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PROOF OF INSURANCE (2017 - 2018) CLOSED
SOUTBAY-15 KTIE—I(�, .................... F LIABILITY INSURANCE D 10/16/2017) 0 C„ERTIFICATE ... . ................. ......__.............m........................ ............... 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 sINS ..an ADDITIONAL .....RE... ....... U D,the poiolicy(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 License#0148837 mlrACT SeaTechl Insurance Agency,Inc. PHONE FAX dba,Pacific Unified Insurance Agency yA/C,No,Ext):(310)370-5000 (A/C,No):(310)370-5454 15901 Hawthorne Blvd.Suite 200 AVORE . ss Lawndale,CA 90260 AooRE INSURER(S)AFFORDING COVERAGE NAIL# INSURER A:Markel American Insurance Co. INSURED INSURER B:Technology Insurance Company South Bay Children's Health Center Association,Inc. INSURER C: Center Association Inc. 410 So.Camino Real INSURER D: Redondo Beach,CA 90277 INSURER E: INSURER F: COVERAGES CE'RTIFICAT'E 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 POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS IINSR TYPE OF INSURANCE ADDL ”"""X�s'w°' POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD tP°W i'u'I I0.1?.(YYXXI.....Lfa�M/O.RRY.XYI..�............. A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1'000'000 CLAIMS-MADE X OCCUR X HUP1239 0313112017 03/31/2018 DAMAGE TORnNTEDnCA) $ Included PREMISEaX SEXUAL MI'SCONDT-$'11MM MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN1N1.AGGREGATE LIMIT APPLIES PER. GENERAL AC>,GREGA'T'E $ 3,000,000 POLICY PRO- f ILOC 3,000,000 JECT l -----1 PRODUCTS-COMI'IOP AGG $ 'GATHER Emp Ben$1M/3M $ + AUTOMOBILE LIABILITY COMUIN'E"D SINGLE LIMIT 1,000,000 yEa aCCYe6u7RYIy .$ ANY AUTO HUP1239 03/31/2017 03/31/2018 B0DILY INJURY(Per person) s OWNED SCHEDULED AUTOS ONLY AUTOS N (y BODILY INJURY(Per accident) S X AUTOS ONLY X ALP'SN I Ohhfl (Peri accidentDAMAGE $ m A ......X UMBRELLA LIAR............... .,_.X A,.00CIR............... ......, ......... ....... FACH OCCURRENC"E...............................11'0001,000 EXCESS LIAB CLAIMS-MADE HUU1240 03/31/2017 03/31/2018 AGGREGATE 1,000,000 DED X RETENTION$ 10,000 B WORKERS COMPENSATION Y/NI TWC3590849 12/0112016 12101/2017 X EA/~IrN ACCIDENT CRt s 110 AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE X 001,000 F'F1{;ERIMEMBER EXCLUDED? N/A andatory in NH) 1'„0001.000 E'�N.. I:DISE.Pr'`�E:'��EA EMPLOYEE S If yes,describe under 1,000,000 ,.,, DESCRIPTION OF OPERATIONS below E��N DISEASE:,•POI..ICY'I,IMI E S A Property HUP1239 j 03/31/2017 03/31/2018 Loc. 1/RC-Building 458,100 A Property IHUP1239 03/31/2017 03/31/2018 /',Loc.#1/RC-Contents 95,200 i I I /VEHICLES ACORD 101 Additional Remarks Schedule may be attached if more ace is required)................................................ DESCRIPTION Of OPERATIONS A k.00AT'NONS � __. Y P Certificate Holder is Included as Additiona$Insured per Gletieral Liability form MGL 1241 03 14 RE:'Counseling of abused children and their families who are referred to the South Bay Youth Project. SEE.HOLDER NOTES FOR ADDITIONAL POLICY FORMS&CONDITIONS. Certificate Holder Note: **Increased"Rented Premises"and"Medical Expense"coverage limits per SEE ATTACHED ACORD 101 CERTIFIC'A'TE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ci Of EI Segundo CDBG Grant THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City 9 ACCORDANCE WITH THE POLICY PROVISIONS. Attn:Tina Gall 350 Main Street ........................................................w...... wW. EI Segundo,CA 90245 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID:SOUTBAY-15 KTEDFORD LOC#: 1 ' � 64 ADDITIONAL REMARKS SCHEDULE Page 1 of 1 �w�.....�............................................................_......................._...................................................................................................................... .............................. .........................................—........._.�W....... _ AGENCY License#0148. . .i NAMED INSURED SeaTech Insurance Agency, Inc. South Say Children's Health Center Association,Inc. Center Association Inc. POLICY NUMBER 410 So.Camino Real SEE PAGE 1 Redondo Beach,CA 90277 CARRIER NAIC CODE SEE PAGE 1 SEE P 1 EFFECTIVE DATE: _ ...... $.E�PA..(CE 1.................____. ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: A ORIS 26 FORM TITLE: Certificate,of Liability Insurance Description of Operations/Locations/Vehicles: the commercial general liability plus extension endorsement form#MGL242(03/14). "Medical Expense"coverage is EXCLUDED for inmates, PATIENTS or prisoners, per form CG 22 52(10/93).