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PROOF OF INSURANCE (2019) CLOSED AC a DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 1111 06/11/2018 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Hannah Reneau NAt,VE°°, Arroyo Insurance Services PHONN.Exit: 792-7654 (626)584-0839 fmc (Binney,Chase and Van Horne) E,MhAIL hannahr@arroyoins,com ADDRESS': 11 W.Del Mar Blvd,Suite 200 I INSURER(S)AFFORDING COVERAGE NAIC# Pasadena CA 91105 INSURER A: Sentinel Ins Co 11000 INSURED INSURER 8: USLI LOIS Starr INSURER C! I 308 Standard St Apt a INSURER D! I II INSURER E: EI Segundo CA 90245 INSURER F: COVERAGES CERTIFICATE NUMBER: 18/19 PKG/EO 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 AUPSC`SU�BR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MMIDDIYYYY) )MMIDDW'YYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE I$ 2,000,000 ❑ AMnORE:N'rED 1,000,000 CLAIMS-MADE X OCCUR ,1�EACH 1lEMISES(Ea mcuaenti.0 I$ MED EXP(Any one person) $ 10,000 A T Y 72SBMIT6458 06/07/2018 06/07/2019 PERSONAL&ADV INJURY I$ 2,000,000 GEWLAGGREOA'I"ELIMITAPPLIES PER: GENERAL AGGREGATE $ 4,000,000 IRI- POLICY JECT PRO ❑ LOC PRODUCTS-COMP/OPAGG I $ 4,000,000 OTHER: �I$ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 2,000,000 (Ea accident) ANYAUTO BODILY INJURY(Per person) $ ... -................. __....__....._,. A OWNED SCHEDULED 72SBMIT6458 06/07/2018 06/07/2019 BODILY INJURY(Per accident) $ AUTOSONLY AUTOS ,....�,.. ..._..........................._.,.._...................._r.................._r.. HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY 1EX , AUTOS ONLY (Per accident) .... ................................................................_. ............................... ^.,OCCUR MADE..................................................................................................................... ..__._............,.,............,.,.,.,.,.,.............................�.,_...2 UMBRELLA LIAB EACH OCCURRENCE $ EXCESS LIAB AGGREGATE $ DED ........ ............................... . ......................... ____� .� RETENTION$ $ WORKERS COMPENSATIONII PER OTH- AND EMPLOYERS'LIABILITY YIN V STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE """ NIA _,ELL EACH ACCIDENT s OFFICER/MEMBER EXCLUDED? ��""" "" (Mandatory in NH) """"""' EL,DISEASE-EA EMPLOYEE $ If yes,describe under """....""""""...... DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ Professional Liability Each Clam $1,000,000 B SP1567391 12/15/2017 12/15/2018 Aggregate $1,000,000 ' _ _DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) ___..........�,-..,W.n.,..... Certificate holder is named as an additional insured as defined in the policy form if required in a written agreement CE'RT'IFICA"T"E HOLDER CANCELLATIONI 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. 350 Main Street AUTHORIZED REPRESENTATIVE' EI Segundo CA 90245 / B ��tlll ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 72 SBM IT6458 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED • PERSON-ORGANIZATION CITY OF HERMOSA BEACH 1315 VALLEY DRIVE HERMOSA BEACH, CA 90254 CITY OF ARTESIA 18747 CLARKDALE AVENUE ARTESIA, CA 90701 CITY OF HAWTHORNE 3901 W EL SEGUNDO AVENUE HAWTHORNE, CA 90250 LOC 001 BLDG 001 THE CITY OF MANHATTAN BEACH, ITS OFFICERS, EMPLOYEES, AGENTS, AND VOLUNTEERS 1400 HIGHLAND AVE MANHATAN BEACH, CA 90266 CITY OF EL SEGUNDO 350 MAIN STREET EL SEGUNDO, CA 90245 Form IH 12 00 11 85 T SEQ. NO. 001 Printed in U.S.A. Page 001. Process Date: 03/23/18 Expiration Date: 06/07/19 POLICY NUMBER: 72 SBM IT6458 ik THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNER, LESSEES OR CONTRACTOR LOC 001 BLDG 001 CITY OF EL SEGUNDO 350 MAIN STREET EL SEGUNDO, CA 90245 Form IH 12 00 11 85 T SEQ.NO. 002 Printed in U.S.A. Page 00 3, Process Date: 03/23/18 Expiration Date: 06/07/19 THE HARTFORD Select Customer Insurance Center 3600 WISEMAN BLVD. SAN ANTONIO TX 78251 Policyholder, please callus at: (866) 467-8730 Agent, please callus at: (866) 467-8730 SERVICE.TX@THEHARTFORD.COM INSURANCE ENDORSEMENT ATTACHED *** PLEASE REVIEW THE CHANGE *** Enclosed is an endorsement for your business insurance policy. Please review it at your convenience. If you have questions or need to make further changes: Policyholder, please call us at: (8 66) 467-8730 Agent, please call us at: (866) 467-8730 between 7 A.M. and 7 P.M. CST . The premium billing will be mailed to you separately. You can expect to receive it soon. Thank you for allowing us to service your business needs. BINNEY CHASE & VAN HORNE INC/PHS THE HARTFORD SELECT CUSTOMER INSURANCE CENTER The Hartford Hartford Fire Insurance Company and its Affiliates One Hartford Plaza, Hartford,Connecticut 06155 it THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGE, This endorsement changes the policy effective on the Inception Date of the policy unless another date is indicated below: Policy Number: 72 SBM IT6458 DX Named Insured and Mailing Address; LOIS STARR 308 STANDARD ST APT A EL SEGUNDO CA 90245 Policy Change Effective Date: 06/07/18 Effective hour is the same as stated in the Declarations Page of the Policy. Policy Change Number: 001 Agent Name: BINNEY CHASE & VAN HORNE INC/PHS Code: 255653 POLICY CHANGES: SENTINEL INSURANCE COMPANY, LIMITED Y CHANGES IN YOUR PREMIUM WILL BE REFLECTED IN YOUR NEXT BILLING STATEMENT,IF YOU ARE ENROLLED IN REPETITIVE EFT DRAWS FROM YOUR BANK ACCOUNT, CHANGES IN PREMIUM WILL CHANGE FUTURE DRAW AMOUNTS. THIS IS NOT A BILL. NO PREMIUM DUE AS OF POLICY CHANGE EFFECTIVE DATE LIABILITY AND MEDICAL EXPENSES ARE REVISED LIABILITY AND MEDICAL EXPENSES LIMIT IS CHANGED FROM $1, 000, 000 EACH OCCURRENCE TO $2,000, 000 EACH OCCURRENCE PERSONAL AND ADVERTISING INJURY LIMIT IS CHANGED FROM $1, 000, 000 TO $2, 000, 000 PRO RATA FACTOR: 1.000 THIS ENDORSEMENT DOES NOT CHANGE THE POLICY EXCEPT AS SHOWN, Form SS 12 11 0405 T Page 001 (CONTINUED ON NEXT PAGE) Process Date: 04/27/18 Policy Effective Date: 06/07/18 Policy Expiration Date: 06/07/19 POLICY CHANGE (Continued) Policy Number: 72 SBM IT6458 Policy Change Number: 001 AGGREGATE LIMITS- GENERAL AGGREGATE LIMIT IS CHANGED FROM $2, 000, 000 TO $4, 000, 000 BUSINESS LIABILITY OPTIONAL COVERAGES ARE REVISED HIRED/NON-OWNED AUTO LIABILITY LIMIT OF INSURANCE IS CHANGED FROM $1, 000, 000 EACH OCCURRENCE TO $2,000,000 EACH OCCURRENCE Form SS 12 1104 05 T Page 002 Process Date: 04/27/18 Policy