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PROOF OF INSURANCE (2018 - 2018) CLOSED CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) Ill 15/25/2017 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 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). PRODUCER CONTACT NAME: Christian Brothers Services Artex Risk Solutions, Inc. (CB) PHONE800-807-0300 FAX 630-378-25 2850 Golf Road, 5th Floor (AIC„No,Ext). (AIC No); 08 Rolling Meadows IL 60008-4050 ADDRESS: INSURER(S)AFFORDING COVERAGE .., NAIC# INSURER A:Pennsylvania Manufacturers Assoc In 112262 INSURED CHRIBRO-14 INSURER B:Old Republic Insurance Company 24147 Brothers of the Christian Schools&Affiliates INSURERC: Loc#1177028 DAUGHTERS OF CHARITY OF SVDP INSURER 1205 Windham Parkway RERo. .. Romeoville IL 60446-1679INSURE„RE„„, .... .... .. INSURER F: COVERAGES CERTIFICATE NUMBER: 1950940799 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 INSR TYPE OF INSURANCE IADDL SUBR POLICY EFF PO4,UCY EXP LIMITS... LTR a INSD WVD POLICY NUMBER (MM/DDIYYYY) WM'IDD,IY'Y'Y'Yy_ AXCOMMERCIAL GENERAL LIABILITY Y 821700 0578617 6/15/2017 6/15/2016 EACH OCCURRENCE $2,000,000 CLAIMS-MADE ( X I OCCUR DAMAGE.PRE.MSESO(Ea pc TTflra,),••••••••••,$,Included MED EXP(Any one person) '$15,000 PERSONAL&ADV INJURY 'Slnc'luded PRO $2,000.000 XEU'LAGGRiGAT01�APPLIES PROOrLlCTSGCOMP"TE, POLICY POPAGG $Included OTHER: ..,,, .... ., $ B AUTOMOBILE LIABILITY MWTB 21543 6/15/2017 6/15/20181.MI a $1,000,000 (Euro accidenI)I r.............fl.. X ANY AUTO BODILY INJURY(Per person) $ BODILY OWNED SCHEDULED INJURY(Per accident) $ AUTOS ONLY _ AUTOS ( ) HIRED NON-OWNED "'PPOl'��6NYY C'A'PrYAG15., X X (Per $ AUTOS ONLY AUTOS ONLY a $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LI AB CLAIMS-MADE AGGREGATE $ DFD I RETENTIONS $ B WORKERS COMPENSATION MWC 305311 02 1/1/2017 1/1/2018X PER OTH AND EMPLO ERS'L ASTATUTE BILIITY YIN EkANY MandatoPRIE NHRIPARTNER/EXECUTIVE [ ""' N/A EL EACH ACCIDENT $1,000,000 OFFICE(Mandatory in N )EXCLUDED N EL DISEASE-EA EMPLOYEE $1,000,000 D yqhs,describe under y� _ kus'a41RlPT'ION OF OPERATIONS below EL DISEASE-POLICY LIMIT $1,000,000 A Limited Professional Healthcare 821700 0578617 6/15/2017 6/15/2018 $1,000,000 Occ $2,000,000 Agg, DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Only the General Liability Coverage will apply on a Primary and Non-Contributory bases(per attached endorsement)if required by fully executed written contract. Certificate Holder is added as Additional Insured (per attached endorsement)for General Liability coverage solely, strictly and specifically with regards to: Renewal of St Vincent Meals on Wheels Agreement to provide home meal delivery to EI Segundo homebound residents from October 1,2015 through September 30,2017. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo its Officials and Employees THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 Main St ACCORDANCE WITH THE POLICY PROVISIONS. EI Segundo CA 92045 AUTHORIZED REPRESENTATIVE r U ©1988-2015 ACORD CORPORATION. All rights reserved, ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD PENNSYLVANIA MANUFACTURERS' ASSOCIATION INSURANCE COMPANY Attaching to and forming part of Policy No.821700 0578617 Named Insured: THE RELIGIOUS AND CHARITABLE RISK POOLING TRUST OF THE BROTHERS OF THE CHRISTIAN SCHOOLS AND AFFILIATES Effective date of this endorsement is June 15,2017 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. ADDITIONAL INSURED SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under SECTION II INSURING AGREEMENT C,GENERAL LIABILITY COVERAGE defined within the Coverage Agreement SECTION 1:Schedule Name of Additional Insured Person(s) Designated Location(s) Of CoN-eted Or Organlzation(s): Operations ANY PERSON OR ORGANIZATION WHEN YOU HAVE AGREED IN A WRITTEN CONTRACT FOR THAT PERSON OR ORGANIZATION TO BE ADDED AS AN ADDITIONAL INSURED ON YOUR POLICY, If no entry appears above, information required to complete this endorsement will be shown in the Certificate of Coverage as applicable to this endorsement. Section II Insuring Agreement C-Name of Insured Amended A Who Is An Insured defined in the General Insurance Agreement is amended to include as an Additional Insured the person(s)or organization(s)shown in the Schedule above, but only with respect to liability in the performance of the Named Insured's ongoing operations for the Additional Insured(s)at the Location(s) designated in the Schedule above for"bodily injury"or"property damage",caused in whole or in part, by the Named Insured's acts or omissions Mich takes