** Workers Compensation policy includes blanket waiver of subrogation per form WC 04 03 06 ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY III MARKS Markel Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY PLUS ENHANCEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM The following coverages and extensions are added to this policy as detailed below. As respects any coverage provided by this endorsement, if higher limits are provided on any other schedule, declarations or endorsement attached to this policy,then the limits and coverage provided by this endorsement would not apply for that coverage. SCHEDULE Limited Product Withdrawal Expense $10,000 All Product Withdrawal Expenses Extended Property Damage - Expected Or Intended Included Injury Non-Owned Watercraft Increased To 51 Feet Long Non-Owned Aircraft If Rented Or Loaned With A Paid Crew Property Damage To Borrowed Equipment $10,000 Each Occurrence Property Damage To Customers' Goods $10,000 Each Occurrence Damage To Premises Rented To You Equal To The General Liability Each Occurrence Limit Property Damage From Elevator Use Included Personal And Advertising Injury From Televised Or Included Videotaped Material Supplementary Payments Bail Bonds Up To $5,000 Loss Of Earnings Up To$500 A Day Medical Personnel $100,000 Any One Person Broadened Definition Of Insured Included Automatic Additional Insureds When Required By Contract Or Agreement Included Managers Or Lessors Of Premises Included Mortgagees, Assignees Or Receivers Included Vendors Included Medical Payments $10,000 Any One Person(Unless Excluded) Each Location And Each Project Aggregates Equal To The General Aggregate Limit Duties In The Event Of Occurrence, Offense, Claim Included Or Suit Unintentional Failure To Disclose All Hazards Included Waiver Of Transfer Of Rights Of Recovery Against Included Others To Us Liberalization Included Mental Anguish Resulting From Bodily Injury Included Broadened Definition Of Mobile Equipment Included MGL 1242 03 14 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 12 with its permission. A. LIMITED PRODUCT WITHDRAWAL EXPENSE THIS COVERAGE ONLY PROVIDES REIMBURSEMENT TO YOU FOR EXPENSES INCURRED BECAUSE OF A COVERED "PRODUCT WITHDRAWAL". THIS COVERAGE DOES NOT PROVIDE ANY LIABILITY COVER- AGE OR COVERAGE FOR THE COST OR EXPENSE OF DEFENDING ANY CLAIM OR"SUIT". 1. The following is added to Section I -Coverages: LIMITED PRODUCT WITHDRAWAL EXPENSE COVERAGE Insuring Agreement a. We will reimburse you for"product withdrawal expenses" incurred by you because of a "product withdraw- al'to which this insurance applies. The amount of such reimbursement is limited as described in Section III-Limits Of Insurance, as amended by this endorsement. No other obligation or liability to pay sums or perform acts or services is covered. b. This insurance applies to a"product withdrawal" only if the "product withdrawal' is initiated in the"coverage territory"during the policy period because: (1) You determine that the"product withdrawal'is necessary; or (2) An authorized government entity has ordered you to conduct a"product withdrawal'. c. We will reimburse"product withdrawal expenses"only if: (1) The expenses are incurred within one year of the date the"product withdrawal'was initiated; (2) The expenses are reported to us within one year of the date the expenses were incurred; and (3) The product that is the subject of the"product withdrawal'was produced during the policy period. d. The initiation of a "product withdrawal' will be deemed to have been made only at the earliest of the follow- ing times: (1) When you first announced, in any manner, to the general public, your vendors or to your"employees" (other than those "employees" directly involved in making the determination) your decision to conduct or participate in a"product withdrawal'. This applies regardless of whether the determination to conduct a "product withdrawal' is made by you or is requested by a third party; or (2) When you first received, either orally or in writing, notification of an order from an authorized govern- ment entity to conduct a"product withdrawal'. e. "Product withdrawal expenses" incurred to withdraw"your products"which contain the same or substantial- ly similar"defects"will be deemed to have arisen out of the same"product withdrawal'. Exclusions This insurance does not apply to"product withdrawal expenses"arising out of: a. Breach Of Warranty And Failure To Conform To Intended Purpose Any"product withdrawal' initiated due to the failure of"your product'to accomplish its intended purpose, in- cluding any breach of warranty of fitness, whether written or implied. This exclusion does not apply if such failure has caused or is reasonably expected to cause "bodily injury" or physical damage to tangible prop- erty other than "your product'. b. Infringement Of Copyright, Patent,Trade Secret,Trade Dress Or Trademark Any "product withdrawal' initiated due to copyright, patent, trade secret, trade dress or trademark infringe- ments. c. Chemical Transformation, Deterioration Or Decomposition Any "product withdrawal' initiated due to transformation of a chemical nature, deterioration or decomposi- tion of"your product'. This exclusion does not apply if transformation of a chemical nature, deterioration or decomposition is caused by: MGL 1242 03 14 Includes copyrighted material of Insurance Services Office, Inc., Page 2 of 12 with its permission. (1) An error in manufacturing, design or processing; (2) Transportation of"your product"; or (3) "Product tampering". d. Goodwill, Market Share, Revenue, Profit Or Redesign The costs of goodwill, market share, revenue or"profit"or the costs of redesigning "your product". e. Expiration Of Shelf Life Any"product withdrawal" initiated due to expiration of the designated shelf life of"your product". f. Known Defect A "product withdrawal" initiated because of a "defect" in "your product" known to exist by the Named In- sured or the Named Insured's "executive officers" prior to the policy period or the time "your product" leaves your control or possession. g. Otherwise Excluded Products A recall of any specific products for which "bodily