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PROOF OF INSURANCE (2018 - 2018) CLOSED C"R "� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) fit.....-' 112812017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les) must have ADDITIONAL INSURED provisions or 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). CONTACI PRODUCER Bolton & CompanyNAML. 3475 E. PHO I NE ,� Pasadena, CA19B107' Suite 100 [AIC,N (' ) - FAX,wrr ((, ()583M?'l 17 pA Exei; r2G PJ;f 7C)t)4D ADDRESS: !NSURER(S)AFFORDING OVERAGE NAIC# www.boltonco.com 0008309 INSURER A: Vigilant Insurance Company 20397 INSUREDFCompany ..... ...., 1 11 Atkinson, Andelson, Loya, Ruud & Romo INSURER „.I ; Federal IIISUranC2 CQm an 2Q28 12800 Center Court Drive#300 Cerritos CA 90703 INSURER D INSURER E INSURER F; COVERAGES CERTIFICATE NUMBER: 369"-14493 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. INSRT, ...__ _..................................................:I .la,....!/E'.1✓.d�.. POL,IC,V,, .,.........(... TYPE OF INSURANCE NUM POLICY EFF POLICY EXP TR ,.... R...................... ...n... ....,.....BERMM,IIn1D/XYYV�,_.LMM/DIIYYYV„),L, LIMITS A ,/ COMMERCIAL GENERAL LIABILITY ✓ 35344557 4/1/2017 4/1%2018 EACH OCCURRENCE $ 1,000,000 DAMACLAIMS-MADE OCCUR PREMISES (Ea occurrence) rJ 1,000,000 ❑✓ PREMISES fEa occurrence) $ MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- POLICY JECT ]LOC PRODUCTS-COMP/OP AGG $ Included OTHER: $ B AUTOMOBILE LIABILITY 73508514 4/1/2017 4/112018 INJURY( ' $ BODILY I)Suk A n , . (F; 1.000,000 RLUMl11,000LOOO ANY AUTO Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PY lY/S NE`i Y I)APw1A4'.,i, „ AUTOS ONLY ✓ AUTOS ONLY (Per f(!a Wnl) $ ✓ UMBRELLA LIAR OCCUR 79757104 4/1/2017 4/1/2018 EACH OCCURRENCE $ 8,000,000 L AB C AGGREGATE $ 8,000,000 _ DED RETENTION$ $ B WORKERS COMPENSATION 71732870 4/1/2017 4/1/2018 V STATUTE ER AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N N/A E.L:EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? FN—] (Mandatory in NH) E .DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E .DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Re:Client No.0845 The firm does not own any autos and auto liability applies to hired and non-owned autos only. Additional Insured:The City of EI Segundo,its elected or appointed officers,officials,employees and volunteers Additional Insured(s)named additional insured respecting general liability per the attached form 80-02-2367(Rev.5-07) MM CERTIFICATE HOLDER CANCELLATION Client No.0845 CIt Clerk, City of EI Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y Y g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. EI Segundo CA 90245 AUTHORIZED REPRESENTATIVE William A.Lewis ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 36974493 1 AALRR 1 17-16 Master Certificate Melissa Greenwood 1 7/26/2017 10:33:41 AM (PDT) I Page 1 of 4 C H U B B° Liability Insurance Endorsement Policy Period APRIL 1,2017 TO APRIL 1,2018 Effective Date APRIL 1,2017 Policy Number 3534-45-57 WC Insured ATKINSON ANDELSON LOYA RUUD&ROMO Name of Company VIGILANT INSURANCE COMPANY Date Issued APRIL 6,2017 This Endorsement applies to the following forms: GENERAL LIABILITY Under Who Is An Insured,the following provision is added Who Is An Insured Additional Insured- Persons or organizations shown in the Schedule are insureds;but they are insureds only if you are Scheduled Person obligated pursuant to a contract or agreement to provide them with such insurance as is afforded by Or Organization this policy. However,the person or organization is an insured only: • if and then only to the extent the person or organization is described in the Schedule; • to the extent such contract or agreement requires the person or organization to be afforded status as an insured; • for activities that did not occur,in whole or in part,before the execution of the contract or agreement;and • with respect to damages,loss,cost or expense for injury or damage to which this insurance applies. No person or organization is an insured under this provision: • that is more specifically identified under any other provision of the Who Is An Insured section(regardless of any limitation applicable thereto). • with respect to any assumption of liability(of another person or organization)by them in a contract or agreement.This limitation does not apply to the liability for damages,loss,cost or expense for injury or damage,to which this insurance applies,that the person or organization would have in the absence of such contract or agreement. Liability Insurance Additional Insured-Scheduled Person Or Organization continued ....-.-..-�..-�.........._.............. .