PROOF OF INSURANCE (2018) CLOSED Client#- 12641 GROMA
ACORD. DATE
CERTIFICATE OF LIABILITY INSURANCE CE I 07/21/2017(MMIDDIYYYY) d
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Ashbrook-Clevidence, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
3000 W.MacArthur Blvd.,#320 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
License#0188788
Santa Ana,CA 92704 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Fireman's Fund Insurance Co. 1 A
Mark Groh INSURER B: Scottsdale Indemnity Co. II
5481 Vallecito Avenue l
INSURER C:
Westminster,CA 92683 INSURER D
INSURER E:
...................
COVERAGES
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 AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADD14 LTYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR-iNS'RC DATE(MMIDD/YY) DATE'(MWDD1Y'Y)
A GENERAL LIABILITY AZC80896701 07/06/17 07/06/18 EACH OCCURRENCE $1,000,000
X COMMERCIAL GENERAL LIABILITYDAMA(:aE T,Y RENTEC} aM $100,000
CLAIMS MADE ®
OCCUR MED EXP(Any one person) $10000
i Hired-Non-Owned PERSONAL&ADV INJURY V$Inciuded
Auto-Limit Included GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG (S
I POLICY F(I'R? F-1 LOC
AU`OMOBILE LIABILITY COMBINED SINGLE LIMIT
ANY AUTO (Ea accident) $
ALL OWNED AUTOS BODILY INJURY
r—I SCHEDULED AUTOS (Per person)
HIRED AUTOS BODILY INJURY
NON-OWNED AUTOS (Per accident) $
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY I AUTO ONLY-EA ACCIDENT I$
ANY AUTO �I OTHER THAN EA ACC $
AUTO ONLY: AGG S
EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $
[-AGGREGATE
................................El OCCUR CLAIMS MADE �$
p@ $
DEDUCTIBLE I$
RETENTION 'S Ii$
WC STATU�
WORKERS COMPENSATION AND (MIT OTH-I
EMPLOYERS'LIABILITY
E L EACH ACCIDENT $
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? E L DISEASE-EA EMPLOYEE, S
If yes,describe under
SPECIAL PROVISIONS below E .DISEASE-POLICY LIMIT S
B OTHER Errors&Omm EKI3227482 07/11/17 07/11/18 $1,000,000 Limit
$2,500 Retention
[DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
j The City of EI Segundo and its officers,employees,elected officials,volunteers,and members of
boards and commissions are included as additional insureds,but only insofar as the operations under this
agreement or contract are concerned per Endorsement ABC Multicover-AB91890807. This policy includes a
Blanket Waiver of Subrogation.
CERTIFICATE HOLDER CANCELLATION 10 Days for Non-payment
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of EI Segundo (DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL A0_ DAYS WRITTEN
350 Main Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
EI Segundo,CA 90245 (IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
O ACORD CORPORATION 1988
ACORD 25(2001/08)1 of 2 #S30629/M30628 L M
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
I
I
I
ACORD 25-S(2001108) 2 of 2 #S30629/M30628
ABC MultiCover - AB 91 89 08 07
This endorsement modifies insurance provided under the following:
American Business Coverage
Your policy is broadened and clarified as follows: permanent lodging, or premises by or at
the direction of any insured; or
1. Non Employment Discrimination Liability
Unless Personal Injury or Advertising Injury is (13)Arising out of discrimination,if insurance
! Y g ! rY thereof is prohibited by law; or
excluded from this policy:
(14) Fines, penalties, specific performance, or
A. Section III - Definitions, Item 17. Personal injunctions levied or imposed by a go-
vernmental entity, or governmental code,
f. Discrimination law,or stature because of discrimination.
B. Section III - Definitions, Item 2: Advertising
2. Blanket Additional Insured
Injury is amended to include: Section II- Liability Coverage,Part L Who Is An
e. Discrimination Insured, Item 2. is amended to include:
f. Any person or organization that you are re-
C. Section III - Definitions is amended to in- quired by a written insured contract to include
elude: as an insured, subject to all of the following
30. Discrimination means the unlawful treat- provisions:
rnent of individuals based on race, color, (1) Coverage is limited to their liability aris-
ethnic origin, gender, religion, age, or ing out of
sexual preference.
