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PROOF OF INSURANCE (2018 - 2018) CLOSED SPCAL-2 op IDLO CERTIFICATE OF LIABILITY INSURANCE DATE1301 0117 Of3J30d2ta17 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 WANED, 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 endorsementis). PRODUCER 310473-9611 92WCT Lynn Grosslight Grosslight Insurance, Inc. PHONE310-473-9611 � FAX 310-31'2'-4993 License#0247283 AIG,No,E� ei, g; WC,N 1333 Westwood Blvd N%0. nnPgrosslIght.com Los Angeles, CA 90024 Gil Grosslight INSUREFq§J AFFORQING COVERAGE NAIC 0 INSURER A:Great Am Ins CO 16691 INSURED spcaLA eta! INSURERS: Elizabeth De La Rosa 5026 W.Jefferson BI INSURERG: Los Angeles,CA 90016 INSURERD: INSURER E INSURER F: .V 9 R,Ali?,. . ........................................................................... .....UR Ih.N ATE_.14 .Mb: ,_........................ y.).31 . 1..1j RMBER': 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 PERT''IN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EYCLUSIONS AND CONDITIONS OF SUCH POLICES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIR TYPE OF INSURANCE _INSD S POLICY EFF POLE Y XP POLICY NUMBER LIMBS R ADDL IPOLIC r EFF li'MID "YYI_ _w... A X COMMERCIAL GENERAL LIABILnY1,000000 EACH OCC(-pRRENCE $ CLAIMS-MADE 1 V 1 accuR PAC5603474 09/01/2017 09101!2018 DAMAGE 70 PENTED 300,000X eerRr:,xiI $ MED EXP(Any ana PePsonl...._._. $ 10,0001 PERSONAL&ADV INJI,iRv 1$ ..... ....... .. ............. 1 -. ' GENERAL AGGREGATE $ 20,00000000000 0 Lv PPeT �Loc _PRODUCTS-C® I0PPOG $ 2 .IHER Emp Ben. . 10 ,0000000 0 AUTOMOBILE LWBILnY �Ea COMBINED Y'Ip^*LE'LIMIT $ ANY AUTOBODILY INJURY Par persan $ OWNED (SCHEDULED AUTOS ONLY RforyLSXn ,XAIYwdU TOS --... BP�OGIVD.I..F.ILY.c6._ITrNwl.a�t-J'AiIF°Uw rRhCYI4.D.A.mPaNFrT a....v...o._.d...a.�n t 1II$ 0r4i VV rYDD- ----... t$ UMBRELLA LIAB OCCUR EACH OCCURRENCE 1$ EXCESS LIAB CLAIMS-MADE AGrRFUATF DED �RETENTION $ VERSDRP OYIN + TLME IE�'S'ATION PER R AW EUYECUTIVE 0 P EArX DD? NIA $$$ E I. DISEASE-EA FMPI.OYEF..1$ It yes,descnbe under .................................................................................._.___ ........... SEASE,-,,POLICY LIMIT $ I...L........�.�,,,,mp,P,E;RATIQFJS,irelaw E t..,DI,�,p.............i..�...............................................R...A............(............................................IN .,_0____p_.,,tpY, q .,_..___.,,,..............................,,..... .....,.. ..... �ieSrt$tOBTFisPa$Ae$f a s0 �tNOna~� nSUINII A N I ,RNio ?ee T4r11196� eSachod If more space is required) Which Includes Wavier wording"` (*}Cancel ation for non-payment of premium is ten(10)days. Cancellation for all other is thirty(30)day's. .............................. CERTIFICATE HOLDER CANCELLATION ELSEGUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of EI Segundo ACCORDANCE WITH THE POLICY PROVISIONS. City Clerk's Office Attn: Mona Shilling ALriHORI�DREPRESENTATiVE 350 Main Street �r I -30,95 �?91 ACORD 25(2018!03) ®1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Administrative Offices i 301 E 4th Street f f 17 'r11�/ Cincinnati OH 45202-4201 CG 89 70 (Ed. 11/14) INSURANCE GROUP 613 369 5000 ph THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SIGNATURE GENERAL LIABILITY BROADENING ENDORSEMENT This Endorsement modifies and is subject to the insurance provided under the following form: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following extension only applies in the event that no other specific coverage for the indicated loss exposure is provided under this Policy. If other specific coverage applies, the terms, conditions and limits of that Coverage are the exclusive coverage applicable under this Policy, unless otherwise noted in this Endorsement. This is a summary of the various additional coverages and coverage modifications provided by this Endorsement. For complete details on specific coverages, consult the actual policy wording. Coverage Description Limit of Insurance Page Non-Owned Aircraft Included 2 Non-Owned Watercraft Included 2 Bodily Injury - Mental Injury, Mental Anguish, Humiliation or Shock Included 3 Medical Payments $ 20,000 3 Damage to Premises Rented to You $ 1,000,000 3 Supplementary Payments - Bail Bonds $ 3,000 4 Supplementary Payments - Loss of Earnings $ 1,000 per day 4 Newly Formed or Acquired Organizations Included 4 Unintentional Failure to Disclose Hazards Included 5 Knowledge of Occurrence, Claim or Suit Included 5 Property Damage Liability - Elevators Included 5 Property Damage Liability - Borrowed Equipment Included 5 Liberalization Clause Included 6 Amendment of Pollution Exclusion (Premises) Included 6 Limited Property Damage to Property