__. Form 60-02-2367(Rev.5-07) Endorsement Page 1 36974493 AALRR 17-18 Master Certificate I Melissa Greenwood 17/2B/2017 10:33:41 AM (PDT) I Page 2 of 4 CHUBB" .._.. .......... Liability Endorsement (continued) Under Conditions,the following provision is added to the condition titled Other Insurance. Conditions Other Insurance— If you are obligated,pursuant to a contract or agreement,to provide the person or organization Primary, Noncontributory shown in the Schedule with primary insurance such as is afforded by this policy,then in such case Insurance—Scheduled this insurance is primary and we will not seek contribution from insurance available to such person Person Or Organization or organization. Schedule PERSONS OR ORGANIZATIONS THAT YOU ARE OBLIGATED, PURSUANT TO WRITTEN CONTRACT OR AGREEMENT BETWEEN YOU AND SUCH PERSON OR ORGANIZATION,TO PROVIDE WITH SUCH INSURANCE AS IS AFFORDED BY THIS POLICY;BUT THEY ARE "INSUREDS"ONLY IF AND TO THE MINIMUM EXTENT THAT SUCH CONTRACT OR AGREEMENT REQUIRES THE PERSON OR ORGANIZATION TO BE AFFORDED STATUS AS AN"INSURED". HOWEVER,NO PERSON OR ORGANIZATION IS AN"INSURED"UNDER THIS PROVISION WHO IS MORE SPECIFICALLY DESCRIBED UNDER ANY OTHER PROVISION OF THE WHO IS AN INSURED SECTION OF THIS POLICY(REGARDLESS OF ANY LIMITATION APPLICABLE THERETO). All other terms and conditions remain unchanged. A .m Authorized Representative Liability Insurance Additional Insured-Scheduled Person Or Organization last page ..........�............ w _........_................._ Form 80-02-2367(Rev.5-07) Endorsement Page 2- 6,9714 9R ( A&F, TfR ( 11"r Vn rn.inL('e C°o�t A t i,'PoM v^. 1 M,21. oni, (1a,f'Vli'ood ( 'I lo1't AV MIJ P'i94n 3 of 'd ISO LU C) tam > C4 twCl o _P.- — m Q CIO W cy M C;) Ww; dye yu all, VQ LL >Ul W RN I pox 2 ua =5=w A J., Ccati 'd rr r7 , LE 10 WX pi _J10 P 0 L" 4 ma a ii CO dears d cc< arca cq z errs aha rz v < to �:, -,rW tr nz, ucl�,"1-:1 1 1>1 10as _j tc ix Orc cm w "I WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WC 99 03 04(Ed. 7-08) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT- CALIFORNIA This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following"attaching clause"need be completed only when this endorsement is issued subsequent to preparation of the policy.) This endorsement, effective on 04/01/2017 at 12:01 A. M. standard time,forms a part of (DATE) Policy No. 71732870 of the Federal Insurance Company (NAME OF INSURANCE COMPANY) Issued to Atkinson,Andelson,Loya,Ruud&Romo Endorsement No. Authorized Representative We have the right to recover our payments from anyone liable for an injury covered by this policy.We will not enforce our right against the person or organization named in the Schedule.The additional premium for the blanket waiver offered by this endorsement shall be 1.00%of total California premium. Schedule Person or Organization Job Description BLANKET WAIVER-ANY PERSON OR ORGANIZATION ALL CALIFORNIA OPERATIONS FOR WHOM THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER WC 99 03 04(Ed.7-08) AC"O CERTIFICATE OF LIABILITY INSURANCE DATE IYVYY) II 08/088/20/2017 ✓" .................. AAA THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). ................. _........ PRODUCER 1-847-385-6800 ICONTACT NAME: Rob Herchert Integro Insurance Brokers PHONE 847-385-6800 FAX (A/P,No Ext)' (AfC Noj 111 West Campbell EMAIL rob.herchert@inte:grogrotAp.com 4th Floor Arlington Heights, IL 60005 NSURER(S)AFFORDING COVERAGE NAIC# INSURER A: NAUTILUS INS CO 17370 INSURED INSURER B Atkinson, Andelson, Loya, Ruud & Romo INSURER C: 12800 Center Court Drive INSURER D: Suite 300 Cerritos, CA 90703 INSURER E: INSURER F COVERAGES_ CERTIFICATE NUMBER: 50557775 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"OLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER IMMIDDIXVYVI fMMIDDIVVVX ER POLICY EFF POLICY EXPO LIMITS INSR ADOI,' 41N�3R ___.._. -- GENERAL LIABILITY EACH OCCURRENCE $ GENERALCOMMERCIAL LIABILITY UAMMGIS ES(,Ea occurrenrel -_ $ PRE 10 i, CLAIMS-MADE OCCUR MED EXP Any one person) $ PERSONAL&ADV INJURY $ ... GENERAL AGGREGATE $ GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY IT. L..........'I LOC .... ........................ $ Fa ar AUTOMOBILE LIABILITY ('O MBINEINC DSINGLE LIMIT t,).........., - ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED BODILY IN...................,, __ ....., AUTOS AUTOS JURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Peracridenf $ DE AGGREGATE $ EXCESS LIAB OCCUR EACH OCCURRENCE CLAIMS-MADE UMBRELLA LIAB $ DED RETENTION$ WORKERS COMPENSATION WC STA'l U- I OTH- AND EMPLOYERS'LIABILITY Y/N ..,,.,T.OR.Y.LAs"'4�I�MTS. I ER _ .. ............ ANY (Mandatory in HPROPRIETOR/PARTNER/EXECUTIVE ""� E L DISEASE ACCIDENT $ EXCLUDED? OFFICERIMEMBER EXCLUDED? �� N I A -EA EMPLOYEE $ If yes,describe under .. ........................ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A (Professional Liability EDLP 1000434_,P-5 08/08/1; 08/08/1$ EACH CLAIM 1,000,000 AGGREGATE 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Client No. 0845 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Clerk, City of E1 Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street AUTHORIZED REPRESENTATIVE El Segundo, CA 90245 USA ................ �..................... ....-......_... ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Linda.Schwartz@integrogroup.com LEM