Effective Date: 06/07/18 Policy Expiration Date: 06/07/19 58 This Spectrum Policy consists of the Declarations, Coverage Forms, Common Policy Conditions and any 64 other Forms and Endorsements issued to be a part of the Policy. This insurance is provided by the stock IT insurance company of The Hartford Insurance Group shown below. SBM INSURER: SENTINEL INSURANCE COMPANY, LIMITED ONE HARTFORD PLAZA, HARTFORD, CT 06155 COMPANY CODE: A THE Policy Number: 72 SBM IT6458 DX HARTFORD SPECTRUM POLICY DECLARATIONS Named Insured and Mailing Address: LOIS STARR (No., Street, Town, State, Zip Code) 308 STANDARD ST APT A EL SEGUNDO CA 90245 Policy Period: From 06/07/18 To 06/07/19 1 YEAR 12:01 a.m., Standard time at your mailing address shown above. Exception: 12 noon in New Hampshire. Name of Agent/Broker: BINNEY CHASE & VAN HORNE INC/PHS Code: 255653 Previous Policy Number: 72 SBM IT6458 Named Insured is: INDIVIDUAL Audit Period: NON-AUDITABLE Type of Property Coverage: NONE Insurance Provided: In return for the payment of the premium and subject to all of the terms of this policy, we agree with you to provide insurance as stated in this policy. TOTAL ANNUAL PREMIUM IS: $500 MP Countersigned by 03/23/18 Authorized Representative Date Form SS 00 02 12 06 Page 001 (CONTINUED ON NEXT PAGE) Process Date: 03/23/18 Policy Expiration Date: 06/07/19 SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 72 SBM IT6458 Location(s), Building(s), Business of Named Insured and Schedule of Coverages for Premises as designated by Number below. Location: 001 Building: ool 308 STANDARD ST APT A EL SEGUNDO CA 90245 Description of Business: Consultant - Business and Management Deductible: NO COVERAGE BUILDING AND BUSINESS PERSONAL PROPERTY LIMITS OF INSURANCE BUILDING NO COVERAGE BUSINESS PERSONAL PROPERTY REPLACEMENT COST NO COVERAGE PERSONAL PROPERTY OF OTHERS REPLACEMENT COST NO COVERAGE MONEY AND SECURITIES INSIDE THE PREMISES NO COVERAGE OUTSIDE THE PREMISES NO COVERAGE Form SS 00 02 12 06 Page 002 (CONTINUED ON NEXT PAGE) Process Date: 03/23/18 Policy Expiration Date: 06/07/19 SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 72 SBM IT6458 BUSINESS LIABILITY LIMITS OF INSURANCE LIABILITY AND MEDICAL EXPENSES $1, 000,000 MEDICAL EXPENSES -ANY ONE PERSON $ 10, 000 PERSONAL AND ADVERTISING INJURY $1, 000, 000 DAMAGES TO PREMISES RENTED TO YOU $1, 000, 000 ANY ONE PREMISES AGGREGATE LIMITS PRODUCTS-COMPLETED OPERATIONS $2, 000, 000 FORM SS 05 09 GENERAL AGGREGATE $2, 000, 000 BUSINESS LIABILITY OPTIONAL COVERAGES HIRED/NON-OWNED AUTO LIABILITY $1, 000, 000 CYBERFLEX COVERAGE FORM SS 40 26 Form SS 00 02 12 06 Page 003 (CONTINUED ON NEXT PAGE) Process Date: 03/23/18 Policy Expiration Date: 06/07/19 SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 72 SBM IT6458 BUSINESS LIABILITY OPTIONAL COVERAGES LIMITS OF INSURANCE (Continued) UNMANNED AIRCRAFT LIABILITY FORM: SS 42 06 Form SS 00 02 12 06 Page 004 (CONTINUED ON NEXT PAGE) Process Date: 03/23/18 Policy Expiration Date: 06/07/19 SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 72 SSM IT6458 Form Numbers of Forms and Endorsements that apply: SS 00 01 03 14 SS 00 05 10 08 SS 00 08 04 05 SS 00 45 12 06 SS 00 60 09 15 SS 00 64 09 16 SS 01 21 03 17 SS 42 06 03 17 SS 04 38 09 09 SS 40 26 03 17 SS 41 63 06 11 SS 05 09 07 00 SS 05 47 09 15 SS 50 19 01 15 IH 99 40 04 09 IH 99 41 04 09 SS 83 76 01 15 SS 89 93 07 16 IH 12 00 11 85 ADDITIONAL INSURED -• PERSON-ORGANIZATION IH 12 00 11 85 ADDITIONAL INSURED - OWNER, LESSEES OR CONTRACTOR Form SS 00 02 12 06 Page 006 Process Date: 03/23/18 Policy Expiration Date: 06/07/19 SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 72 SBM IT6458 SUPPLEMENTAL DECLARATIONS: A service fee of $ 7.00 is charged for each installment when your premium is paid in installments. The service fee is $ 5.00 per withdrawal when you select an electronic fund transfer payment plan. The service fee will be added to the premium amount shown on your premium billing statement. Form SS 00 4512 06 Process Date: 03/23/18 Policy Expiration Date: 06/07/19 POLICY NUMBER: 72 SBM IT6458 THIS ENDORSEMENT IS ATTACHED TO AND MADE PART OF YOUR POLICY IN RESPONSE TO THE DISCLOSURE REQUIREMENTS OF THE TERRORISM RISK INSURANCE ACT. DISCLOSURE PURSUANT T TO TERRORISM, DISI INSURANCE ACT SCHEDULE Terrorism Premium: $ $6.00 A. Disclosure Of Premium United States or to influence the policy or In accordance with the federal Terrorism Risk affect the conduct of the United States Insurance Act, as amended (TRIA), we are required Government by coercion to provide you with a notice disclosing the portion of C. Disclosure Of Federal Share Of Terrorism your premium, if any, attributable to coverage for Losses "certified acts of terrorism" under TRIA. The portion The United States Department of the Treasury will of your premium attributable to such coverage is reimburse insurers for a portion of insured losses, shown in the Schedule of this endorsement. as indicated in the table below, attributable to B. The following definition is added with respect to the "certified acts of terrorism" under TRIA that exceeds provisions of this endorsement: the applicable insurer deductible: 1. A"certified act of terrorism"means an act that is Calendar Year Federal Share of certified by the Secretary of the Treasury, in Terrorism Losses accordance with the provisions of TRIA, to be an act of terrorism under TRIA. The criteria 2015 85% contained in TRIA for a "certified act of V 2016 84% terrorism" include the following: I 2017 83% a. The act results in insured losses in excess 2018 82% of$5 million in the aggregate, attributable to all types of insurance subject to TRIA; and I 2019 81% b. The act results in damage within the United I 2020 or later 80% States, or outside the United States in the case of certain air carriers or vessels or the However, if aggregate industry insured losses under premises of an United States mission; and TRIA exceed $100 billion in a calendar year, the c. The act is a violent act or an act that is Treasury shall not make any payment for any dangerous to human life, property or portion of the amount of such losses that exceeds infrastructure and is committed by an $100 billion. The United States government has not individual or individuals as part of an effort charged any premium for their participation in to coerce the civilian population