injury" or"property damage" is excluded under Coverage A-Bodily Injury And Property Damage Liability. h. Governmental Ban A recall when "your product"or a component contained within"your product" has been: (1) Banned from the market by an authorized government entity prior to the policy period; or (2) Distributed or sold by you subsequent to any governmental ban. i. Defense Of Claim The defense of a claim or"suit"against you for liability arising out of a"product withdrawal". j. Third Party Damages, Fines And Penalties Any compensatory damages, fines, penalties, punitive or exemplary or other non-compensatory damages imposed upon the insured. k. Pollution-Related Expenses Any loss, cost, or expense due to any: (1) Request, demand, order, statutory or regulatory requirement that any insured or others test for, moni- tor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to or assess the ef- fects of, "pollutants";or (2) Claim or "suit" by or on behalf of a governmental authority for damages because of testing for, moni- toring, cleaning up, removing, containing, treating, detoxifying or neutralizing, or in any way responding to or assessing the effects of, "pollutants". 2. The following is added to Section III - Limits Of Insurance: The most that we will reimburse you for the sum of all "product withdrawal expenses" incurred for all "product withdrawals" initiated during the policy period is the amount shown in the Schedule of this endorsement, re- gardless of the number of: a. Insureds; b. "Product withdrawals" initiated; or c. "Your products"withdrawn. 3. Section IV-Commercial General Liability Conditions is amended as follows: a. Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit is replaced by the following: 2. Duties In The Event Of A Defect Or A Product Withdrawal MGL 1242 0314 Includes copyrighted material of Insurance Services Office, Inc., Page 3 of 12 with its permission. a. You must see to it that we are notified as soon as practicable of any actual, suspected or threat- ened "defect' in "your product', or any governmental investigation, that may result in a "product withdrawal".To the extent possible, notice should include: (1) How,when and where the"defect'was discovered; (2) The names and addresses of any injured persons and witnesses; and (3) The nature, location and circumstances of any injury or damage arising out of use or consump- tion of"your product'. Your obligation to notify us as soon as practicable is satisfied if you send us written notice as soon as practicable after any of your"executive officers", directors, partners, insurance managers or le- gal representatives become aware of or should have become aware of such actual, suspected or threatened "defect' in "your product', or any governmental investigation, that may result in a "prod- uct withdrawal'. b. If a"product withdrawal"is initiated, you must: (1) Immediately record the specifics of the"product withdrawal' and the date where it was initiated; and (2) Notify us as soon as practicable. You must see to it that we receive written notice of the"product withdrawal"as soon as practicable. c. You must promptly take all reasonable steps to mitigate the expenses associated with a "product withdrawal'. Any "profit"that you receive from mitigating the expenses will be deducted from the a- mount of reimbursement that you will receive for"product withdrawal expenses". d. You and any other involved insured must: (1) Immediately send us copies of pertinent correspondence received in connection with the "prod- uct withdrawal; (2) Authorize us to obtain records and other information; and (3) Cooperate with us in our investigation of the"product withdrawal'. b. The following Conditions are added: Concealment Or Fraud We will not provide"product withdrawal expense"coverage to you or any other insured who, at any time: a. Engaged in fraudulent conduct; or b. Intentionally concealed or misrepresented a material fact concerning a "product withdrawal' or"product withdrawal expenses"incurred by you. Product Tampering Limitation When "product tampering" is known, suspected or threatened, a "product withdrawal' will be limited to those batches of"your product'which are known or suspected to have been tampered with. 4. The following definitions are added: a. "Defect'means a flaw, deficiency or inadequacy that creates a dangerous condition. b. "Product tampering" means an act of intentional alteration of "your product' which has caused or is rea- sonably expected to cause"bodily injury"or physical injury to tangible property other than "your product'. For purposes of this insurance, electronic data is not tangible property. As used in this definition, electronic data means information, facts or programs stored as or on, created or used on, or transmitted to or from computer software, including systems and application software, hard or floppy disks, CD-ROMs, tapes, drives, cells, data processing devices or any other media which are used with electronically controlled equipment. MGL 1242 03 14 Includes copyrighted material of Insurance Services Office, Inc., Page 4 of 12 with its permission. c. "Product withdrawal'means the recall or withdrawal: (1) From the market; or (2) From use by any other person or organization; of"your products" or products which contain "your products", because of known or suspected "defects" in "your product" or known or