of Others $ 5,000 6 Additional Insured - Manager or Lessor of Premises Included 7 CG 89 70 (Ed. 11/14) (Page 1 of 12) Coverage Description Limit of Insurance Page Additional Insured - Funding Sources Included 7 u Additional Insured - By Contract Included 8 Primary and Non-Contributory Additional Insured Extension Included 10 Additional Insureds - Protection of Your Limits Included 10 Blanket Waiver of Transfer of Rights of Recovery Against Others Included to Us (Subrogation) 11 Property Damage Extension With Voluntary Payments $ 1,000/$ 5,000 11 Who Is An Insured - Fellow Employee Extension - Management Included Employees 12 Broadened Personal and Advertising Injury Included 12 A. Non-Owned Aircraft Under paragraph 2. Exclusions of SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability, exclusion g. Aircraft, Auto or Watercraft does not apply to an aircraft provided: 1. it is not owned by any insured; 2. it is hired, chartered or loaned with a trained paid crew; 3. the pilot in command holds a currently effective certificate, issued by the duly constituted authority of the United States of America or Canada, designating him or her a commercial or airline pilot; and 4. it is not being used to carry persons or property for a charge. However, the insurance afforded by this provision does not apply if there is available to the Insured other valid and collectible insurance, whether primary, excess (other than insurance written to apply specifically in excess of this Policy), contingent or on any other basis, that would also apply to the loss covered under this provision. B. Non-Owned Watercraft Under paragraph 2. Exclusions of SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability, subparagraph (2) of exclusion g. Aircraft, Auto or Watercraft is replaced by the following: This exclusion does not apply to: (2) A watercraft you do not own that is: (a) less than 60 feet long; and CG 89 70 (Ed. 11/14) (Page 2 of 12) (b) not being used to carry persons or property for a charge,. C. Bodily Injury - Mental Injury, Mental Anguish, Humiliation or Shock Under SECTION V - DEFINITIONS, Definition 3. is replaced by the following: 3. "Bodily Injury" means physical injury, sickness, or disease, including death of a person. "Bodily Injury" also means mental injury, mental anguish, humiliation, or shock if directly resulting from physical injury, sickness, or disease to that person. D. Medical Payments If Coverage C Medical Payments is not otherwise excluded, the Medical Payments provided by this Policy are amended as follows: The Medical Expense Limit in paragraph 7. of SECTION III - LIMITS OF INSURANCE is replaced by the following Medical expense Limit: The Medical Expense Limit provided by this Policy shall be the greater of: a. $ 20,000; or b. the amount shown in the Declarations for Medical Expense Limit This provision 7. is subject to all the terms of SECTION III - LIMITS OF INSURANCE. E. Damage to Premises Rented to You If Damage to Premises Rented to You is not otherwise excluded from this Coverage Part: 1. Under paragraph 2. Exclusions of SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability: 3. The last paragraph of paragraph 2. Exclusions is deleted in its entirety and replaced by the following: Exclusions c. through n. do not apply to damage by fire, lightning, explosion, smoke, leakage from an automatic fire protection system or water 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 III - LIMITS OF INSURANCE. However, this insurance does not apply to damage to premises while rented to you, or temporarily occupied by you with the permission of the owner, caused by: i. rupture, bursting, or operation of pressure relief devices; II. rupture or bursting due to expansion or swelling of the contents of any building or structure, caused by or resulting from water; Ill. explosion of steam boilers, steam pipes, steam engines, or steam turbines; or Iv. flood 2. Paragraph 6. Under SECTION III - LIMITS OF INSURANCE is deleted in its entirety and replaced with the following: CG 89 70 (Ed. 11114) (Page 3 of 12) 6. Subject to paragraph 5. above, the most we will pay under Coverage A for damages because of "property damage" to any one premises, while rented to you, or in the case of damage caused by fire, lightning, explosion, smoke, leakage from automatic fire protection system or water while rented to you or temporarily occupied by you with the permission of the owner, for all such damage caused by fire, lightning, explosion, smoke, leakage from automatic fire protection systems or water proximately caused by the same event, whether such damage results from fire, lightning, explosion, smoke, leakage from automatic fire protection systems or water or any combination of the six, is the higher of $ 1,000,000 or the amount shown in the Declarations for the Damage to Premises Rented to You Limit. 3. Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, subsection 4. Other Insurance, paragraph b. Excess Insurance where the words "Fire insurance" appear they are changed to "insurance for fire, lightning, explosion, smoke, leakage from an automatic fire protection system or water." 4. As regards coverage provided by this provision I. Damage to Premises Rented to You - paragraph 9.a. of Definitions is replaced with the following: 9. a. a contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion, smoke, leakage from automatic fire protection systems or water to premises while rented to you or temporarily occupied by you with the permission of the owner is not an "insured contract"; F. Supplementary Payments 1. In the Supplementary Payments - Coverages A and B provision, paragraph 1.b. is replaced with: b. Up to $ 3,000 for the cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. 2. Paragraph 1.d. is replaced by the following: 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 $ 1,000 a day because of time off work. G. Newly Formed or Acquired Organizations Paragraph 3. of SECTION II - WHO IS AN INSURED is replaced by the following: 3. Any organization you newly acquire or form and over which you maintain ownership or majority interest, will qualify as a named insured if there is no other similar insurance available to that organization. However: a. coverage under this provision is afforded only until the expiration of the policy period in which the entity was acquired or formed by you; b. coverage A does not apply to "bodily injury" or property damage that occurred before you acquired or formed the organization; and c. coverage B does not apply to "personal and advertising injury" arising out of an offense committed before you acquired or formed the organization. CG 89 70 (Ed. 11/14) (Page 4 of 12) d. records and descriptions of operations must be maintained by the first named insured, No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a named insured in the Declarations or qualifies as an insured under this provision. H. Unintentional Failure to Disclose Hazards Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, the following is added to Condition 6. Representations: Failure of the Insured to disclose all hazards existing as of the inception date of this Policy shall not prejudice the insurance with respect to the coverage afforded by this Policy, provided such failure or omission is not intentional on the part of the Insured. I. Knowledge of Occurrence, Claim or Suit Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, the following is added to Condition 2. Duties in the Event of Occurrence, Offense, Claim or Suit: Knowledge of any occurrence, claim, or suit by any agent, servant or employee of the Named Insured does not in itself constitute knowledge by the Insured unless notice of such injury, claim or suit shall have been received by: a. you, if you are an individual; b. a partner, if you are a partnership c. an executive officer or insurance manager, if you are a corporation. J. Property Damage Liability - Elevators 1. Under paragraph 2. Exclusions of SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability, subparagraphs (3), (4) and (6) of exclusion J. Damage to Property do not apply if such property damage results from the use of elevators. 2. The following is added to SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, Condition 4. Other Insurance, paragraph b. Excess Insurance: The insurance afforded by this provision of this Endorsement is excess over any property insurance, whether primary, excess, contingent or on any other basis. K. Property Damage Liability - Borrowed Equipment 1. Under paragraph 2. Exclusions of SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability, subparagraph (4) of exclusion J. Damage to Property does not apply to "property damage" to borrowed equipment while not being used to perform operations at a job site. 2. The following is added to SECTION IV - COMMERCIAL GENERAL LIABILITY Conditions, Condition 4. Other Insurance, paragraph b. Excess Insurance: The insurance afforded by this provision of this Endorsement is excess over any property insurance, whether primary, excess, contingent or on any other basis. CG 89 70 (Ed. 11/14) (Page 5 of 12) L. Liberalization Clause If we revise this Signature General Liability Broadening Endorsement to provide more coverage without additional premium charge, your policy will automatically provide the