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PROOF OF INSURANCE (2019 - 2019) CLOSED DATE(MMIDD/YYYY) ACCORL> CERTIFICATE OF LIABILITY INSURANCE .• 1 5/29/2018 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 Artex Risk Solutions, Inc. (CB) PHONE Chg00 807rD3D FAX R ImGolf Meadows IL 0Floor 008-4050 E-M ass t) Brothers Services (Ac Nt) 630-378,2508 ADD 0 9 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Pennsylvania Manufacturers Assoc Ins Co 12262 INSURED CHRIBRO-14 INSURER B Old Republic Insurance Company 24147 Brothers of the Christian Schools&Affiliates Loc#1177028 DAUGHTERS OF CHARITY OF SVDP INSURERC 1205 Windham Parkway INSURER Romeoville IL 60446-1679 INSURER E. INSURER F: COVERAGES CERTIFICATE NUMBER:707504569 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. INSLICY EXP RR TYPE OF INSURANCE N WVD POLICY NUMBER (MMIDWYYYY)POLICY EFIF_(MMIDWYYYYr LIMITS A X COMMERCIAL GENERAL LIABILITY Y 821800 0998922 6/15/2018 6/15/2019 EACH OCCURRENCE $4,000 000 CLAIMS-MADE OCCUR PREMISE,;((E<r=Qcurr X I PR�MISP$tPe occurrence) $Included I I MED EXP(Any one person) $15 000 PERSONAL&ADV INJURY $Included GEN'L AGGREGATE LIMIT GENERAL AGGREGATE $N/A X POLICY ^IEC-APPLIES PER: PITO LOC PRODUCTS-COMP/OP AGG $Included r COMBINED e7JtlURY(Per person) $ DO X ANY AUTO BODILYINJURY DDO 0 B AUTI)OMWONELDE LIABILITY SCHEDULED ! Y MWTB 21543 6/15/2018 6/15/2019BODILY INJURY(Per accident)I $1 AUTOS ONLY AUTOS X X HIRED � NON-OWNED PROPERTYAUTOS ONLY (Per accident)DAMAGE AUTOS ONLY f UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ . .$ WORKERS COMPENSATIONPER OTH- AND EMPLOYERS'LIABILITY YIN ��,STATUTE_. FIR ANYPROPRIETOR/PARTNER/EXECUTIVEE L EACH ACCIDENT $ F7OFFICER/MEMBER EXCLUDED? N/AI (Mandatory in NH) EL DISEASE-EA EMPLOYEEI$ If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Only the General Liability Coverage will apply on a Primary and Non-Contributory basis(per attached endorsement)if required by fully executed written contract.Certificate Holder is added as Additional Insured(per attached endorsement)for General Liability and Automobile liability coverages solely,strictly and specifically with regards to: Consultant Services for the Community Development Block Grant Program for Home Delivered Meals. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of EI Segundo its Official and Employees ACCORDANCE WITH THE POLICY PROVISIONS. Office of City Clerk 350 Main Street EI Segundo CA 90245-3813 AtuTrioRl - REPRESENTATIVE USA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD PENNSYLVANIA MANUFACTURERS' ASSOCIATION INSURANCE COMPANY Attaching to and forming part of Policy No.821800 0998922 Named Insured: THE RELIGIOUS AND CHARITABLE RISK POOLING TRUST OF THE BROTHERS OF THE CHRISTIAN SCHOOLS AND AFFILIATES Effective date of this endorsement is June 15,2018 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. ADDITIONAL INSURED SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under SECTION II INSURING AGREEMENT C, GENERAL LIABILITY COVERAGE defined within the Coverage Agreement SECTION 1:Schedule Name of Additional Insured Persons(s) or Designated Location(s)Of Covered Operations: Organization(s): ANY PERSON OR ORGANIZATION WHEN YOU HAVE AGREED IN A WRITTEN CONTRACT FOR THAT PERSON OR ORGANIZATION TO BE ADDED AS AN ADDITIONAL INSURED ON YOUR POLICY. If no entry appears above, information required to complete this endorsement will be shown in the Certificate of Coverage as applicable to this endorsement. Section II Insuring Agreement C-Name of Insured Amended A Who Is An Insured defined in the General Insurance Agreement is amended to include as an Additional Insured the person(s)or organization(s)shown in the Schedule above but only with respect to liability in the performance of the Named Insured's ongoing operations for the Additional Insured(s)at the Location(s)designated in the Schedule above for"bodily injury"or"property damage",caused in whole or in part, by the Named Insured's acts or omissions which takes place after the execution of a written agreement with the Additional Insured(s). B For the coverage provided by this endorsement:the following paragraph is added to Section IV—General Conditions,Section II, Insuring Agreement C-General Liability This insurance is primary insurance as respects to this coverage to the additional insured person or organization, where the written contract or written agreement requires that this insurance be primary and noncontributory. In that event,we will not seek contribution from any other insurance policy available to the additional insured on which the additional insured person or organization is a Named Insured C Who Is An Insured is also amended to include as an additional