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PROOF OF INSURANCE (2018) CLOSED
DATE(MM/DD/YY) A�" YYCERTIFICATE OF LIABILITY INSURANCE 1/4/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT I NAME: Mary Strohman Kessler Alair Insurance Services, Inc I(A/CC..NNo.Ext): (909)931-1500 FAX Kessler No): (909)932-2133 License # OA 91387 IE-MAIL mstrohman@kessleralair.com ADDRESS: 12487 N. Mainstreet, Ste. 240 I INSURER(S)AFFORDING COVERAGE NAIC# Rancho Cucamonga CA 91739 INSURER A:Phi1adelphi a Indemnity Ins Company INSURED INSURER B: Revenue & Cost Specialists, LLC IINSURERC: 1519 E. Chapman Ave., Suite C INSURER D: INSURER E: Fullerton CA 92831-3623 I INSURER F: COVERAGES CERTIFICATE NUMBER:2017-18 GL AUTO EX & PROF 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INcn wan POLICY NUMBER !MM/DDNYYY1 !MM/DD/YYYY1 X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 500,000 A CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ X PHSD1308454 12/31/2017 12/31/2018 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ❑ PRO- JECT ❑ LOC PRODUCTS-COMP/OPAGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ p' ALL OWNED SCHEDULED AUTOS AUTOS PHSD1308454 12/31/2017 12/31/2018 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS (Per accident) $ X UMBRELLA LAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LAB H CLAIMS-MADE AGGREGATE $ 1,000,000 DED I X I RETENTION$ 10,000 PHUB613140 12/31/2017 12/31/2018 $ WORKERS COMPENSATION PER STATUTE OERH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Professional Liability PHSD1308454 12/31/2017 12/31/2018 Liability Each Claim Incl Exp $1,000,000 Retro Date 04/27/1990 Annual Aggregate$2.500 Ded $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Additional Insured is City of E1 Segundo, it's officers, officials, employees and volunteers as per attached, PI-BP-001 (9-05) , CERTIFICATE HOLDER CANCELLATION ntarnay@elsegundo.org SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of E1 Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. E1 Segundo, CA 90245 AUTHORIZED REPRESENTATIVE Mary Strohman/MARYZq`�-`-k ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) F1511131"A"1111101 (911,115) I I 11S IE'NDOIlPRSElk4IEN"'l�' CIl&--I,AI114GE -rHE F:110IV!ICY. 1111, EASEffi.'::�:AE) IT C`AREF::ULE Y. 113USHIMESSIDW11i POLICY Ell ITIE IEN111 LA11114CEMEINT Thi!s enidloirsierrient modirses insitrainicia pmirnw,ided under the ft::n,R,Dwinig E.31USIENIESSOWNEIRS LIABILITYCOVII-E-"RAGE,FORM BUSUNESSOMMERS SPECIAL IV::!'IIROlIr-'EIRTY',C,O'VIll:.,:,,'R,AGlE IFORM it is understood aind agiiieedti,iiat iffie W'IoMing exteri o1iiii1y app[y iri firie eveinitthat iii,iin intherspecirm g:oversge forttiie indicalled loss,explasiiiii provided unideir this paIHqv fli'such spoicific coverage appflies, the I coiniditknis ainid kri'Of that COVE.11'8ge wire C11'm,!L,-,o1e and exictuMve caverage applicable onder this pc)ky. Thirougt!iiout ti-iks eiridoiserneird Che words 1.yoiuil"and"youiii'"irefer to the,INNmed lnsuii,ed WP*win ik's I Declaraflairm,, The words 1 we",,,*us' a iinid"our'refer Ito III'*Comljjpany provid iiii-iq thisirisuranc I Flart'l: ProiDer1w ClOveratie Enhaincierii, Th a for llloyAng arneindii-neants sire a part I the BUSINESSOWINE RS SPECIAL 1:::�IROPERTY G0'VE1FZA(':,4'E 1F;DF?M 1,, Wcraiaseg:lMass, Urnks Section A. Covre, item 4,b, is replaced lby: 1b. or structuiii-e. or paid of ain owdocir signi,we,will irml II ay rinioire khan" 3.0f.)0 ror Ehie too of 0 loss ar damage in airiy cine