suspected "product tampering" which has caused or is reasonably expected to cause"bodily injury"or physical injury to tangible property other than "your product'. For purposes of this insurance, electronic data is not tangible property. As used in this definition, electronic data means information, facts or programs stored as or on, created or used on, or transmitted to or from computer software, including systems and applications software, hard or floppy disks, CD-ROMs, tapes, drives, cells, data processing devices or any other media which are used with electronically controlled equipment. d. "Product withdrawal expenses" means those reasonable and necessary extra expenses, listed below, paid and directly related to a"product withdrawal': (1) Costs of notification; (2) Costs of stationery, envelopes, production of announcements and postage or facsimiles; (3) Costs of overtime paid to your regular non-salary"employees" and costs incurred by your"employees", including costs of transportation and accommodations; (4) Costs of computer time; (5) Costs of hiring independent contractors and other temporary employees; (6) Costs of transportation, shipping or packaging; (7) Costs of warehouse or storage space; or (8) Costs of proper disposal of"your products" or products that contain "your products"that cannot be re- used, not exceeding your purchase price or your costs to produce the products. e. "Profit'means the positive gain from business operation after subtracting for all expenses. B. EXTENDED PROPERTY DAMAGE-EXPECTED OR INTENDED INJURY Exclusion 2.a. Expected Or Intended Injury under Section I - Coverages, Coverage A- Bodily Injury And Property Damage Liability is replaced by the following: a. Expected Or Intended Injury "Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" or"property damage" resulting from the use of reasonable force to protect per- sons or property. C. NON-OWNED WATERCRAFT AND NON-OWNED AIRCRAFT Exclusion 2.g. Aircraft, Auto Or Watercraft under Section I - Coverages, Coverage A- Bodily Injury And Property Damage Liability is amended as follows: 1. Paragraph (2) is replaced by the following: (2) A watercraft you do not own that is: (a) Less than 51 feet long; and (b) Not being used to carry persons or property for a charge; 2. The following is added: (6) 'Bodily injury" or "property damage" arising out of any aircraft not owned by any insured that is rented or loaned to you with a paid crew. If other insurance applies to a loss because of"property damage" to non-owned watercraft or aircraft as described in Paragraphs (2) or(6) above, the insurance provided by this Coverage Form does not apply, whether the other in- surance is primary, excess, contingent or issued on any other basis. MGL 1242 03 14 Includes copyrighted material of Insurance Services Office, Inc., Page 5 of 12 with its permission. D. PROPERTY DAMAGE TO BORROWED EQUIPMENT 1. The following is added to Exclusion 2.j. Damage To Property under Section I-Coverages, Coverage A-Bodily Injury And Property Damage Liability: Paragraph (4) of this exclusion does not apply to "property damage" to borrowed equipment while that equip- ment is: a. Not being used to perform operations; and b. Away from an insured's premises. 2. The following is added to Section III-Limits Of Insurance: Subject to the General Aggregate limit, the most we will pay for "property damage" to borrowed equipment is the amount shown in the Schedule of this endorsement for each"occurrence". 3. The insurance afforded by Paragraph 1. above is excess over any valid and collectible property insurance (in- cluding any deductible) available to the insured, whether primary, excess, contingent or issued on any other basis. E. PROPERTY DAMAGE TO CUSTOMERS' GOODS 1. The following is added to Exclusion 2.j. Damage To Property under Section I -Coverages, Coverage A-Bodily Injury And Property Damage Liability: Paragraphs (3), (4) and (6) of this exclusion do not apply to "property damage"to"customers' goods" while on your premises. 2. The following is added to Section III- Limits Of Insurance: Subject to the General Aggregate limit, the most we will pay for"property damage"to"customers' goods" is the amount shown in the Schedule of this endorsement for each"occurrence". 3. The insurance afforded by Paragraph 1. above is excess over any valid and collectible property insurance (in- cluding any deductible) available to the insured, whether primary, excess, contingent or issued on any other basis. 4. The following definition is added: "Customers' goods" means tangible personal property belonging to your customers and left with you for stor- age, service or repair. "Customers' goods"does not include: a. Accounts, bills, currency, deeds, food stamps or other evidences of debt, money, notes or securities. Lottery tickets held for sale are not securities; b. Animals; c. Contraband, or property in the course of illegal transportation or trade; d. Personal property while airborne or waterborne; e. Property that is covered under another coverage form of this or any other policy in which it is more specific- ally described, except for the excess of the amount due (whether you can collect on it or not)from that oth- er insurance; f. Vehicles or self-propelled machines that are licensed for use on public roads; aircraft; or watercraft; This paragraph does not apply to: (1) Vehicles or