coverage as of the date the revision is effective in your state. M. Amendment of Pollution Exclusion (Premises) 1. The following is added to paragraph (1xa) of Exclusion f. of SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability: (iv) "Bodily injury" or "property damage" arising out of the actual discharge, dispersal, seepage, migration, release or escape of "pollutants." As used in this Endorsement, the actual discharge, dispersal, seepage, migration, release or escape of pollutants must: (aa) commence on a clearly identifiable day during the policy period; and (bb) end, in its entirety, within seventy-two (72) hours of the commencement of the discharge, dispersal; seepage, migration, release or escape of "pollutants"; and (cc) be discovered and reported to us within fifteen (15) days of the clearly identifiable day that the discharge, dispersal, seepage, migration, release or escape of "pollutants" commences; and (dd) be neither expected nor intended from the standpoint of any insured; and (ee) be unrelated to any previous discharge, dispersal, seepage, migration, release or escape; and (ff) not originate at or from a storage tank or other container, duct or piping which: a. is below the surface of the ground or water; or b. at any time has been buried under the surface of the ground or water and then is subsequently exposed. 2. For the purposes of this coverage, the following is added to the definition of "property damage" of SECTION V - DEFINITIONS and applies only as respects this coverage: Land or water, whether below ground level or not, is not tangible property. 3. Coverage provided hereunder does not apply to any discharge, dispersal, seepage, migration, release or escape that is merely threatened or alleged rather than shown to have actually occurred. N. Limited Property Damage to Property of Others The following is added under SECTION I - SUPPLEMENTARY PAYMENTS - COVERAGES A and B: 3. We will pay up to $ 5,000 for loss to personal property of others while in the temporary care, custody or control of an insured caused by any person participating in your organized activities. For the purpose of this supplementary payment, loss shall mean damage or destruction but does not include mysterious disappearance or loss of use. In the event of a theft, a police report must be filed. This supplementary payment does not apply if: a. coverage is otherwise provided by the Property Coverage part (if any) of this Policy; or CG 89 70 (Ed. 11114) (Page 6 of 12) b. the loss is covered by any other insurance you have or by any insurance of such person who causes such loss. These payments will not reduce the Limits of Insurance. O. Additional Insured - Manager or Lessor of Premises 1. SECTION II - WHO IS AN INSURED is amended to include as an additional insured any person or organization from whom you lease or rent property and which requires you to add such person or organization as an additional insured on this Policy under: (a) a written contract; or (b) an oral agreement or contract where a Certificate of Insurance showing that person or organization as an additional insured has been issued; but the written or oral contract or agreement must be an "insured contract," and, (1) currently in effect or become effective during the term of this Policy; and (11) executed prior to the "bodily injury," "property damage," "personal and advertising injury." 2. With respect to the insurance afforded to the Additional Insured identified in paragraph 1. above, the following additional provisions apply: (a) This insurance applies only with respect to the liability arising out of the ownership, maintenance or use of that part of the premises leased to you. (b) The Limits of Insurance applicable to the Additional Insured are the lesser of those specified in the written contract or agreement or in the Declarations for this Policy and subject to all the terms, conditions and exclusions for this Policy. The Limits of Insurance applicable to the Additional Insured are inclusive of and not in addition to the Limits of Insurance shown in the Declarations. (c) In no event shall the coverages or Limits of Insurance in this Coverage Form be increased by such contract. (d) Coverage provided herein is excess over any other valid and collectible insurance available to the Additional Insured whether the other insurance is primary, excess, contingent or on any other basis unless a written contractual arrangement specifically requires this insurance to be primary. (e) This insurance applies only to the extent permitted by law. 3. This insurance does not apply to; (a) Any 'occurrence" or offense which takes place after you cease to be a