occuiii"rencie. This I.JirrsRafiorii does not Bipplyto loss or dairinagebyppm e",.q.mcified causies o,f toss'%except varm idalisirri 2, tincreaseid F'Ire Il spairtmieirot Slarviliclhiarge ,15eclibori k Coverage, illern 5.t-iI Irepip aiced Ibly: c. Mire IDepprtiii,neirii't,Seiv-,vIice Chaiii VWlien 0--iiii departnwird I catledto save air Iprrop.ect(!!,overed Propeidy fraim a Covered use Of I Osswe witi poy up to�53,000 foryour liabifi�for fire,depairtrineint service charges,- (1)Asi,snw..lud by cori or argireervient IlGwrilor to llos%or (2)Ill uked by Ikocall oirdilrtance 3. Ftediuced Walfiiii Peirfiod and ioinqier Dui ation rorONDAuthorky Ciii::wieairai 9 Section A. Coveii-alge, ftem 5 i is reppaicii by, 1, Givil Authority 'We Wil 11piny for theai:tual Iloss of Business Iiii yot.ist.wa.,in 31111d inecessary Extra Expense ci:::1u!,w.- d by aLfilort of 60 aiulhodty iffiat pircii access to the descdbW pir"rhises due in dilrect physical loss of or darwge to,propedy,offiri.ir thain alti-!Iie descAbed preimises.1,r.aused by or M-5UNTIg from any Covered Cause of Loss. The coveraige for Business[neon:e w10'begin 48 hours afteir Lhe firrma of that actilDn and OR appltly fair speriod 611).1p 110 corisecufive weeks after wveraige begins, I o,f 5 sindudes Crura Yfight MINIM Of Me IIInsurame Serykas office,ft uW Mh Jbs permkitsion, F::`kBP 001 (905) "rhe cloveirage foir ineiressary Extra lE:::xjj::Iieili!se wilili Ibeglin, krnimedlalely afteir thefir-nie oftiVial actiloill arid enlds� (1) 5 coirtsecutive i spur thie V Iof that Il cljoriii or (2) fterl�your Busirmss Lnclom�,. cover aoie ends, Michever ib s Iliallar,. IT rm lullefiri of Busilness fricame ani Extra Expert!:ne Icomntaaiirned lin the Businloss lincogiiie and Coverage, nre Civil Ali crity Adidlfional Coverage Is,rint ubject to Hr e Lirnits of Inswilrairice. 4.Broadened Pemonal IFlrm 1pmurly Coverag..ie Section& Coveragle, hern "I b , tll'tefirsit pwragiraptii is re-pWc:eid, by b. Personat Property,bcaled i�n or-on the bidildings at thle described pirerrrises oHirm thel-open(air in a vel-iiiiide)wittfliri 1,250 Feet i descrit:wd prler'61sei....,i,tricludillg. �S. Increased, fimft For Peirsonaf Pircopierty Off FlireinflSes Sectioin A. Coveirage, tles'n i is rqjj::fl,ac0d by: b. PensiDiriml IPmriqlplaq Off ll:Pireirirolsies You may exlend the liesuirance that ej.:iipfics J,o!Buslnei.',S Plef&Dnat property to apjj:::oly to coverii Bustiness ll:::leirsoinalPri i than 7mininley"" and 1 securlitles",, "valuable pe.q::mir 4 and reicordis"oir accii,un is receire all'ei,wl'ii,He ft lis In the i of trairrLit,or,lempoiradly at a promises lou do it owiri�, lease cir crierate, Thie most wie 'mii Y 'r V il pla oir lloss or damal e under fl*i is Ext,iensloirm is�$10,o1000, i tinicireaseld Hrrifts for Outdoor IF-Iropeirty, Sectlion X, Coverage,Rem&c. lis rsplacedAmy; cOutdoor Pirqxiiity Yo�u may sixtend the linsuirance piii.iVlded Ib'y ltii'Ns policy,tic S�ji::qply to your oultdoor fienices,, radial anid,lelevision mitennas(Includingsatelfite dishes),sigirts i it-Ian si�gns altsdl"led to shirii.�ibs and plants,tniOudinig debds removW expeirssel, caused ll::u'Y or resultlinig frorn ainy of the following c*uses of qlOssn (1) Fire� (2) Ligt-nllniinlg�i (3) Exp lios'K)111; (4) Mot oir Civit Clommotion; or (5) Aircraft, Thle most we'willpay,for Iloss air damage under 111-10s Exteirisbin i!s'$5,000,bitst not more. Pliaill-li $1,,1000'for'any uripliree, hrui' Ior plard 7. Flire IExtboulsher Redhargie, Section X, ICovenagel,fteharm G.I overage Extensbas MINI also inctude: rr-w extend the Insuirairice provided 1:�y lf-�Is covexai e farm to cli expu'.