of the covering terrorism losses. Form SS 83 76 01 15 Page 1 of 2 C 2015 , The Hartford (Includes copyrighted material of the Insurance Services Office, Inc., with its permission.) D. Cap On Insurer Liability for Terrorism Losses If aggregate industry insured losses attributable to "certified acts of terrorism" under TRIA exceed $100 billion in a calendar year and we have met, or will meet, our insurer deductible under TRIA, we shall not be liable for the payment of any portion of the amount of such losses that exceed $100 billion. In such case, your coverage for terrorism losses may be reduced on a pro-rata basis in accordance with procedures established by the Treasury, based on its estimates of aggregate industry losses and our estimate that we will exceed our insurer deductible. In accordance with the Treasury's procedures, amounts paid for losses may be subject to further adjustments based on differences between actual losses and estimates. E. Application of Other Exclusions The terms and limitations of any terrorism exclusion, the inapplicability or omission of a terrorism exclusion, or the inclusion of terrorism coverage, do not serve to create coverage for any loss which would otherwise be excluded under this Coverage Form, Coverage Part or Policy. F. All other terms and conditions remain the same. Form SS 83 76 01 15 Page 2 of 2 COMMON POLICY CONDITIONS Form SS 00 05 10 08 0 2008, The Hartford QUICK REFERENCE -SPECTRUM POLICY DECLARATIONS and COMMON POLICY CONDITIONS I. DECLARATIONS Named Insured and Mailing Address Policy Period Description and Business Location Coverages and Limits of Insurance II. COMMON POLICY CONDITIONS Beginning on Page A. Cancellation 1 B. Changes 1 C. Concealment, Misrepresentation Or Fraud 2 D. Examination Of Your Books And Records 2 E. Inspections And Surveys 2 F. Insurance Under Two Or More Coverages 2 G. Liberalization 2 H. Other Insurance -Property Coverage 2 I. Premiums 2 J. Transfer Of Rights Of Recovery Against Others To Us 2 K. Transfer Of Your Rights And Duties Under This Policy 3 L. Premium Audit 3 Form SS 00 05 10 08 it COMMON POLICY CONDITIONS All coverages of this policy are subject to the following conditions. A. Cancellation (5) Failure to: 1. The first Named Insured shown in the (a) Furnish necessary heat, water, Declarations may cancel this policy by mailing sewer service or electricity for 30 or delivering to us advance written notice of consecutive days or more, except cancellation. during a period of seasonal 2. We may cancel this policy by mailing or unoccupancy; or delivering to the first Named Insured written (b) Pay property taxes that are owing notice of cancellation at least: and have been outstanding for a. 5 days before the effective date of more than one year following the cancellation if any one of the following date due, except that this conditions exists at any building that is provision will not apply where you Covered Property in this policy: are in a bona fide dispute with the (1) The building has been vacant or taxing authority regarding payment of such taxes. unoccupied 60 or more consecutive days. This does not apply to: b. 10 days before the effective date of (a) Seasonal unoccupancy; or cancellation if we cancel for nonpayment of premium. (b) Buildings in the course of c. 30 days before the effective date of construction, renovation or cancellation if we cancel for any other addition. reason. Buildings with 65% or more of the 3. We will mail or deliver our notice to the first rental units or floor area vacant or Named Insured's last mailing address known unoccupied are considered to us. unoccupied under this provision. 4. Notice of cancellation will state the effective (2) After damage by a Covered Cause of date of cancellation. The policy period will end Loss, permanent repairs to the on that date. building: 5. If this policy is canceled, we will send the first (a) Have not started; and Named Insured any premium refund due. (b) Have not been contracted for, Such refund will be pro rata. If the first Named within 30 days of initial payment of Insured cancels, the refund may be less than loss. pro rata. The cancellation will be effective even (3) The building has: if we have not made or offered a refund. 6. If notice is mailed, proof of mailing will be (a) An outstanding order to vacate; sufficient proof of notice. (b) An outstanding demolition order; B. Changes or This policy contains all the agreements between you (c) Been declared unsafe by and us concerning the insurance afforded. The first governmental authority. Named Insured shown in the Declarations is (4) Fixed and salvageable items have authorized to make changes in the terms of this policy been or are being removed from the with our consent. This policy's terms can be building and are not being replaced. amended or waived only by endorsement issued This does not apply to such removal by us and made a part of this policy. that is necessary or incidental to any renovation or remodeling. Form SS 00 05 10 08 Page 1 of 3 © 2008, The Hartford (Includes copyrighted material of Insurance Services Office, Inc. with its permission) COMMON POLICY CONDITIONS C. Concealment, Misrepresentation Or Fraud due from that other insurance, whether you can This policy is void in any case of fraud by you as it collect on it or not. But we will not pay more than relates to this policy at any time. It is also void if you the applicable Limit of Insurance. or any other insured, at any time, intentionally conceal I. Premiums or misrepresent a material fact concerning: 1. The first Named Insured shown in the 1. This policy; Declarations: 2. The Covered Property; a. Is responsible for the payment of all 3. Your interest in the Covered Property; or premiums; and 4. A claim under this policy. b. Will be the payee for any return premiums D. Examination Of Your Books And Records we pay. 2. The premium shown in the Declarations was We may examine and audit your books and computed based on rates in effect at the time records as they relate to the policy at any time the policy was issued. If applicable, on each during the policy period and up to three years renewal, continuation or anniversary of the afterward. effective date of this policy, we will compute E. Inspections And Surveys the premium in accordance with our rates and 1. We have the right but are not obligated to: rules then in effect. a. Make inspections and surveys at any time; 3. With our consent, you may continue this policy you reports on the conditions we find; in force by paying a continuation premium for b. Give Y p each successive one-year period. The and premium must be: c. Recommend changes. a. Paid to us prior to the anniversary date; and 2. Any inspections, surveys, reports or b. Determined in accordance with Paragraph recommendations will relate only to insurability 2.above. and the premiums to be charged. We do not make safety inspections. We do not Our forms then in effect will apply. If you do undertake to perform the duty of any person or not pay the continuation premium, this policy will expire organization to provide for the health or safety the first anniversary date that we of any person. We do not represent or warrant have not received the premium. that conditions: 4. Changes in exposures or changes in your a. Are safe or healthful; or business operation, acquisition or use of locations that are not shown in the Declarations b. Comply with laws, regulations, codes or may occur during the policy period. If so,we may standards. require an additional premium. That premium will 3. This condition applies not only to us, but also be determined in accordance with our rates and to any rating, advisory, rate service or similar rules then in effect. organization which makes insurance J. Transfer Of Rights Of Recovery Against Others inspections, surveys, reports or To Us recommendations on our behalf. Applicable to Property Coverage: F. Insurance Under Two Or More Coverages covers es apply to If any person or organization to or for whom we If two or more of this policy's 9 pp Y make payment under this policy has rights to the same loss or damage, we will not pay more recover damages from another, those rights are than the actual amount of the loss or damage. transferred to us to the extent of our payment. G. Liberalization That person or organization must do everything If we adopt any revision that would broaden the necessary to secure our rights and must do coverage under this policy without additional nothing after loss to impair them. But you may premium within 45 days prior to, or at any time waive your rights against another party in writing: during, the policy period, the broadened coverage 1. Prior to a loss to your Covered Property; or will immediately apply to this policy. 2. After a loss to your Covered Property only if, at H. Other Insurance-Property Coverage time of loss,that party is one of the following: If there is other insurance covering the same loss or damage, we will pay only for the amount of covered loss or damage in excess of the amount Page 2 of 3 Form SS 00 05 10 08 COMMON POLICY CONDITIONS a. Someone insured by this insurance; appointed, anyone having proper temporary b. A business firm: custody of your property will have your rights and (1) Owned or controlled by you; or duties but only with respect to that property. L. Premium Audit (2) That owns or controls you; or a. We will compute all premiums for this policy in c. Your tenant. accordance with our rules and rates. You may also accept the usual bills of lading or b. The premium amount shown in the shipping receipts limiting the liability of carriers. Declarations is a deposit premium only. At the This will not restrict your insurance. close of each audit period we will compute the K. Transfer Of Your Rights And Duties Under This earned premium for that period. Any Policy additional premium found to be due as a result of the audit are due and payable on notice to Your rights and duties under this policy may not be the first Named Insured. If the deposit transferred without our written consent except in premium paid for the policy term is greater the case of death of an individual Named Insured. than the earned premium, we will return the If you die, your rights and duties will be transferred excess to the first Named Insured. to your legal representative but only while acting c. The first Named Insured must maintain all within the scope of duties as your legal records related to the coverage provided by representative. Until your legal representative is this policy and necessary to finalize the premium audit, and send us copies of the same upon our request. Our President and Secretary have signed this policy. Where required by law,the Declarations page has also been countersigned by our duly authorized representative. Lisa Levin,Secretary Douglas Elliot,President Form SS 00 05 10 08 Page 3 of 3 t THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA C'HANGE'S This endorsement modifies insurance provided under the following: COMMON POLICY CONDITIONS SPECIAL PROPERTY COVERAGE FORM STANDARD PROPERTY COVERAGE FORM BUSINESS LIABILITY COVERAGE FORM EMPLOYMENT PRACTICES LIABILITY COVERAGE FORM A. Paragraphs 2. and 3. of the Cancellation Common (b) You or your representative in Policy Condition are replaced by the following: pursuing a claim under this policy. 2. All Policies in Effect for 60 Days Or Less: (3) A judgment by a court or an If this policy has been in effect for 60 days or administrative tribunal that you have less, and is not a renewal of a policy we have violated a California or Federal law, previously issued, we may cancel this policy by having as one of its necessary elements mailing or delivering to the first Named Insured an act which materially increases any of at the mailing address shown in the policy and to the risks insured against. the producer of record, advance written notice of (4) Discovery of willful or grossly negligent cancellation, stating the reason for cancellation, acts or omissions, or of any violations of at least: state laws or regulations establishing a. 10 days before the effective date of safety standards, by you or your cancellation if we cancel for: representative, which materially increase (1) Nonpayment of premium; or any of the risks insured against. (2) Discovery of fraud or material (5) Failure by you or your representative to misrepresentation by: implement reasonable loss control requirements, agreed to by you as a (a) Any insured or his or her condition of policy issuance, or which representative in obtaining this were conditions precedent to our use of insurance; or a particular rate or rating plan, if that (b) You or your representative in