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PROOF OF INSURANCE (2019 - 2019) CLOSED DATE(MM/DD/YYYY) ACCW '°' CERTIFICATE OF LIABILITY INSURANCE I 03/12/2018 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 License# 0751768 CONTACT BOB HADZOR Robert Hadzor Insurance Services PHONE A DRIES n, (925) 372-9000 FAX N0 (925) 372-9003 3755 Alhambra Ave. Suite 7 S.bob@hadzorinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# .....m.........._.._..._._ Martinez, CA 94553- INSURER A:Nonprof its Insurance Allance O INSURED El Segundo Nursery .School INSURER B: � - P.O. Box 73 I INSURER C:Markel Insurance Company 300 E. Pine Avenue. INSURER D: J INSURER E: E1 Segundo CA 90245- INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR AODM.SUBR POLICY EFF POLICY EXP LIMITS 201 GENERAL LIABILITY 1 -,(MM/DO/YVYV1 LTR TYPE OF INSURANCE D POLICY NUMBER (MMIDDIYYYYI 4/01/2018� 4/0 101/2019 DAMAGE TO REN'fE� 2018-20766-NPO EACH OCCURRENCE I$ 1,000,0001 A 1 X COMMERCIAL GENERAL LIABILITY PREMISES(Fa occurrence) $ 100,000) CLAIMS-MADE [j] OCCUR / / / / MED EXP(Any one person) $ 10,0001 PERSONAL&ADV INJURY $ 1_000,000 GENERAL AGGREGATE Is 3,000,0001 GEN'L AGGREGATE LIMIT APPLIES PER / / / / _PRODUCTS-COMP/OP AGG $ 3,000,0001 X POLICY�I R n,LOC / / / / LIQUOR $ 1,000,0001 A AUTOMOBILE LIABILITY 2018-20766-NPO 04/01/2018 04/01/2019 COMBINEDSINGLE LIMN ...,,w,.._. (Fa accxdnMII $ 1,000,CCCJ ANY AUTO / / / / BODILY INJURY(Per person) $ 1 ALL OWNED SCHEDULED / / / / BODILY INJURY(Per accident) $ AUTOS AUTOS X }{ NON-OWNED / / / / PROPERTY DAMAGE $ HIRED AUTOS AUTOS Iter accmdenll UMBRELLA LIAB OCCUR / / / EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE / / / / AGGREGATE $ II / .......................................... DED V RETENTION$ $ C WORKERS COMPENSATION :VIWC0023768-07 02/01/2018 02/01/2019I TORY LIMITS WC STATU- I MOTH- R FR AND EMPLOYERS'LIABILITY Y F N X ANY PROPRIETOR/PARTNER/EXECUTIVE / / / / E L,EACH ACCIDENT $ 1,000,0001 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E L,DISEASE-EA EMPLOYEE $ 1,000,0001 IF yes,describe under DESCRIPTION OF OPERATIONS blow E L DISEASE-POLICY LIMIT $ 1,000,000 1 A PERSONAL PROPERTY 2018-20766-Prop 04/01/201804/01/2019 SPECIAL FORM RC 5,000' A D&O INSURANCE 2018-20766-NPO-D&O 04/01/2018 04/01/2019 SPECIAL FORM RC 5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) City of E1 Segundo its Officers, Officials, Directors, Employees and Voluteers to be named as additional insured and Also attached is the Waiver of Subrogation for Work Comp policy through Markel Insurance company. Re: Landlord of E1 Segundo Nursery School CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of E1 Segundo its Official and Employees c/o City Clerk AUTHORIZED REPRESENT'ATt 350 Main Street RM 5 ✓ E1 Segundo CA 90245-3813 ACORD 25(2010/05) ©1988-2010 ACOI "D CORPORATION. All rights reserved. INS025(201005)01 The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 20 11 01 96 INSURED: EL SEGUNDO NURSERY SCHOOL POLICY NUMBER: 2018-20766-NPO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES This endorsement modifies insurance provided under the following: City of El Segundo its Official and Employees C/O City Clerk 350 Main Street. RM 5 El Segundo, CA 90245-3813 ISSUED TO: City of El Segundo its Officers, Officials, Directors, Employees and Volunteers RE: Landlord of El Segundo Nursery School SCHEDULE (If no entry appears above,the information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED(Section II)is amended to include as an insured the person or organization shown in the Schedule but only with respect to liability arising out of the ownership,maintenance or use of that part of the premises leased to you and shown in the Schedule and subject to the following additional exclusions: This insurance does not apply to: 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 person or organization shown in the Schedule. CG 20 11 01 96 Copyright,Insurance Services Office,Inc., 1994 Page 1 of 1 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 5 %of the California workers'compensation premium otherwise due on such remuneration. Work performed by EL SEGUNDO CO-OP NURSERY SCHOOL(NONPROFIT) at: PO Box 73 EI Segundo, CA 90245-0073 Schedule Subrogant Information Class Code Description Payroll City of EI Segundo its officials& Employees c/o City Clerk 8868 Colleges/Schools–private–professionals $0.00 350 Main Street Room 5 EI Segundo, CA 90245 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 02/01/2018 Policy No. MWC0023768-07 Endorsement No. Insured: EL SEGUNDO CO-OP NURSERY SCHOOL(NONPROFIT) Pre S A ched) Insurance Company: Markel Insurance Company Countersigned W (Ed.d.04-8 D4-84) m 1998 by the Workers'Compensation Insurance Rating Bureau of California.All rights reserved. From the WCIRB's California Workers'Compensation Insurance Forms Manual®2001 18 of 32 i