&risiras y,oiu incuir to Y 9 recharge lportable EwfirigiWshers,dI lr1mlrrnllledt,cairbon dioddel, or fliquid ai.daimatic fire exilnguisfiiingsyst eirirts and the cast of reseffing aulamotic Fuialkshut-off cloninlection s,if arvy of the above aire discItiarged to fu to fire ioir are&s6l,mirged dluetal a nwchairticdl'irna.l[funictlion The mcmd we wlifl Ipay for,Iliosis oir dairnage uirtirleir thil.; i!:!ix!leinsbin is$31,000, PnIraq !-5 llnirJLWe!s i mairedas ialf ft linstrance&Mcies Mica,hi used Md' a IpierTrossilon, (9105) No deldiucilibleshaIN a;:qj::0y to this coveiii 8 t3luslirvess tinievilne E-Entmirvice.un ent Sectiloin A. Coveraga, Iterm 5. Additional Covera ges,sectli on f Business lincognie is arnarliclip,,id As (nillows: If"he rere i-ence to 60 day!li:ii' i the Ikmiitafiori,oll IIGmayroll exiFienses is replaced by 365 da.ys 9 Ill,,,oick Rieplacernent Section X Cioverage,Hem&Coverage Extex 11 tsilai,,iis Mill Rlslo ii'rnclud,c YOLI vi,-wyeAr..in,id Ip.11hmru limn.uiii pirolvi 'ed bythis caverage forilln to ciolver vilo'CLISSRry explenise to rq::!iaIIIf toileplacie r;,,xiedor or intericii,door Icicks of a covered bluillding a 11 your door Illyeys aiirc.µstiolen in an coveirMtll,,�ieft loss cir 1:)) Whein your;.:rirnpeii,,Ily Is daiinor. anid your der keys eiru sloWiii Ibyr ft Iburglaii,-s The mor-twe will pay uii,-Weir thh,exiznsWii, of$2510 For any one cccuii,-renomm, TD.lRemilavall of Sewer Siaicictqj::ro:Exclusl0113 Section E:I,. Exch.miciil-irsi, itleiii g(3)is ain-teri'to inciude'. ic.lf sewers will not bie excluided, lbiultt,*.,most we will ji::ey foil"SLICh losses is$510101 in the policy Nj?: I lal)WtvCoveiii Enhance 1 ri ..................................................M.S.,............. are apart offl-iie SIUSINESSOWNEFtS UIABIR-i r,e COVERAGE FORM: lf li Payn-minits Cmverage(Coveii-age A2.)is ncRI oVIlieii-wisleexch.A ied from ft!i;is Coverage I112,airl Ii Mic..ndlcal 'L imil is chartgodstibiect to aill the terli or,I irrifts flinstvi,aiiilice(Section �to the clf., �R. $10,01010;ior �b. The Ipu ical Expense I irnftst.kcwiillr iii the Declarations E)f this Coverlge Pajl,,t,, IFkayirinents firm itt-m Suir.ulplViniriu,iieirii,t�try Payrinients (Cloveiii I A.) T. TheliMit for ClIe cast cog ibailluainids tl,QSOWS5001i,and 2, It he C[Mitfair luss or eaiirnlillni (ReFT-111(4))iS 161"I.IT-11giedfmcn$250ay to oo, a day 3. E.Mairliket Addld=W lim;iurecg! s Mo is An Insluired(Section C)is ari to iiii the folikWiii but only for Rabifilly airis4-iq owt of 01*ii leir.0[geirice ofthe Namedl Insured, Ei of the klOrmriing i!s 61!Lrio uuIiii a,, any Conkirixtor,finc:Jlilli:ding contracting governirrieriUd eiii wliiiica hires you im their s%,rl caiii..ctoli, persain oiir clirganization wl'-�in has an owriieii,ship interest inyou-, ic. ail.sy Of leased equil,,iiii who rents ecI141prine,11111,1113 Youl,but.oii--Ry wifll'�rc-,,,sp.L�ct to, Cki-abilkity arising cut of the ii.iinteiiili�ii apeiii-aticin, or tize Iby yclu,Pa"),vidied lhinm,-ver that this Page 3 05 Inducies I.T. 11;0911,14 mialleii,ilial of Ove snsurano SeNCES,10MCM,111110 LW%4VW4kh i pennils,51cin. IPI-BF 00 1 (9105), iteci�-iii c,wilit ii,ldappl�y to(1)anly(X..."Cit.111irrence vel-dich talkes pWicle after the egWilpmo.mil lease expkes', ii,v(2 TI odill y tnp..mrry or r'otnummrt IDaii,nr "erisiii-,iig intft of the ne.glfigeii,,iicln of Cl,-iiie lessor or clontractior