failure materially increases any of the pursuing a claim under this policy. risks insured against. b. 30 days before the effective date of (6) A determination by the Commissioner of cancellation if we cancel for any other reason. Insurance that the: 3. All Policies in Effect For More Than 60 Days (a) Loss of, or changes in, our a. If this policy has been in effect for more than reinsurance covering all or part of 60 days, or is a renewal of a policy we the risk would threaten our financial issued, we may cancel this policy only upon integrity or solvency; or the occurrence, after the effective date of (b) Continuation of the policy coverage the policy, of one or more of the following, or would: as permitted under applicable California law: I. Place us in violation of (1) Nonpayment of premium, including California law or the laws of the payment due on a prior policy we issued state where we are domiciled; and due during the current policy term or covering the same risks. ii. Threaten our solvency. (2) Discovery of fraud or material (7) A change by you or your representative misrepresentation by: in the activities or property of the (a) Any insured or his or her commercial or industrial enterprise, representative in obtaining this which results in a materially added, insurance; or increased or changed risk, unless the Form SS 01 21 03 17 Page 1 of 4 ©2017, The Hartford added, increased or changed risk is c. We may not cancel such coverage included in the policy. solely because corrosive soil conditions I. Place us in violation of exist on the premises. This restriction California law or the laws of the (c.) applies only if coverage under the state where we are domiciled; Special Property Coverage Form, or which excludes loss or damage caused ii. Threaten our solvency. by or resulting from corrosive soil (7) A change by you or your representative conditions. in the activities or property of the C. The following is added and supersedes any commercial or industrial enterprise, provisions to the contrary: which results in a materially added, NONRENEWAL increased or changed risk, unless the added, increased or changed risk is 1. Subject to the provisions of paragraphs C.2. and included in the policy. C.3. below, if we elect not to renew this policy, b. We will mail or deliver advance written we will mail or deliver written notice stating the notice of cancellation, stating the reason for reason for nonrenewal to the first Named cancellation, to the first Named Insured, at Insured shown in the Declarations and to the the mailing address shown in the policy, and producer of record, at least 60 days but not to the producer of record, at least: more than 120 days, before the expiration or anniversary date. (1) 10 days before the effective date of We will mail or deliver our notice to the first cancellation we cancel for Named Insured, and to the producer of record, nonpayment of premium or discovery of fraud, or at the mailing address shown in the policy. (2) 30 days before the effective date of 2. Residential Property cancellation if we cancel for any other This provision applies to coverage on real reason listed in paragraph 3.a. property used predominantly for residential purposes and consisting of not more than four B. The following provisions is added to the dwelling units, and to coverage on tenants' Cancellation Common Policy Condition: household property contained in a residential 7. Residential Property unit, if such coverage is written under this policy. This provision applies to coverage on real a. We may elect not to renew such coverage property which is used predominantly for for any reason, except as provided in b., c. residential purposes and consisting of not and d. below: more than four dwelling units, and to b. We will not refuse to renew such coverage coverage on tenants' household personal solely because the first Named Insured has property in a residential unit, if such coverage is written under this policy: accepted an offer of earthquake coverage. a. If such coverage has been in effect for However, the following applies only to 60 days or less, and is not a renewal of insurers who are associated participating coverage we previously issued, we may insurers as established by Cal. Ins. Code cancel this coverage: for any reason, Section 10089.16. We may elect not to except as provided in b. and c. below. renew such coverage after the first Named Insured has accepted an offer of earthquake b. We may not cancel solely because the coverage, if one or more of the following first Named Insured has: reasons applies: (1) Accepted an offer of earthquake (1) The nonrenewal is based on sound coverage; or underwriting principles that relate to the (2) Cancelled or did not renew a policy coverages provided by this policy and issued by the California Earthquake that are consistent with the approved Authority (CEA) that included and rating plan and related documents filed earthquake policy premium with the Department of Insurance as surcharge. However, we shall required by existing law; cancel this policy if the first Named (2) The Commissioner of Insurance finds Insured has accepted a new or that the exposure to potential losses will renewal policy issued by the CEA threaten our solvency or place us in a that includes an earthquake policy hazardous condition. A hazardous premium surcharge but fails to pay condition in which we make claims the earthquake policy premium payments for losses resulting from an surcharge authorized by the CEA. earthquake that occurred within the Page 2 of 4 Form SS 01 21 03 17 preceding two years and that required a d. If the policy is for a period of no more than reduction in policyholder surplus of at 60 days and you are notified at the time of least 25% for payment of those claims; issuance that it will not be renewed. or e. If the first Named Insured requests a (2) The Commissioner of Insurance finds change in the terms or conditions or risks that the exposure to potential losses will covered by the policy within 60 days of the threaten our solvency or place us in a end of the policy period. hazardous condition. A hazardous f. If we have made a written offer to the first condition in which we make claims Named Insured, in accordance with the time payments for losses resulting from an frames shown in paragraph C.1., to renew earthquake that occurred