self-propelled machines, other than "autos", you hold for sale; or (2) Rowboats or canoes out of water at your premises; or g. The following property while outside of buildings: (1) Grain, hay, straw or other crops; (2) Fences, radio or television antennas (including satellite dishes) and their lead-in wiring, masts or tow- ers,trees, shrubs or plants(other than trees, shrubs or plants held for sale). MGL 1242 03 14 Includes copyrighted material of Insurance Services Office, Inc., Page 6 of 12 with its permission. F. DAMAGE TO PREMISES RENTED TO YOU The following applies only if Damage To Premises Rented To You is not excluded from the policy to which this en- dorsement is attached: 1. The first paragraph following Paragraph (6)of Exclusion 2.j. Damage To Property under Section I -Coverages, Coverage A -Bodily Injury And Property Damage Liability is replaced by the following: Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" (other than damage by fire) to premises, including the contents of such premises, rented to you. A separate limit of insurance applies to Dam- age To Premises Rented To You as described in Section III-Limits Of Insurance. 2. The final paragraph of Paragraph 2. Exclusions under Section I - Coverages, Coverage A - Bodily Injury And Property Damage Liability is replaced by the following: Exclusions c. through n. do not apply to damage by fire, lightning, explosion, smoke or sprinkler leakage 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. 3. Paragraph 6. under Section III-Limits Of Insurance is replaced by the following: 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 by fire, lightning, explosion, smoke or sprinkler leakage, while rented to you or temporarily occupied by you with permission of the own- er, is equal to the Each Occurrence limit shown in the Declarations. 4. Paragraph 4.b.(1)(a)(ii) of the Commercial General Liability Coverage Form, and Paragraph 4.b.(1)(a)(iii)of the Commercial General Liability Coverage Form (Claims-Made Version) under Section IV - Commercial General Liability Conditions are replaced by the following: That is fire, lightning, explosion, smoke or sprinkler leakage insurance for premises rented to you or temporarily occupied by you with permission of the owner; 5. Paragraph a. of Definition 9. "insured contract" is replaced by the following: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that in- demnifies any person or organization for damage by fire, lightning, explosion, smoke or sprinkler leakage to premises while rented to you or temporarily occupied by you with permission of the owner is not an "in- sured contract"; G. PROPERTY DAMAGE FROM ELEVATOR USE 1. The following is added to Exclusion 2.j. Damage To Property under Section I - Coverages, Coverage A - Bodily Injury And Property Damage Liability: Paragraphs (3), (4) and (6)of this exclusion do not apply if such "property damage" arises out of the use of ele- vators at premises you own, rent, lease or occupy. 2. The insurance afforded by Paragraph 1. above is excess overy any other valid and collectible insurance which applies to a loss because of"property damage" arising out of the use of elevators, whether such other insur- ance is primary, excess, contingent or issued on any other basis. H. PERSONAL AND ADVERTISING INJURY FROM TELEVISED OR VIDEOTAPED MATERIAL 1. Exclusions 2.b. and 2.c. under Section I - Coverages, Coverage B - Personal And Advertising Injury Liability are replaced by the following: b. Material Published With Knowledge Of Falsity "Personal and advertising injury" arising out of oral, written or professionally produced televised or video- taped publication, in any manner, of material, if done by or at the direction of the insured with knowledge of its falsity. c. Material Published Prior To Policy Period "Personal and advertising injury" arising out of oral, written or professionally produced televised or video- taped publication, in any manner, of material whose first publication took place before the beginning of the policy period. MGL 1242 03 14 Includes copyrighted material of Insurance Services Office, Inc., Page 7 of 12 with its permission. 2. Paragraphs d.and e. of the definition of"personal and advertising injury" are replaced by the following: d. Oral, written or professionally produced televised or videotaped publication, in any manner, of material that slanders or libels a person or organization, or disparages a person's or organization's goods, products or services; e. Oral, written or professionally produced televised or videotaped publication, in any manner, of material that violates a person's right to privacy; I. SUPPLEMENTARY PAYMENTS-BAIL BONDS AND LOSS OF EARNINGS Paragraphs 1.b. and 1.d. under Section I - Coverages, Supplementary Payments - Coverages A And B are re- placed by the following: b. Up to the amount shown in the Schedule of this endorsement for cost of bail bonds required because of ac- cidents or traffic law violations arising out of the use of any vehicle to which Bodily Injury Liability Coverage ap- plies.We do not have to furnish these bonds; 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 the amount shown in the Schedule of this endorse- ment because of time off from work; J. MEDICAL PERSONNEL The following applies only if no other similar coverage is included on or added to the policy to which this endorse- ment is attached: 1. Paragraph 2.a.