enag,ed to olperate IIM Ileased equi�jpirnet,iiit" sii--iiicll id an, owner, niort pic lar, limsslor, laindlorid, armcciiation or mariagleir of a pimmises leasield by you,blu,t only roir%xicmirrenices' ilit-iiatlake 1place wtiiiiie YrOjU InCCIL.uPy ll-m preirnises, providled howevF-.!iii,-that Otis item rt,'M0 Inot apply,lo stroxti.iiirmil s.willeiriaid inns,, rm-m canislinxtjoiril, cir dc.im,dHflo in,iopeil,-istions�: gamild Will-ii regard to parties qppiticable tv-iideir items a fi-iiirough d,abinvel, thip Instaer anid thle INIarined linsuiredagreetem lvnlaive dqhils in:'r Irmramrm:;ary,as provilided wid"iiiin 0-iiietaratUm fir. Noltiiiiriig cointai'i in thIssection G, shaOf serve lo mAlity matters excltuded itmindleir slacticirl El aft1hie pofictr. 4. Bodily Iprmjtwy-Illtleiii,slital An!.;uish TI'm defiriJitilan of'bodHy'inn uii Y'is,cl,iiiariiglpid to rei 1 Bodily InOmy : ,a, Mearis L-widly ini rj;ickiniess seasesuslaiineld lb�y a� persion, and Incliuderp s nirital aii reSdIfiling Frorn any of lhese�ainor d1iiid b Ei far imental airiiglullst,ii,iirmicludes i resulting frfromk1letam r.goling(itern a,, above), ill a �a:ny firriie,.)i 5,, Uberallization V wei reviSe this pinidairsementlo p"civildle rniore cciveiragle Mll-iia.d aiddifilnt-tW We wiRl autlarnalically Cli-im adidificn--iiiall coverage'to M andorserneirill hoti ras ofthe day the revision is effective. in your stata, Eimp loyeeDiefensie Caveiii--aqjia t kideir SUIFTI EMENTARY PAYMENT13 COVIE.i.]RAGES A.I.Al,the floMinwing Idcled (6)We will pay oin, ouir twRialf dii i p', ed ll::q an*ieri--�ployee"fin a cffiri--iiina' prc:c r ig Y I Red n.,, pri.n,i hiowc.,,,,veil-thi8l YOU MIIJIIO�fllir-M a pil-lioll"written, RgIl"ISPRILnitwith sucitm `eqpmlciyee wheii-,eby you agreew to �iriden--iinffiv Ul,ie"e.iirn�i;Aayee'for si,ich defeinse clostmul, �a�nd iffie agireernent inicluctes�a provisioii,-i�for rl rr*.nit cifidefeinsitt,cos'ts irvIii-iiie eveird of P,.in aldverse Judgment The ,y i"nost we.WH,pR$vFc:w any "lr-wnnpkqlEe,. whic is alillegic.m.110 be �t,vvdllvled in a crilii,rdiii-iiiali pirciceeding lis$21,500 rel ardlPESS Of thie int.unber W i:kqmj, cilaillins, 01,"BUIts"Ibm,light Or 1::iiemsions ai,-orgenizations ri�,%akfng i cir t:mlir#Ing "suits." T. moan endirnerst of AiggregatI8 I 11IT11111. SECI 11ON 1).4........Aggregate I Imilts, lilem 8 iii rqj::mIacm..u,d by, ibfli otl-,�iri InJuiry or damiagel, iii-,icluctlirig niiii explenses,i kul-W aN"micluti' t'u IImlicy j!::w.ii'lod is three times'll,iie Liability INIedicalExj:xiriisew;Hirnit rii.ios Himiltatiolirii does i"tol q:qo�ly tio"pirnper�r dianivgie"to 1:::aireirri1c.ms wl-*He remintiW lal you oii-,lernporallilly occulpied by you witt-!� of thle ie"to Eilinslirlig Oli offire,or eX$)lOislan,, S. Airnlpndirirveinit tin Wa'ter icinaft'Exclusion Pail 13 IExiclusiciris,iitern g.(2)1(,a)is amended Ib'y t1he folilovii "I'liie prat'ur lume lesnm6 Ell-tan 26 freill"is reptaiceld lay lcms llhaii,-u 51 remit ' IPlage 4 of�5 lindul",cnIpyrigIll mwteiirwlll W Owe SerWices i IInc,wed Nwith its privii-iiiii Pl,4Rl::D-D0`T (5)MIS) 1.Mer pmWsbn!s of t'h;e pfiry Chis ;:ii,ohicy Wilt Ilbe pir mmn l Ifor 8H 1',�ilereiin, ainid the exisleirice of cNtheir limmsmmraurme MR isnot!clerve 1c)irpdiucic,o our dWlobn,, Z You wM hmm Mis right to YmNs our icif rec.,loveiry ph"o a Wss lk"�any 1:m,arty Tbis rnittst, be dome b w2bg to aNed our dolisi Page 5 of 51 linilicill"llaits lippyfl4lhill MOW W UM (311ffke, linc, llwsj�,'d NMlfiNjllill[�,;,pllpnW!�slOvl,