D. Section It - Liability Coverage, Part H. Ex- (a) the ownership, maintenance or use
of that part of the premises, or land
elusions, Item 1.15 Personal, Injury or Adver-
owned by, rented to, or leased to
tising Injury is amended to include:
you; or
(I1) Arising out of diserimina#ion directly or (b) your ongoing operations performed
indirectly related to the past employ- for that insured; or
ment, employment or prospective em-
ployment of any person or class of (c) that insured's financial control of
persons by any insured; or you; or C
(12) Arising out of discrimination directly or (d) the maintenance, operation or use
indirectly related to the sale, rental, lease by you of equip vett Ieased to you
or sub-lease or prospective sale, rental, by such person(s)or organization(s);
lease or sub-lease of any dwelling, or
This Form must be attached to Change Endorsement when issued atter the policy is written.
One of the Fircman's Fund Insurttnee Companies as named in the policy
M.
Seer t
ar'y President
AB9189 8.07
Page I of 6 i
(e) a state or political subdivision per- assumption of liability in a contract
mit issued to you. or agreement. This exclusion does
not apply to liability for damages
(2) Coverage does not apply to any occur- that the vendor would have in the
rence or offense: absence of the contract or agree-
(a) which took place before the exe- ment;
cution of, or subsequent to the b. Any express warranty unauthorized
completion or expiration of, the by you;
written insured contract, or
c. Any physical or chemical change in
(b) which takes place after you cease to
be a tenant in that premises. the product made intentionally by
�--'— the vendor;
(3) With respect to architects, engineers, or d, Repackaging,unless unpacked solely
surveyors, coverage does not apply to for the purpose of inspection, dem-
Bodily Injury, Property Damage, Per-
sonal Injury or Advertising Injury arising onstration, testing, or the subs#i-
out of the rendering or the failure to tution of parts under instructions
render any professional services by or for from the manufacturer, and then re-
you including. packaged in the original container.
(a) The preparing, approving, or failing e. Any failure to make such in-
to prepare or approve maps, draw- spections, adjustments, tests or ser-
ings, opinions, reports, surveys, vicing as the vendor has agreed to
achange orders, designs or specifrca- make or normally undertakes to
tions; and make in the usual course of busi-
ness, in connection with the distrib-
(b) Supervisory, inspection, or engi- ution or sale of the products;
nearing services.
f. Demonstration, installation, servic-
If an Additional Insured endorsement is attached ing or repair operations, except such
to this policy that specifically names a person or operations performed at the vendor's
organization as an insured,then this coverage does premises in connection with the sale
not apply to that person or organization, of the product;
3. Blanket Additional Insured for Vendors g. Products which, after distribution
Unless the Products-Completed Operations Haz- or sale by you, have been labeled or
and is excluded from this policy, Section Il - Li- relabeled or used as a container,part
ability Coverage, Part 1. Who Is an Insured, Item or ingredient of any other thing or
2.is amended to include: substance by or for the vendor.
D
g. Any vendor but only with respect to Bodily
2. This iusm nce does not apply to gray in-
Injury or Property Damage arising out of your cured person or organization, from
whom you have acquired such products,
products which are distributed or sold in the
regular course of the vendor's business, sub- or any ingredient, part or container, en-
ject to the following additional exclusions: tering into, accompanying or containing
0
such products:
i. The insurance afforded the vendor does If an Additional Insured - Vendors endorsement
not apply to: is attached to this policy that specifically names a
w a. Bodily Injury or Property Damage person or organization as an insured, then this
for which the vendor is obligated to coverage does not apply to that person or organ-
N pay damages by reason of the ization.
U
Ap9189 8.07
4
Page 2 of 5
4. Blanket Waiver of Subrogation before you acquired or formed the or-
Section H - Liability Coverage, Part K. Liability ganization;
and Medical Payments General Conditions, is (c) Coverage C does not apply to personal
amended to include: injury or advertising injury arising out of
an offense committed before you ac-
6. Transfer of Rights of Recovery Against Oth- quired or formed the organization.
ers to us and Blanket Waiver of Subrogation
6. Medical Payments
a- If the insured has rights to recover all or
part of any payment we have made under Unless Coverage D.Medical Payments is excluded
this Coverage Part, those rights are from this policy.
transferred to us. The insured must do
nothing after loss to impair those rights, A. Section H - Liability. Coverage, Part FL Ex-
At our request,the insured will bring suit clusions, Item 21 is replaced with:
or transfer those rights to us and help us E Included within the products-completed
enforce them. operations hazard. However, this exclu-
b. If required by a written insured contract, sion does not apply to expenses for den-
we waive any right of recovery we may tal services.
have against any person or organization. B. Section 11 - Liability Coverage,Part G. Cov-
because of payments we make for injury cage,Item 2.,is amended to include:
or damage arising out of your operations
or your work for that person or organ- c., Coverage D. Medical Payments is pri-
ization. mary and not contributing with any
other insurance, even if that other insur-
ance is primary also.
