwater. Pollution condition includes electromagnetic fields, virus(es), and bacteria including Legionella pneumophila. All other terms and conditions remain the same. ENV -3212 (05 -12) Copyright 2012 111A Page 1 of 1 ADDITIONAL INSURED ENDORSEMENT— PRODUCTS - COMPLETED OPERATIONS HAZARD Number Dr. Maureen Sassoon ECPyrolY Policy Number Policy Period Effective Dale of 07/01/2016 to 07/01/2017 07/01/2016 Westchester Surplus Lines Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTOR'S POLLUTION LIABILITY COVERAGE PART SCHEDULE Any person or organization that is an owner of real property or personal property on which you are performing operations, or a contractor on whose behalf you are performing operations, and only at the specific written request of such person or organization to you, wherein such request is made prior to commencement of operations. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section II —Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for bodily injury or property damage caused, in whole or in part, by your work performed for that additional insured and included in the products - completed operations hazard. All other terms and conditions remain the same, ENV -3225 (10 -08) Copyright 0, 2008 PA, Page 1 of 1 ADDITIONAL INSURED ENDORSEMENT — PRODUCTS - COMPLETED OPERATIONS HAZARD PRIMARY 8r NON - CONTRIBUTORY Dr. Maureen Sassoon Policy Symbol Policy NUmDer roncy renou ECP I 1 07/01/2016 to 07/01/2017 L K�ied By (Name of Insurance Company) Westchester Surplus Lines Insurance Company ant Effective Date o 07/01/2016 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTOR'S POLLUTION LIABILITY COVERAGE PART SCHEDULE Any person or organization that is an owner of real property or personal property on which you are performing operations, or a contractor on whose behalf you are performing operations, and only at the specific written request of such person or organization to you, wherein such request is made prior to commencement of operations. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for bodily injury or property damage caused, in whole or in part, by your work performed for that additional insured and included in the products - completed operations hazard. Furthermore, the coverage provided hereunder shall be primary and not contributing with any other insurance available to those designated above under any other third party liability policy. All other terms and conditions remain the same. ENV -3226 (10 -08) Copyright ©2008 I Page 1 of 1 CALIFORNIA INSURANCE IDENTIFICATION CARD afeco COMPANY Insurance SAPECO INSURANCE COMPANY OF' AMERICA 62 MAPLE AVENUE KEENE NH 03431 POLICY NUMBER EFFECTIVE DATE AZ074142 SEPT 1 2016 YEAR MAKE/MODEL 2008 BMW AGENCY /COMPANY ISSUING CARD NHC INSURRAN0pCCE SERVICES INC 47410-if H-ST17 EXPIRATION DATE SEPT 1 20:17 VEHICLE IDENTIFICATION NUMBER WBAVC53578FZ84867 NAIC 24740 A PEDRO CA 90731 -3602 "INSURED MMAURRgpEEN, SSpASS.00N PALWAR IS PEN CA 90274 -8028 CN- 7042 /CAEP 6fl SEE IMPORTANT NOTICE ON REVERSE SIDE CALIFORNIA INSURANCE II ENTIFICATICIN CARET COMPANY' Insurance SAFECO INSURANCE COMPANY OF AMERICA 62 MAPLE AVENUE KEENE NH 0:3431 :EXPIRATION DATE SEPT : "1 2017. VEHICLE IDENTIFICATION NUMBER 2HKRM3H59EH548165 NAIC 24740 RAMORS PEN CA, 90274-8028 CI -7042/CAMP/ SEE IMPORTANT NOTICE ON REVERSE SIDE SEPARATE ID CARD(S) OI ONE COPY MUST BE KEPT I AND PRESENTED UPON DEMAND. THE C TO THE MOTOR VEHI WHEN RENEWING YOUR V CITY OF EL SEGUNDO WORKERS' COMPENSATION DECLARATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SUBJECTS AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN LABOR CODE § 3706, INTEREST, AND ATTORNEY'S FEES. I affirm under penalty of perjury under the laws of California one of the following declarations: (_) I have and will maintain a certificate of consent of self - insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Labor Code § 3700 for the performance of the work set forth the agreement with the City of El Segundo. Policy No. .......... � _ w_ (_) I have and will maintain workers' compensation insurance as required by Labor Code § 3700 for the performance of the work for which the agreement with the City of El Segundo is executed. My workers' compensation insurance carrier and policy number are: Carrier Policy Number Expiration Date Name of Agent _ Phone # * I certify that, in the performance of the work set forth in the agreement with the City of El Segundo, I will not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Labor Code § 3700 1 must immediately comply with those provisions or the agreement will automatically become void. Signature of Applicant Date lb Agreement for:" a ` "gym Dated: Reviewed b,, Y.