insured the person(s)or organization(s)shown in the Schedule, with respect to liability for "bodily injury" or "property damage" caused. in whole or in part, by the "Named Insured's work"at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the"products-completed operations hazard". The most we will pay is the amount of insurance required by the written contract or the amount of applicable limits of insurance under this policy;whichever is less. This Insurance does not apply to any claims or suits seeking damages, including defense, arising out of, directly or indirectly,from any actual or alleged participation in any act of sexual misconduct, sexual harassment, sexual molestation, sexual abuse or any claim sexual in nature,physical or mental,of any person. Except as amended in this endorsement, this insurance is subject to all coverage terms, clauses and conditions in the policy to which this endorsement is attached and only applies to the extent permitted by law. THIS FORM APPLIES IN STATES WHICH USE: CA 00 01 (10-13) IL 10 (12106) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM SCHEDULE Name of Person(s)or Organization(s): All persons or organizations as required by contract or agreement With respect to COVERED AUTOS LIABILITY COVERAGE, Who Is An Insured is changed with the addition of the following: Each person or organization shown in the Schedule for whom you are doing work is an "insured". But only for "bodily injury" or "property damage" that results from the ownership, maintenance or use of a covered "auto"by: 1. You; 2. an "employee" of yours; or 3. anyone who drives a covered "auto" with your permission or with the permission of one of your "employees". However, the insurance afforded to the person or organization shown in the Schedule shall not exceed the scope of coverage and/or limits of this policy. Not withstanding the foregoing sentence, in no event shall the insurance provided by this policy exceed the scope of coverage and/or limits required by the contract or agreement. PCA 001 10 13 MWTS 21543 Religious and Charitable Risk Pooling Trust 06/15/2018-06/1512019 a, YYY I DATE(MMIDD/Y ) AtIC"R ' CERTIFICATE OF LIABILITY INSURANCE 12/19/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NA MEa Christian Brothers Services Artex Risk Solutions, Inc. (CB) PHO Nn Ext): 630-378-2508 2850 Golf Road, 5th Floor 800-807-0300 MC.Nor Rolling Meadows IL 60008-4050 ADORES$, INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Old Republic Insurance Company 24147 INSURED CH R I BRO-14 INSURER B Brothers of the Christian Schools&Affiliates INSURER C: Loc#1177028 Romeo nd am )604 0rkwa 9ST VINCENT SENIOR CITIZEN NTR INSURERS ille INSURER F: COVERAGES CERTIFI'CAT'E(NUMBER:93177856 RE'V'ISION 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, 1" INSRR TYPE OF INSURANCE 'IINSO ISWVD. POLICY NUMBER I EFF IMMMID'D/YF fPOLICY EXP N Ip,�O LIMITS OL DDFYYYYd_ LIABILITY EACH OCCURRENCE $ COMMERCIAL IERAL dAMAGE'YUREWY b CLAIMS-MADE OCCUR PREMISES,(Ea occurrence) $,,,,, MED EXP(Any one person) S PERSONAL&ADV INJURY .,$,,,,, .,, GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S IR'o• POLICY P �gF;;C;r ( J II'_T-% I � PRODUCTS-COMP/OPAGG $ OTHER .,$ AUTOMOBILE LIABILITY CU MrBINE rG`a'INUL. L,IMI1 $ ) I ( rpersan ) $ANY AUTO , AUTOS ONLYAUTOS u:1TY OAM/Cr"c� cid t)I$ SCHEDULED HIRED NON-OWNED act) n AUTOS ONLY AUTOS ONLY iter arxAdend9 $ �s UMBRELLA EXCESS LIABAB OCCUR EACH I AGGREGATE OCCURRENCE $ E _ $ 1 DED I I RETENTIONS $ A WORKERS COMPENSATION y MWC 305311 03(CA) 1/1/2018 1/1/2019 X PER ERH OFDICERO/MOEMNEFIREXCBIUDED ECUTIVE Yg�"�"')' EL DISEP�SECIDAEEMPLOYEE 81.00 0 0 nE ( ry. ) 0 0 If yes,describe under DESCRIPTION OF OPERATIONS below E 1. DISEASE-POLICY LIMIT $1,000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) Wavier of Subrogation, per the attached endorsement, (where allowed by law) is provided under the Worker's Compensation coverage when required by fully executed written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CII: of EI Segundo,its officials and employees THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Office of the City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main St EI Segundo CA 90245 AUTtIORIZ REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved„ ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 0484) POLICY NUMBER: MWC 305311 03 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 0 % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ALL PERSONS OR ORGANIZATIONS WHERE REQUIRED BY WRITTEN CONTRACT C 1998 by the Workerd Compensation Insurance Rating Bureau of California. Al rights reserved. From the WCIRB's Califomia Workers'Compensation Insurance Forms Manual© 1999.