within the the policy under changed terms or preceding two years and that required a conditions or at an increased premium rate, reduction in policyholder surplus of at when the increase exceeds 25%. least 25% for payment of those claims; or If there is an appraisal, we will still retain our (3) We have: right to deny the claim. (a) Lost or experienced a substantial D. The Concealment, Misrepresentation Or Fraud reduction in the availability or scope Condition is replaced by the following with respect to of reinsurance coverage; or loss of damage caused by fire: (b) Experienced a substantial increase We do not provide coverage to the insured who, in the premium charged for whether before or after a loss, has committed fraud reinsurance coverage of our or intentionally concealed or misrepresented any residential property insurance material fact or circumstance concerning: policies; and the Commissioner has 1. This Coverage Part; approved a plan for the 2. The Covered Property; nonrenewals that is fair and equitable, and that is responsive to 3. That insured's interest in the Covered Property; the changes in our reinsurance or position. 4. A claim under this Coverage Part or Coverage (c) We will not refuse to renew such Form. coverage solely because the first E. The Concealment, Misrepresentation Or Fraud Named Insured has cancelled or did Condition is replaced by the following with respect to not renew a policy, issued by the loss of damage caused by a Covered Cause of Loss California Earthquake Authority that other than fire: included an earthquake policy premium surcharge. This Coverage Part is void if any insured, whether before or after a loss, has committed fraud or (d) We will not refuse to renew such intentionally concealed or misrepresented any coverage solely because corrosive soil conditions exist on, the material fact or circumstance concerning: premises. This restriction (d) 1. This Coverage Part; applies only if coverage is subject to 2. The Covered Property; the Special Property Coverage 3. That insured's interest in the Covered Property; Form, which excludes loss or or damage caused by or resulting from corrosive soil conditions. 4. A claim under this Coverage Part or Coverage 3. We are not required to send notice of Form. nonrenewal in the following situations: F. The Other Insurance - Property Coverage a. If the transfer or renewal of a policy, without Condition is replaced by the following: any changes in terms, conditions, or rates, If there is other insurance covering the same loss or is between us and a member of our damage, we will pay our share of the covered loss or insurance group. damage. Our share is the proportion that the b. If the policy has been extended for 90 days applicable limit of insurance bears to the limits of or less, provided that notice has been given insurance of all insurance covering on same basis. in accordance with paragraph C.I. G. The Appraisal Property Loss Condition of the c. If you have obtained replacement coverage, Standard and Special Property Form is replaced or if the first Named Insured has agreed, in by the following: writing, within 60 days of the termination of If we and you disagree on the value of the property the policy, to obtain that coverage. or the amount of loss, either may make written Form SS 01 21 0317 Page 3 of 4 request for an appraisal of the loss. If the request is 2. Actual cash value is determined as follows: accepted, each party will select a competent and a. In the event of a total loss to a building or impartial appraiser. Each parry shall notify the other structure, actual cash value is calculated as of the appraiser selected within 20 days of the the Limit of Insurance applicable to that request. The two appraisers will select an umpire. If building or structure or the fair market value they cannot agree within 15 days, either may of the building or structure, which ever is request that selection be made by a judge of a court less. having jurisdiction. The appraisers will state separately the value of the property and amount of b. In the event of a partial loss to a building or loss. If they fail to agree, they will submit their structure, actual cash value is calculated as differences to the umpire. A decision agreed to by shown below,which ever is less: any two will be binding. Each party will: (1) The amount it would cost to repair, a. Pay its chosen appraiser; and rebuild or replace the property less a fair b. Bear the other expenses of the appraisal and and reasonable deduction for physical umpire equally. depreciation of the components of the If there is an appraisal, we will still retain our right to building or structure that are normally deny the claim. subject to repair or replacement during its useful life. Physical depreciation is H. With respect to an "Open Policy", the Loss based upon the condition of the property Payment Condition of the Standard and Special at the time of the loss; Property Form is amended by the following: (2) The limit of Insurance applicable to the 1. Paragraph 5.d.(1).(b). of the Loss Payment property. condition is deleted and replaced by: c. In the event of a partial or total loss to We will not pay on a replacement cost basis for Covered Property other than a building or any loss or damage until the lost or damaged structure, actual cash value is calculated as property is actually repaired or replaced, and the lesser of the following: then only subject to deduction for depreciation. (1) The amount it would cost to repair or Prior to such repair or replacement, and in replace the property less a fair and accordance with the terms applicable Loss reasonable deduction for physical Payment conditions in this policy, we will pay the depreciation, based on the condition of actual cash value of the lost or damaged the property at the time of loss; or property as described in this endorsement. If the actual cash value does not exhaust the (2) The Limit of Insurance applicable to the applicable Limit of Insurance, we will then pay property. the difference between the actual cash value 3. An "Open Policy" is a policy under which the and the replacement cost, provided that the value of Covered Property is not fixed at policy repair or replacement is completed: inception, but is determined at the time of loss in a. Within 12 months after our payment of the accordance