Section H- Liability Coverage, Part I.Who Is An 7. Tenant's Legal Liability
Insured, Item 4. is replaced with: A. Section M - Liability Coverage, Part J. Li-
4. At of your subsidiaries, companies, corpo- ability and Medical Payments Limits or In-
rations, firms, or organizations, as now or surance, Item 3.is replaced with:
hereafter constituted, qualify as Named In-
sured under this policy if: 3. The most we will pay under Coverage C
Liability for damages because of prop-
(a) you have the responsibility of placing in- erty damage to premises while rented to
surance for each such entity-,and you, temporarily occupied by you with
(b) coverage for the entity is not otherwise the permission of the owner,or managed
more specifically provided; and by you under a written agreement with
the owner:
(c) the entity is incorporated or organized
under the laws of the United States of a. arising out of any Covered Cause of
Loss shall be the greater of:
America.
But each entity is 'insured only while you (1) $1,000,000; or
own, during the polidy"'p6riod, a controlling (2) The Teriant's legal, Liability
interest in such entity of greater than 50% of limit shown in the Declarations.
the stock or assets. However. 8. Chartered Aircraft
(a) Coverage under this provision is afforded
only until the end of the policy period, Section H- Liability Coverage, Coverage C, Part
or the 12 month anniversary of the policy It Exclusions, Item l.g. is amended to include:
inception date,whichever is earlier, (5) An aircraft in which you have no ownership
(b) Coverage C doles not apply to bodily in- interest and that you have chartered with
jury or property damage that occurred crew.
AD9189 9-07 Page 3 of 6
3
9. Coverage Territory Broadened Payments Definitions, Items 17.b., d. and e. are
replaced with:
Section III- Definitions, Item 5.a.is replaced with:
a. The United States of America (including its b. Malicious prosecution or abuse of process;
territories and possessions), Puerto Rico, Ca- d. Oral, written,televised or videotaped publica-
nada, Bermuda, the Bahamas, the Cayman tio,.of mate;;A that slanders or libels a person
Islands and the British Virgin Islands. or organization or disparages a person's or
10. Broadened Advertising Injury organization's goods, products or services;
Unless Advertising Injury is excluded from this e. Oral, written, televised or videotaped publica-
policy. tion of material that violates a persons right
of privacy;
A. Section III - Definitions, Item 2, is replaced
With12. Broadened Personal or Advertising Injury
2. Advertising Injury means injury arising Unless Personal Injury or Advertising Injury is
out of one or more of the following of excluded from this policy, Section II - Liability
fenses: Coverage, Coverage C, Part H. Exclusions, Item
l.p.(4)Exclusions is deleted in its entirety.
a. Oral,written,televised or videotaped
publication of material that slanders 13. Fellow Employees Coverage
or libels a person or organization or
disparages a person's or organiza- Section 11 - Liability Coverage, Part I.Who Is an
a
tiods goods,products or services; Insured, Item 2.a.(1)is amended as follows:
b. Oral,written,televised or videotaped (1) Personal Injury to you or to a co�employee
� publication of material that violates while in the course of his or her employment,
a person's right of privacy; or the spouse, child, fetus, embryo, parent,
brother, sister or any member of the house-
P, c. Misappropriation of advertising hold of that employee or co-employee as a
ideas or style of doing business; or consequence of such Personal Injury, or for
any obligation to share damages with or repay
d. Infringement of trademark, copy- someone else who must pay damages because
right, title or slogan. of the injury; or
B. Section II - Liability Coverage, Coverage C, 14. Mental Anguish Is Included in Bodily Jnjury
Part H. Exclusions, Items l.p.(1) and(2)are
replaced with: Section III- Definitions, Item 4.is replaced with:
(1) Arising out of oral, written, televised or 4. Bodily injury means bodily injury, sickness or
videotaped publication of material, if disease sustained by a person. It includes
`— done by or at the direction of the insured death or mental anguish which result at any
with knowledge of its falsity; time from such physical harm, physical sick-
(2) Arising out of oral, written, televised or ness or physical disease. Mental anguish me-
s ans any type of mental or emotional illness
videotaped publication of material whose or disease.