tenant in that premises. (b) Structural alterations, new construction or demolition operations performed by or on behalf of the Additional Insured. P. Additional Insured - Funding Sources 1. SECTION II - WHO IS AN INSURED is amended to include as an additional insured any Funding Source which requires you in a written contract to name the Funding Source as an additional insured but only with respect to liability arising out of: CG 89 70 (Ed. 11/14) (Page 7 of 12) a. your premises; or b. "your work" for such additional insured; or c. acts or omissions of such additional insured in connection with the general supervision of "your work" and only to the extent set forth as follows: a. The Limits of Insurance applicable to the Additional Insured are the lesser of those specified in the written contract or agreement or in the Declarations for this Policy and subject to all the terms, conditions and exclusions for this Policy. The Limits of Insurance applicable to the Additional Insured are inclusive of and not in addition to the Limits of Insurance shown in the Declarations. b. The insurance afforded to the Additional Insured only applies to the extent permitted by law c. If coverage provided to the Additional Insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. d. In no event shall the coverages or Limits of Insurance in this Coverage Form be increased by such contract. Q. Additional Insureds - By Contract 1. SECTION II - WHO IS AN INSURED is amended to include as an insured any person or organization whom you have agreed to add as an additional insured in a written contract, written agreement or permit, Such person or organization is an additional insured but only with respect to liability for "bodily injury," "property damage" or "personal and advertising injury" arising out of: a. your acts or omissions, or the acts or omissions of those acting on your behalf, in the performance of your ongoing operations for the Additional Insured that are subject of the written contract or written agreement provided that the "bodily injury" or "property damage occurs, or the "personal and advertising injury" is committed, subsequent to the signing of such written contract or written agreement; or b. the maintenance, operation or use by you of equipment rented or leased to you by such person or organization; or c. the Additional Insureds financial control of you; or d. operations performed by you or on your behalf for which the state or political subdivision has issued a permit However: 1. the insurance afforded to such additional insured only applies to the extent permitted by law; and 2. if coverage provided to the Additional Insured is required by contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide such additional insured. With respect to paragraph 1.a. above, a person's or organization's status as an additional insured under this Endorsement ends when: CG 89 70 (Ed. 11/14) (Page 8 of 12) (1) all work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed for or on behalf of the Additional Insured(s) at the location of the covered operations has been completed; or (2) that portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. With respect to paragraph 1.b. above, this insurance does not apply to any "occurrence" which takes place after the equipment rental or lease agreement has expired or you have returned such equipment to the lessor. The insurance provided by this Endorsement applies only if the written contract or written agreement is signed prior to the "bodily injury" or "property damage." We have no duty to defend an additional insured under this Endorsement until we receive written notice of a "suit" by the Additional Insured as required in paragraph b. of Condition 2. Duties In the Event of Occurrence, Offense, Claim or Suit under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITION. 2. With respect to the insurance provided by this Endorsement, the following are added to paragraph 2. Exclusions under SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability: This insurance does not apply to: a. "Bodily injury" or "property damage" that occurs prior to your commencing operations at the location where such "bodily injury" or "property damage" occurs. b. "Bodily injury," "property damage" or "personal and advertising injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or surveying services, including: (1) the preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (2) supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that Insured, if the "occurrence" which caused the "bodily injury" or "property damage," or the offense which caused the "personal and advertising injury," involved the rendering of, or failure to render, any professional architectural, engineering or surveying services, c. "Bodily injury" or "property damage" occurring after: (1) all work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed for or on behalf of the Additional Insured(s) at the location of the covered operations has been completed; or (2) that portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 89 70 (Ed, 11/14) (Page 9 of 12) d. Any person or organization specifically designated as an additional insured for ongoing operations by a separate additional insured endorsement issued by us and made part of this Policy. 