with policy provisions on valuation. actual cash value; or The term 'open policy" does not apply to b. Within 24 months after our payment of the Covered Property that is subject to an Agreed actual cash value if the loss or damage Value clause or similar clause that establishes relates to a state of emergency as described an agreed value prior to loss, unless such in Section 8558 of the Government Code; clause has expired. unless we extend the time period for good cause. The foregoing provisions do not constitute a waiver of our right to deny the claim for any valid reason or to restrict payment in cases of suspected fraud. Page 4 of 4 Form SS 01 21 03 17 POLICY NUMBER: 72 SBM IT6458 Ji THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. UNMANNED AIRCRAFT - LIABILITY ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS LIABILITY COVERAGE FORM SCHEDULE Option 1: If an "X" is shown in this box, Bodily Injury and Property Damage coverage for Unmanned Aircraft applies and the Unmanned Aircraft Exclusion in Paragraph A.1.g.(1)of this endorsement does not apply. Option 2: If an "X" is shown in this box, Personal And Advertising Injury coverage for Unmanned Aircraft applies and the Unmanned Aircraft - Personal And Advertising Injury Exclusion in Paragraph A.2. of this endorsement does not apply. Except as otherwise stated in this endorsement or the owned or operated by or rented or schedule above, the terms and conditions of the policy loaned to any insured. Use includes apply to the insurance stated below. operation and 'loading or unloading". A. The following changes are made to Section B.1., This Paragraph g.(2) applies even if the EXCLUSIONS: claims against any insured allege 1. Paragraph g., Aircraft, Auto or Watercraft, is negligence or other wrongdoing in the deleted and replaced with the following: supervision, hiring, employment, training g. Aircraft,Auto or Watercraft or monitoring of others by that insured, if the 'occurrence" which caused the (1) Unmanned Aircraft "bodily injury" or "property damage" "Bodily injury" or "property damage" involved the ownership, maintenance, arising out of the ownership, use or entrustment to others of any maintenance, use or entrustment to aircraft (other than "unmanned aircraft), others of any aircraft that is an "auto" or watercraft that is owned or "unmanned aircraft". Use includes operated by or rented or loaned to any operation and"loading or unloading". insured. This Paragraph g.(1) applies even if the Paragraph g. (2)does not apply to: claims against any insured allege (a) A watercraft while ashore on negligence or other wrongdoing in the premises you own or rent; supervision, hiring, employment, training (b) A watercraft you do not own that is: or monitoring of others by that insured, if the 'occurrence" which caused the (i) Less than 51 feet long; and "bodily injury" or "property damage" (ii) Not being used to carry persons involved the ownership, maintenance, for a charge; use or entrustment to others of any (c) Parking an "auto" on, or on the aircraft that is an "unmanned aircraft". ways next to, premises you own or (2) Aircraft (Other Than Unmanned rent, provided the "auto" is not Aircraft),Auto Or Watercraft owned by or rented or loaned to you "Bodily injury" or "property damage" or the insured; arising out of the ownership, (d) Liability assumed under any maintenance, use or entrustment to "insured contract'for the ownership, others of any aircraft (other than maintenance or use of aircraft or "unmanned aircraft), "auto" or watercraft watercraft; Form SS 42 06 03 17 Page 1 of 2 Process Date: 03/23/18 Policy Expiration Date: 06/07/19 (e) "Bodily injury" or "property damage" B. The following changes apply to Section G. arising out of the operation of any of LIABILITY AND MEDICAL EXPENSES the equipment listed in Section G DEFINITIONS: Liability and Medical Expenses 1. The following definition is added: Definitions, Paragraph 15 f. (2) or f. (3) of the definition of "mobile "Unmanned aircraft" means an aircraft that is equipment'; or not: (f) An aircraft (other than unmanned a. Designed; aircraft) that is not owned by any b. Manufactured; or insured and is hired, chartered or c. Modified after manufacture loaned with a paid crew. However, this exception does not apply if the to be controlled directly by a person from within insured has any other insurance for or on the aircraft. such "bodily injury" or "property damage", whether the other insurance is primary, excess, contingent or on any other basis. 2. The following is added to Section B. EXCLUSIONS Paragraph p., Personal and Advertising Injury: Unmanned Aircraft - Personal and Advertising Injury Arising out of the ownership, maintenance, use or entrustment to others of any aircraft that is an "unmanned aircraft". Use includes operation and"loading or unloading". 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 offense which caused the "personal and advertising injury" involved the ownership, maintenance, use or entrustment to others of any aircraft that is an "unmanned aircraft". However, this exclusion does not apply if the only allegation in the claim or"suit" involves an intellectual property right which is limited to: (a) Infringement, in your "advertisement", of: (i) Copyright; (ii) Slogan; or (iii) Title of any literary or artistic work; or (b) Copying, in your "advertisement", a person's or organization's "advertising idea" or style of "advertisement". Page 2 of 2 Form SS 42 06 03 17 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CYBERFLEX COVERAGE This endorsement modifies insurance provided under the following: BUSINESS LIABILITY COVERAGE FORM This endorsement modifies coverage under the (2) Copying in your"advertisement", a Business Liability Coverage Form for your web site or person's or organization's internet related activities. "advertising idea" or style of A. Exclusion 1.p. "Personal and Advertising Injury" "advertisement". (Section B.-EXCLUSIONS)is modified as follows: 2. Paragraph (9) does not apply. 