(1)(d) under Section II - Who Is An Insured does not apply to any registered nurse, licensed practical nurse, certified emergency medical technician or certified paramedic who is employed by you to pro- vide professional health care services, but only while acting within the scope and course of their duties as such. 2. The following is added to Section III -Limits Of Insurance: Subject to the General Aggregate limit, the most we will pay under Medical Personnel Coverage is the amount shown in the Schedule of this endorsement for all loss sustained by any one person from professional health services. K. BROADENED DEFINITION OF INSURED Section II -Who Is An Insured is amended as follows: 1. The following is added to Paragraph 2.a.: Paragraph (1)does not apply to managers at the supervisory level or above. 2. Paragraph 2. is amended to include the following as insureds: Any legally incorporated entity of which you own at least 51% of the voting stock on the inception date of this Coverage Form and on the date of any covered "occurrence", claim or"suit". This insurance shall not apply to any entity that is already insured under any other insurance provided by any company or that would be an insured but for the exhaustion of its limits of insurance. 3. Paragraph 3.a. is replaced by the following: a. Coverage for your newly acquired or formed organization shall be: (1) Effective on the date of acquisition or formation; and (2) Afforded until the end of the policy period of this Coverage Form. L. AUTOMATIC ADDITIONAL INSUREDS The following paragraphs are added to Section II-Who Is An Insured: 1. The following are also insureds under this policy, subject to the following provisions: a. When Required By Contract Or Agreement Any person or organization to whom you are required by written contract, agreement, permit or authoriza- tion to provide insurance, but only if the contract, agreement, permit or authorization is in effect during the policy period shown in the Declarations and was executed prior to the "bodily injury", "property damage" or "personal and advertising injury". However: MGL 1242 03 14 Includes copyrighted material of Insurance Services Office, Inc., Page 8 of 12 with its permission. (1) The person or organization is an insured only to the extent you are held liable due to: (a) The ownership, maintenance or use of that part of premises you own, rent, lease or occupy, sub- ject to the following additional provisions: (i) This insurance does not apply to any "occurrence" which takes place after you cease to be a tenant in any premises leased to or rented to you;and (ii) This insurance does not apply to any structural alterations, new construction or demolition op- erations performed by or on behalf of the person or organization; (b) Your ongoing operations for that insured,whether the work is performed by you or for you; (c) The maintenance, operation or use by you of equipment leased to you by such person or organiza- tion, subject to the following additional provisions: (i) This insurance does not apply to any"occurrence"which takes place after the equipment lease expires or you cease to lease that equipment; and (ii) This insurance does not apply to "bodily injury" or "property damage" arising out of the sole negligence of such person or organization; (d) Permits or authorizations issued by any state or political subdivision with respect to operations per- formed by you or on your behalf, subject to the following additional provision: This insurance does not apply to"bodily injury", "property damage" or"personal and advertising in- jury"arising out of operations performed for that state or municipality. (2) The insurance with respect to any architect, engineer or surveyor does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of or failure to ren- der any professional services by or for you, including: (a) The preparing, approving or failure to prepare or approve maps, drawings, opinions, reports, sur- veys, change orders, designs or specifications; and (b) Supervisory, inspection or engineering services. (3) This insurance does not apply to "bodily injury" or "property damage" included within the "products- completed operations hazard". (4) This insurance does not apply to "bodily injury", "property damage" or"personal and advertising injury" arising out of the rendering of or failure to render any professional services. (5) This insurance does not apply to any insured person or organization if the loss, cost, injury or damage is otherwise excluded from coverage under this insurance, including any endorsements made a part of this policy. (6) A person's or organization's status as an insured under this endorsement ends when your operations for that insured are completed. (7) This insurance does not apply to any person or organization included as an insured by an endorsement issued by us or otherwise made part of this insurance. (8) No coverage will be provided if, in the absence of this endorsement, no liability will be imposed by law on you. Coverage will be limited to the extent of your negligence or fault according to the applicable principles of comparative fault. This Additional Insured provision does not apply to managers or lessors of premises; mortgagees, assign- ees or receivers; or vendors. b. Managers Or Lessors Of Premises Any person or organization who leases to you or