3. With respect to the insurance afforded to these Additional Insureds, the following is added to SECTION III - LIMITS OF INSURANCE: If coverage provided to the Additional Insured is required by a contract or agreement, the most we will pay on behalf of the Additional Insured is the amount of insurance: a. required by the contract or agreement; or b. available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This Endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. R. Primary and Non-Contributory Additional Insured Extension This provision applies to any person or organization who qualifies as an additional insured under any form or endorsement under this Policy. Condition 4. Other Insurance of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: a. The following is added to paragraph a. Primary Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) the Additional Insured is a named insured under such other insurance; and (2) you have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the Additional Insured. b. The following is added to paragraph b. Excess Insurance: When a written contract or written agreement, other than a premises lease, facilities rental contract or agreement, an equipment rental or lease contract or agreement or permit issued by a state or political subdivision between you and an additional insured does not require this insurance to be primary or primary and non-contributory, this insurance is excess over any other insurance for which the Additional Insured is designated as a named insured. Regardless of the written agreement between you and an additional insured, this insurance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the Additional Insured has been added as an additional insured on other policies. S. Additional Insureds - Protection of Your Limits This provision applies to any person or organization who qualifies as an additional insured under any form or endorsement under this Policy. 1. The following is added to Condition 2. Duties in the Event of Occurrence, Offense, Claim or Suit: An additional insured under this Endorsement will as soon as practicable: CG 89 70 (Ed. 11114) (Page 10 of 12) a. give written notice of an 'occurrence" or an offense that may result in a claim or "suit" under this insurance to us; b. tender the defense and indemnity of any claim or "suit' to all insurers whom also have insurance available to the Additional Insured; and c. agree to make available any other insurance which the Additional Insured has for a loss we cover under this Coverage Part. d. we have no duty to defend or indemnify an additional insured under this Endorsement until we receive written notice of a "suit' by the Additional Insured. 2. The Limits of Insurance applicable to the Additional Insured are those specified in a written contract or written agreement or the Limits of Insurance stated in the Declarations of this Policy and defined in SECTION III - LIMITS OF INSURANCE of this Policy, whichever are less. These limits are inclusive of and not in addition to the Limits of Insurance available under this Policy. T. Blanket Waiver of Transfer of Rights of Recovery Against Others to Us (Subrogation) Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, the following is added to Condition 8. Transfer of Rights of Recovery Against Others to Us: If required by a written contract or written agreement, we waive any right of recovery we may have against a person or organization because of payment we make for injury or damage arising out of your ongoing operations or "your work" done under a contract for that person or organization and included in the "products-completed operations hazard" provided that the injury or damage occurs subsequent to the execution of the written contract or written agreement. U. Property Damage Extension with Voluntary Payments 1. The following is added to paragraph 1. Insuring Agreement of SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability: At your request we will pay for "loss" to property of others caused by your business operations for which this Policy provides liability insurance. Such payment will be made without regard to your legal obligation to do so. The "loss" must occur during the policy period and must take place in the "coverage territory." 