A first publication took place before the
be&ming of the policy period; 15. Unintentional Failure to Disclose Hazards
11. Broadened Personal Injury Section II - Liability Coverage, Part K. Liability
Unless Personal Injury is excluded from this pol- and Medical Payments General Conditions, is
N icy, Section III - Property, Liability and Medical amended to include:
AB9189 8-07
R Page 4 of 6
6. Unintentional Failure to Disclose Hazards legal representatives are aware of the General
Liability occurrence, offense, claim, or suit.
If you tnintentionally fail to disclose any ha- Knowledge of an occurrence, offense, claim,
zards existing at the inception date of' your or suit by other employee(s) does not imply
policy, we will not deny coverage 'under this you also have such knowledge.
Coverage Form because of such failure.
However, this provision does not affect our b. To the extent possible, notice to us should
.ri ,t to collect additional premium or exercise include:
our right of cancellation or non-renewal. (1) How,when and where the occurrence or
16. Supplementary Payments, Increase Limits offense took place;
Section 11- Liability Coverage, Part G. Coverage, (2) The names, addresses, and telephone
Items Le. (2)and (4) are replaced with: numbers of any injured persons and wit-
(2) The cost of bail bonds required because of nesses; and
accidents or traffic law violations arising out (3) The nature and location of any injury or
of the use of any vehicle to which the Bodily damage arising out of the occurrence, of-
Injury Liability Coverage applies. We do not fense, claini, or suit.
have to furnish these bonds.
(4) All reasonable expenses incurred by the in- 19. Common Policy Conditions (AB 00 09 A 01 87),
sured at our request to assist us in the inves-
tigation
Part H. Other Insurance, Item 2.is replaced with:
or defense of the claim or suit 2. Coverage C -Liability
including substantiated loss of earnings up to
$500 a day because of time off work. If other valid and collectible insurance is
available to any insured for a loss we cover
17. Per Location Aggregate under Coverage C of this Coverage Part our
A. Section I1-Liability Coverage,Part J.Limits obligations are limited as follows:
of Insurance, Item 4.is amended to include: a. The insurance provided under this policy
The Aggregate Limit of Insurance applies se- is primary if you are required by a written
parately to each location owned by you, insured contract to include any person
rented to you, or occupied by you with the or organization as an insured, but only
permission of the owner. with respect to that insured's liability
arising out of the ownership, mainte-
B. Section III - Property, Liability and Medical nance, or use of that part of the premises
Payments Definitions,is amended to include: owned by or rented to you, or your work
for that insured by or for you.Any other
31. Location means premises involving the insurance available to that person or or-
same or connecting lots, or prernises ganization is excess and noncontributory
whose connection is interrupted only by with this insurance, or;
a street, roadway, waterway or right-of-
way of railroad. b. Except for the circumstance described in
2.a., above, the insurance provided under
18. Amended Duties in the Event of an Occurrence, this policy is excess over any other h-
Offense Claim or Suit ability insurance available to any insured
Section_1Y = Liability Coverage, Part K. Liability whether such other insurance is written
and Medical Payments General Condition.-,, Items as primary, excess, contingent or any
2,& and b. are replaced with: other basis, An exception applies when
any insured specifically has purchased
a. In the event of an occurrence, offense, claim, excess insurance to apply in excess of the
or suit, you must promptly notify us. Your limits of insurance shown in the Decla-
duty to promptly notify us is effective when rations of this Coverage Part for Cover-
your executive officers, partners, members, of age C.
A139189 8-07 Page 5 of 6
20. Damage to Invitees' Automobiles from Falling kind and quality; subject to a limit of$25,000
Trees or Tree Limbs- Limited Coverage in any one policy period;and
`— The policy applies to direct physical damage to S. This coverage is not subject to the General
automobiles owned by invitees subject to all of the Liability General Aggregate Limit_
� following:
--�— 21. Expected or Intended Injury-Amendment to Ex
1. Provided such damage originates from prem- elusion
--- ises owned, managed, leased or rented by an
insured; SECTION I. - 2. EXCLUSIONS a. Expected or
...^ Intended Injury,is replaced by the following;
2. Coverage applies only to invitees of an in-
sure
nsured or an insure d's tenant; a. Expected or Intended Injury
3. Such damage is directly caused by Bodily injury or property damage expected or
wind-driven falling trees or tree limbs; intended from the standpoint of the insured.
This exclusion does not apply to bodily injury
4. The most we will pay for any one loss is the or property damage resulting from the use of
lesser of the actual cash value of the damaged reasonable force to protect persons or prop-
automobile as of the time of the loss; or the er y.
cost of repairing or replacing the damaged
automobile with another automobile of like All other terms and conditions of the policy apply.
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AB9189 8.07
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