place after the execution of a written agreement with the Additional Insured(s) B For the coverage provided by this endorsement:the following paragraph is added to Section IV—General Conditions, Section Il, Insuring Agreement C-General Liability This insurance is primary insurance as respects to this coverage to the additional insured person or organization, where the written contract or written agreement requires that this insurance be primary and noncontributory In that event,we will not seek contribution from any other insurance policy available to the additional insured on which the additional insured person or organization is a Named Insured C Who Is An Insured is also amended to include as an additional insured the person(s)or organization(s) shown in the Schedule, with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by the "Named Insured's work"at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the"products-completed operations hazard The most we will pay is the amount of insurance required by the written contract or the amount of applicable limits of insurance under this policy;whichever is less. This Insurance does not apply to any claims or suits seeking damages, including defense, arising out of, directly or indirectly, from any actual or alleged participation in any act of sexual misconduct, sexual harassment, sexual molestation, sexual abuse or any claim sexual in nature, physical or mental,of any person. Except as amended in this endorsement. this insurance is subject to all coverage terms, clauses and conditions in the policy to which this endorsement is attached and only applies to the extent permitted by law. 0 DATE(MM/DD/YYYY) A " CERTIFICATE OF LIABILITY INSURANCE 11/21i2016 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 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 riqhts to the certificate holder in lieu of such endorsementLs). PRODUCER CONTACT NAME: Christian Brothers Services Artex Risk Solutions, Inc. (CB) PHONEFAx Two Pierce Place Arc,No Ext). 800-807-0300 (A/cw No);630-378-2508 Itasca IL 60143-3141 • DIIIt' .Jlcao'rtESsr ... .. INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Old Republic Insurance Company 24147 INSURED CH RI BRO-14 INSURER B: Brothers of the Christian Schools&Affiliates INSURER C: Loc#1177028 DOC POW ST VINCENT'S INSTITUTION 1205 Windham Parkway INSURER D: Romeoville IL 60446-1679 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1132491647 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. INTRR TYPE OF INSURANCE B IVSD WND .. POLICY NUM POLICY EFF - --POLICY --- .... ........ . �ADDL'SU'BR ... F POLICY EXP ® BER (POLICY (MWDOIYY'YY9 LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE P, OCCUR DAMAOL T'(,',)��I�I=IV"kF�L�° PREMISES(Lp oac,�,cprr„e;n;cei $ MED EXP,(Any,one,p,ers,on) $ .I PERSONAL&ADV INJURY $ k°FN'k.,AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ POLICY PRO, JEC"I' LOCPRODUCTS-C OMP/OPAGG $ OTHER $ AUTOMOBILE LIABILITY COMBINED INED SIM�it3LE LIMIT $ "' (Ea 5ix,de.q). . ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED tid Per accident)AUTOS ONLY I AUTOS BODILY INJURY( ) $ HIREDr RO EA r DAM�gACr° AUTOS ONLY AUTOS ONLYY (P,or,aoodont) $ ., $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS AB LADE AGGREGATE $ DEDLIAR RETENTION5 CLAIMS-MADE $ A WORKERS COMPENSATION y MWC 305311 02(CA) 1/1/2017 1/1/2018 X I STER ATUTE OTRH AND EMPLOYERS'LIABILITY Y/N m OFFICER/MEMBER EXCLUDED? �W.NW..P N/A EL EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE (Mandatory In NH) EL DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Wavier of Subrogation, per the attached endorsement, (where allowed by law)is provided under the Worker's Compensation coverage when required by fully executed written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of EI Segundo,its officials and employees THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Office of the City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main St EI Segundo CA 90245 AUTHORIZED REPRESENTATIVE ,, Ire ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) POLICY NUMBER: MWC 305311 02 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA 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. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 0 % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ALL PERSONS OR ORGANIZATIONS WHERE REQUIRED BY WRITTEN CONTRACT DATE OF ISSUE; 1-1-17 ©1998 by the Workers'Compensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB's California Workers' Compensation Insurance Forms Manual®r 1999.