2. With respect to the coverage afforded under paragraph 1. above, paragraph 2. Exclusions of SECTION I - COVERAGES A - Bodily Injury and Property Damage Liability is amended as follows: Exclusions J.(3), J.(4), J.(5) and J.(6) are deleted. 3. As respects coverage afforded by this coverage, SECTION III - LIMITS OF INSURANCE is replaced by the following: Regardless of the number of insureds, claims made or "suits" brought or persons or organizations making claims or bring "suits": 1. Subject to 2. Below, the most we will pay for one or more "loss" arising out of any one "occurrence" is $ 1,000. 2. The aggregate amount we will pay for the sum of all "loss" in an annual period is $ 5,000. This aggregate amount is part of and not in addition to the General Aggregate Limit described in paragraph 2. of SECTION III - LIMITS OF INSURANCE, CG 89 70 (Ed. 11/14) (Page 11 of 12) V. Who Is an Insured - Fellow Employee Extension - Management Employees 1. The following is added to paragraph 2.a.(1) of SECTION II - WHO IS AN INSURED: Paragraph (a) and (b) above do not apply to "bodily injury" or "personal and advertising injury" caused by an "employee" who is acting in a supervisory capacity for you. Supervisory capacity as used herein means the "employee's" job responsibilities assigned by you, including the direct supervision of other "employee" of yours. However, none of these "employees" are insureds for "bodily injury" or "personal and advertising injury" arising out of their willful conduct, which is defined as the purposeful or willful intent to cause "bodily injury" or "personal and advertising injury," caused in whole or in part by their intoxication by liquor or controlled substances. This coverage is excess over any other valid and collectable insurance available to ' your "employee." W. Broadened Personal and Advertising Injury 1. Unless "Personal and Advertising Injury" is excluded from this Policy, the following is added to SECTION V - DEFINITIONS Item 14.: h. mental injury, mental anguish, humiliation, or shock, if directly resulting from Items 14.a. through 14.e. CG 89 70 (Ed. 11/14) (Page 12 of 12) SPCAL-2 CIP-10;Loi IDDIYY CERTIFICATE OF LIABILITY INSURANCE DATE 0812 12017 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 pollcy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION 13 WANED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer ri lls to the certlflcate holder In lieu of such endorsement(s). C N - - .............. ... IARC,NcI PRODUCER 310�73ti9611 � :C'� Lynn Grosslight Grosslight Insurance, Inc. PHONE 31'0,473-9611 310.312 4993 License#0247283 o'E'xt 1333 Westwood Blvd .._iVynn0_grossilght.Com Los Angeles, CA 90024 Gil Grosslight INSURER($)AFFORDING COVERAGE NAIL s 1 INSURER A,Great AM Ins Co 16691 INSURED spcaLA etal INSURERB: Elizabeth De La Rosa INSURER C: 5026 W.Jefferson BI Los Angeles,CA 90016 "URERD: INSURER E: INSURER F: .CQVIERAM C MT1191(ZA 5,h(,QI',QE—R: R'EVI I'3 N!UMIaE C: 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 POLIC ES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE AOOL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMBS LTR, INSO 'VWVO .,.�1^IMI,D,!P,NyM_....(MM,IPDM'YY) COMMERCIAL GENERAL LIABILF Y EACH OCC% RENCE $ n� CLAIMS-MADE ❑OCCUR DAMAGE TO REWED P'PFMI,F S f'R y,W r:na $ MED EXP(Any one person) $ PERSONAL f&ADV INJURY $ GEN"L AGGREGATE LIMIT APPLIES PER: GENERAL.AGGREGATE $ P&„'ILI�"Y QCT ❑LOC PRODUCTS-COMP/OP AGG $ r„ITHE6t -_ __..._........m...._.-..... .... -.. ......._..�..... A AUTOMOBILE LIABILITY 501081INELr a NN'I,E C.I'rwrdT' $ 1,000,000 r ='I&A X ANY AUTO CAP5603475 09/01/2017 09/01/2018 BODILY INJURY(per[,arson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ X H1p��s�,��., Hx Ptd.® PgdrYPEf;T"hP f„'�a�J�tA+��E _..-..... AU I V3 ONLY . Ar.�Tr,)" r9+lIL Y m P+r Eaa�CuaiPr�G._..._... ........m.........�.. :�1_.............m.........._._......__................ $ UMBRELLA LRB OCCUR EACH OCCURRENCE $ EXCESS LIAB f CLAIMS-MADE AGGREGATE , DED RETENTION $ �.. Y $ WORHERS COMPENSATION V STATL frE I I ER AND EMPLOYERS'LIABILrrY YIN A, PROF^IiE.T';i,PA,RJRTIErtT"XECUTIVE EL EACH ACCIDENT LReIIROJJYa�-I�f.ti4a.r IDED NIA EL DISEASE-EA EMPLOYEE $ If yes,describe under M DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ V ..................................................................................... ManceJaionEor non` ayyA'nlnen $prsrc�UtnsR710I bn "�° "Itays'�Lanc�f�a° Ibra°ached Kmore apace Is requlrod) or all other is thirty(30 days. CERTIFICATE HOLDER CANCELLATION _...._ ._..