manages property you rent or lease, but only with respect to liability for"bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf in connection with that part of the premises leased or rented to you and shown on the Declarations. The following additional exclusions apply to such managers or lessors of premises: This insurance does not apply to: MGL 1242 03 14 Includes copyrighted material of Insurance Services Office, Inc., Page 9 of 12 with its permission. (1) Any"occurrence"which takes place after you cease to be a tenant in that premises. (2) Structural alterations, new construction or demolition operations performed by or on behalf of the per- sons)or organization(s)who leases to you or manages property you rent or lease. c. Mortgagees,Assignees Or Receivers Any person or organization with respect to their liability as mortgagee, assignee or receiver and arising out of the ownership, maintenance or use of premises by you. However, this insurance does not apply to structural alterations, new construction or demolition operations performed by or for that person or organi- zation. d. Vendors Any vendor with whom you have agreed in a written contract or agreement to provide insurance, but only if the contract or agreement is in effect during the policy period shown in the Declarations and was executed prior to the "bodily injury" or"property damage", and only with respect to "bodily injury" or "property dam- age" arising out of"your products" which are distributed or sold in the regular course of the vendor's busi- ness. (1) The following additional exclusions apply to such vendors: This insurance does not apply to: (a) "Bodily injury" or"property damage"for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; (b) Any express warranty unauthorized by you; (c) Any physical or chemical change in the product made intentionally by the vendor; (d) Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing or the substitution of parts under instructions from the manufacturer, and then repackaged in the origi- nal container; (e) Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distri- bution or sale of the products; (f) Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; (g) Products which, after distribution or sale by you, have been labeled or relabeled or used as a con- tainer, part or ingredient of any other thing or substance by or for the vendor; (h) Any failure to maintain the product in a merchantable condition; or (i) "Bodily injury" or"property damage"arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (i) The exceptions contained in subparagraphs(d) or(f); or (ii) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normal- ly undertakes to make in the usual course of business, in connection with the distribution or sale of the products. (2) This insurance does not apply to any insured person or organization from whom you have acquired such products, or any ingredient, part or container entering into, accompanying or containing such products. (3) This insurance does not apply to any vendor included as an insured by an endorsement issued by us or otherwise made a part of this insurance. (4) This insurance does not apply if "bodily injury" or "property damage" included in the "products-com- pleted operations hazard"is excluded either by the provisions of this insurance or by endorsement. MGL 1242 03 14 Includes copyrighted material of Insurance Services Office, Inc., Page 10 of 12 with its permission. 2. The insurance provided to such automatic additional insureds: a. Only applies to the extent permitted by law; and b. Will not be broader than that which you are required by the contract or agreement to provide for such addi- tional insureds. 3. With respect to the insurance afforded to such automatic 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. The insurance afforded to the additional insured does not increase the applicable limits of insurance shown in the Declarations. M. MEDICAL PAYMENTS The following applies only if Medical Payments Coverage is not excluded from the policy to which this endorsement is attached: Paragraph 7. under Section III -Limits Of Insurance is replaced by the following: 7. Subject to Paragraph 5. above, the Medical Expense limit is equal to the Medical Expense limit stated in the Declarations or the amount shown in the Schedule of this endorsement, whichever is greater, and is the most we will pay under Coverage C for all medical expenses because of"bodily injury" sustained by any one person. N. EACH LOCATION AND EACH PROJECT AGGREGATES The following is added to Section III -Limits Of Insurance: 1. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Coverage A, and for all medical expenses caused by accidents under Coverage C, which can be attributed on- ly to operations at a single designated covered "location"or covered construction project: a. A separate Each Location or Each Project Aggregate limit applies to each covered "location" or covered construction project, and that limit is equal to the General Aggregate limit shown in the Declarations. b. The Each Location or Each Project Aggregate limit is the most we will pay for the sum of all damages un- der Coverage A, except damages because of "bodily injury" or "property damage" included in the "prod- ucts-completed operations hazard", and for medical expenses under Coverage C, regardless of the number of: (1) Insureds; (2) Claims made or"suits" brought; or (3) Persons or organizations making claims or bringing "suits". c. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall re- duce the Each Location or Each Project Aggregate limit for each covered "location" or covered project for which payment is made. Such payments shall not reduce the General Aggregate limit shown in the Decla- rations nor shall they reduce any other covered "location"or covered project's general aggregate. d. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medi- cal Expense continue to apply. However, instead of being subject to the General Aggregate limit shown in the Declarations, such limits will be subject to the applicable Each Location or Each Project Aggregate lim- it. 2. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Coverage A, and for all medical expenses caused by accidents under Coverage C, which cannot be attributed only to ongoing operations at a covered "location"or covered project: a. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall re- duce the amount available under the General Aggregate limit or the Products-Completed Operations Ag- gregate limit,whichever is applicable; and MGL 1242 03 14 Includes copyrighted material of Insurance Services Office, Inc., Page 11 of 12 with its permission. b. Such payments shall not reduce any Each Location or Each Project Aggregate limit. 3. When coverage for liability arising out of the "products-completed operations hazard" is provided, any pay- ments for damages because of"bodily injury" or"property damage" included in the "products-completed opera- tions hazard"will reduce the Products-Completed Operations Aggregate limit, and not reduce the General Ag- gregate limit nor the Each Location or Each Project Aggregate limit. 4. If the applicable covered construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. 5. For the purposes of this section of this endorsement, 'location" means premises involving the same or con- necting lots, or premises whose connection is interrupted only by a street, roadway, waterway or right-of-way of a railroad. 6. The provisions of Section III - Limits Of Insurance not otherwise modified by this endorsement shall continue to apply as stipulated. O. DUTIES IN THE EVENT OF OCCURRENCE, OFFENSE, CLAIM OR SUIT The following is added to Condition 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit under Section IV -Commercial General Liability Conditions: Your obligation to notify us as soon as practicable of an 'occurrence", offense, claim or"suit' is satisfied if you send us written notice as soon as practicable after any of your "executive officers", directors, partners, insurance man- agers or legal representatives become aware of or should have become aware of such 'occurrence", offense, claim or"suit'. P. UNINTENTIONAL FAILURE TO DISCLOSE ALL HAZARDS The following is added to Condition 6. Representations under Section IV-Commercial General Liability Conditions: If you unintentionally fail to disclose all hazards prior to the beginning of the policy period of the Coverage Form,we shall not deny coverage under this Coverage Form because of such failure. Q. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US The following is added to Condition 8. Transfer Of Rights Of Recovery Against Others To Us under Section IV - Commercial General Liability Conditions: We waive any right of recovery we may have against any person or organization 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 or- ganization and included in the "products-completed operations hazard". This waiver applies only to the person or organization with whom you have agreed in a written contract prior to an'occurrence"to waive such rights. R. LIBERALIZATION The following is added to Section IV-Commercial General Liability Conditions: Liberalization Clause If we adopt any revision that would broaden coverage under this Coverage Form without additional premium, the broadened coverage will immediately apply to this Coverage Form as of the day the revision is effective in your state. S. MENTAL ANGUISH RESULTING FROM BODILY INJURY Definition 3. "bodily injury" is replaced by the following: 3. 'Bodily injury"means: a. Bodily injury, sickness or disease sustained by a person, including mental anguish or emotional distress re- sulting from any of these; and b. Death resulting from bodily injury, sickness or disease. T. BROADENED DEFINITION OF MOBILE EQUIPMENT The following is added to Paragraph f.(1) of Definition 12. "mobile equipment': This shall not apply to self-propelled vehicles of less than 1,000 pounds gross vehicle weight. All other terms and conditions remain unchanged. MGL 1242 03 14 Includes copyrighted material of Insurance Services Office, Inc., Page 12 of 12 with its permission. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) 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 2%Of the California workers'compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Any person or organization as required by written contract. 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 is issued subsequent to preparation of the policy.) Endorsement Effective 12/1/2016 Policy No. TWC3590849 Endorsement No. 11 Insured South Bay Children's Health Center Association,Inc Premium$ 16804 Insurance Company Technology Insurance Company,Inc. Countersigned by WC 04 03 06 (Ed.04-84)