1. Paragraphs (4), (5) and (7) are deleted and 3. Subparagraphs (a), (b) and (c) of Paragraph replaced by the following: (12)do not apply. (4) Arising out of any breach of contract, B. Section G. - LIABILITY AND MEDICAL except an implied contract to use EXPENSES DEFINITIONS is amended as follows: another's "advertising idea" in your 1. Paragraph b. of definition 1. "advertisement" is "advertisement"or on "your web site"; deleted and replaced by: (5) Arising out of the failure of goods, "Advertisement" means the widespread public products or services to conform with dissemination of information or images that any statement of quality or has the purpose of inducing the sale of goods, performance made in your products or services through: advertisement or on your web site"; b. The Internet; (7) (a) Arising out of any actual or alleged infringement or violation of any 2. Paragraphs f. and g. of the definition of intellectual property rights, such as "personal and advertising injury" are deleted copyright, patent, trademark, trade and replaced by the following: name, trade secret, service mark or "Personal and advertising injury" means injury, other designation of origin or including consequential "bodily injury", arising authenticity;or out of one or more of the following offenses: (b) Any injury or damage alleged in any f. Copying, in your "advertisement" or on "your claim or "suit" that also alleges an web site", a person's or organization's infringement or violation of any "advertising idea"or style of"advertisement'; intellectual property right, whether g. Infringement of copyright, slogan, or title of such allegation of infringement or any literary or artistic work, in your violation is made against you or any "advertisement"or on "your web site'; or other party involved in the claim or 3. The following is added to the definition of "suit", regardless of whether this "personal and advertising injury": insurance would otherwise apply. As used in this definition, oral, written or electronic However, this exclusion does not apply if publication includes publication of material in your the only allegation in the claim or "suit" care, custody or control by someone not involving any intellectual property right is authorized to access or distribute that material. limited to: 4. The following definition is added: (1) Infringement in your "Your web site" means a web page or set of "advertisement", of: interconnected web pages prepared and (a) Copyright; maintained by you, or by others on your behalf, for (b) Slogan; or the purposes of promoting your goods or services, (c) Title of any literary or artistic that is accessible over a computer network. work; or Form SS 40 26 03 17 Page 1 of 1 0 2017, The Hartford TI-1 E HARTFORD U.S. DEPARTMENT OF THE TREASURY, OFFICE OF FOREIGN ASSETS CONTROL ("OFAC") ADVISORY NOTICE TO POLICYHOLDERS No coverage is provided by this Policyholder Notice nor can it be construed to replace any provisions of your policy. You should read your policy and review your Declarations page for complete information on the coverages you are provided. This Notice provides information concerning possible impact on your insurance coverage due to directives issued by the United States. Please read this Notice carefully. The Office of Foreign Assets Control ("OFAC") of the U.S. Department of the Treasury administers and enforces economic and trade sanctions based on U.S. foreign policy and national security goals against targeted foreign countries and regimes, terrorists, international narcotics traffickers, those engaged in activities related to the proliferation of weapons of mass destruction, and other threats to the national security, foreign policy or economy of the United States. OFAC acts under Presidential national emergency powers, as well as authority granted by specific legislation, to impose controls on transactions and freeze assets under U.S. jurisdiction. OFAC publishes a list of individuals and companies owned or controlled by, or acting for or on behalf of, targeted countries. It also lists individuals, groups, and entities, such as terrorists and narcotics traffickers designated under programs that are not country-specific. Collectively, such individuals and companies are called "Specially Designated Nationals and Blocked Persons" or "SDNs". Their assets are blocked and U.S. persons are generally prohibited from dealing with them. This list can be located on OFAC's web site at—http//www.treas.gov/ofac. In accordance with OFAC regulations, if it is determined that you or any other insured, or any person or entity claiming the benefits of this insurance has violated U.S. sanctions law or is an SDN, as identified by OFAC, the policy is a blocked contract and all dealings with it must involve OFAC. When an insurance policy is considered to be such a blocked or frozen contract, no payments nor premium refunds may be made without authorization from OFAC. Form IH 99 40 04 09 Page 1 of 1 THE HARTFORD Named Insured: LOIS ST RR Policy Number: 72 SBM IT6458 Effective Date: 06/07/18 Expiration Datw 06/07/19 Company Name: SENTINEL INSURANCE COMPANY, LIMITED THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, TRADE OR ECONOMIC SANCTIONS ENDORSEMENT This insurance does not apply to the extent that trade or economic sanctions or other laws or regulations prohibit us from providing insurance, including, but not limited to, the payment of claims. All other terms and conditions remain unchanged. Form IH 99 4104 09 Page 1 of 1 CITY OF EL SEGUNDO WORKERS' COMIPENSATION DECLARATION WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL EMPLOYER TO CRIMINALISA AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($10110,000), IN ADDITION COMPENSATION,, DA FOR IN LABOR CODE . I affirm under penally of pedury underImim of Californiait* n declarations: I have and w0l maontain a certificate of conserit of self-insure for workers'compermadon, issued IIS ft Director Of Industrial Reiations as providedfor by Labor Code§3700 for the performance of the work set forth the agmment with the City at EJ Segundo. Pobcy NO I have and UU maintain workere compensation insurance as requiredby Labor Code§3700 for the perkwnwoe of the work for which the agreemant with te City of B Segundo is executed. My permabon insurance carrier arid pobcy num1mr are: Carrier y Number EVeation Date Narne of Agent Phone 0 I wr t'y :teat. Urr the rrr f thework forth in agreement IE.I , I U not w'7 of y any person in any rr ginner soas to b subject ' aria, and arra that, it' iu s[tould becorne subject to the rs' oomperisation proWsions of Labor Code 3700 I must irrinned0tely comply with thlgd �;provisio r th �r et °UI y ed. nt ► Dated. by. M.. 1