�....... ..�.....__....�.._................ ..._.. ..................... ____................................ ELSEGUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of EI Segundo ACCORDANCE WITH THE POLICY PROVISIONS. City Clerk's Office Attn: Mona Shilling AUTHORIZEDREPRESENTATNE 350 Main Street El-Se l ndOSA.4 -3M ACORD 25(2010103) ®1986-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SPCAL-2 OP-9"0 DATE(MMIDDNYM -- CERTIFICATE OF LIABILITY INSURANCE I 1011212017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIONONN LY 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 pollcy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION 13 WANED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does co to certificate n eu os en o .. e .. . t�....9 _............... ....... ..... —,, — W. PRODUCER' ' 310473- 611T �........ ossl6 ht GrGas9N9turance, Inc, WOS . 30� . FAx ....._....._......__.m.......r..........�I_ ...mm...... 310-312-4993 Insurance, . 1 1333 Westwood Blvd ynngjois1Tmht.c_o.m Los Angeles, CA 90024 Gil Grosslight ....... INSUR ►AFFORDING COVEfE___,� ..... ikl� .I! .._.......__........... .._.._.. ................... .._... ........_...._............................................................................................................ ......, Redwood Fire S Cas Ins Co 11673ITITITITITm INSURED spcaLA etal INSURERS Elizabeth De La Rosa � .............wwww....__� 5026 W.Jefferson BI !h �......... ...mm_...... _..._................................. Los Angeles,CA 90016 INduRRRD INSURER E INSURER F; 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 POLIC ES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I S N Sl1 DR �AM t F LIMITS TYPE OF INSURANCE I � POLICY NUMBER h� POLICYEXP COMMERCIAL GENERAL LIABILITY cLAims-mArrF [ OCCUR DAMAGE TO REWEK'a '.. Eh91.�alr�e.(CFt, srf�:rhCd6..,�� _ WIED EXP(Any rine person) $ _. PESR§0 1 PAR) IM1dJI;RY .__._...... m._... �ArCRErArFr&NL �� 1:1c PRLcTS-COMP/OpAcr �$ 11 ,rHrR $ AUTOMOBILE LIABILITY ;,r°rd ttL{RrdEr'i pR'd,mLE kP911T ANY AUTO BODILY INAIRY(Per r,crrsonM $ OWNED SCHEDULED AUTOS ONLY AUTOS 609LY INJURY(Per rrderfl $ ONLY ...............................................................................ww...........................rr. w� � _..........._...._.... UMBRELLA LIAR OCCUR FACHOCCLIRRE,NCE $ EXCESS LIAB CLAIMS-MADE A>r REGALE $ DED I I RETENTION $ _ _ $ AND EMPLOYERS' D7 YIN N/A X SPWC820772 09/30/2017 09/30/2018 x ��TLL STATUM , I• 1,000"0001 AWORKERS COMPENSATION EXCLUD LIABILITY F �^°W ANY PROPRIE 0PtPARTNERIEXECUTIVE ❑ X FI. L ,"i A4'n. ,£C�fl$ A'.1,a a� 'pn I�) 1,000,000, E.L.DISEASE-EA EMPLOYEE $ If es,describe under ........'....000 000 .07.:,`'°.FtIPTI0I�OF OPERATIONS bolrna E L DISEASE-POLICY LIMIT' S ' ', 4, I �y �p� p r� �A �q� g� gr �gq, �V,�p p�,� �I�, ...., Giert 0� erFl$Pn 1;8 on a1V8GO' I�U U0 gWon en" ,AdVorSBn1len� Ciy �/gU l � /-ore apace lereQulre� 017-ATTACHED (")Cancellatlon for none 'a "Hent of premium Is ten(10) day's, Cancellation for all other is tllYlrty( O days, _................................................................................ ....w..................... � ._ CERTIFICATE HOLDER CANCELLAT'I'ON ..� _........_ . ...... . .._....................................__...... ....... ELSEGUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of EI Segundo ACCORDANCE WITH THE POLICY PROVISIONS. City Clerk's Office w _............ Attn: Mona Shilling AUTHORIZED REPRESENTATIVE 350 Main Street � {� e. IM-Se .tltid0..+.�M024. -40.95 ACORD 25(2016/03) S 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WO gg 04 02 C (Ed.9-14) 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 6%of the applicable manual premium otherwise due on such remuneration subject to a policy maximum charge for all such waivers of 5%of total manual premium. The minimum premium for this endorsement Is$350. This agreement shall not operate directly or indirectly to benefit anyone not named In the Schedule. Schedule Specific Waiver Parson/organlzayonr City of EI Segundo Job Desc+iptiom SpecelA"houses"animals picked up by cities anmial Waiver Premiums 360.00 Payroll Subject Claes !tate to waiver 8831 CA 1.00 This endorsement changes the policy to which it is attached and is effective on the date Issued unless otherwise stated. (The information below Is required only when this endorsement In Issued subsequent to preparation of**policy.) Endorsement Effective; 09/30/2017 Policy No.:SPWC820772 Endorsement No. Insured: Premium$ Insurance Company:Cypress Insurance Company WC 90 04 02C Countersigned by (Ed.9-14)