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PROOF OF INSURANCE (2018 - 2019) CLOSED --o■r KOPPE-1 OP ID: LR lICRQ^ CERT FIICATE OF LIABILITY I JSURAhJCE DATE(MMIDDIYYYY) 1 08/01/2018 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 Ho......l..l... B MCGlinnNAM Alcott nsurance Agency,Inc. PHONE2 -293-3896 3945 Street (NP619-293-3800 C lca619 San Diego,CA 92104-2902E-MAIL ADDR Holly B.McGlinn ESS. INSURERIS)AFFORDING COVERAGE NAIC# INSURER A:Citizens Ins Co of America INSURED Koppel Public Finance Ge ini Insurance Company10833 niVa Cruz,Ste.256 INSURER aros CA 92078 INSURER D: INSURER E 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 TYPE OF INSURANCE .. . c ERIMMIDD/YYYYI IJMWOO/YYYY9 i....,. INS ADbL&J6 POLICY NUMB POLICYEFF POLgCYEif P" LIMITS GENERAL LIABILITY ,EACH OCCURRENCE $ 2,000,000 MRD EsTO RENTED--_-- 300 000. A X COMMERCIAL GENERAL L DAMAGE�(XC �I ka�ACCwrtrtnrrp) $ _ P (Any one person) $ 5,000: CLAIMS-MADE XII occuR X X OB3D42685200 1 E P ................... $ 2,000,000 GENERALAGGREGATE ffRSONAL&ADV INJURY $ 2,000,00 GEN'LAGGREGATELIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 4,000,000- X POLICY i.. PRO- 'd.00 $ ,I AUTOMOBILE LIABILITY .. ....... CO f,0 aDCSINGLE d,IMIT $ 2,000,OOC^ N A ANY AUTO BODILY INJURY(Per person) $ - ALL OWNED AUTOS a 6DULEDOWNED OB3D42685200 11/29/2017 1 PRO DILYINJ INJURY(Per $ X HIRED AUTOS X AUTOS IIppRAgCIPENT), -� X Hired Phy !Damage $ 50,000/5001 UMBRELLA LIABCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE 'U DED.,.,,,,....L,..RETENTION$ $ WORKERS COMPENSATION WC STATU- C,T 11 ANY PROPRIETOR/PARTNER/EXECUTIVE YIN EL EAAC _ AND EMPLOYERS'LIABILITY -1 H ARY CCIDENT I $ OFFICER/MEMBER EXCLUDED? NIA EL DISEASE-EA E (Mandatory in NH) o MPLOYEC$ If yes, B (Prof E g Oe under 6285280 11116/2017 11/16/2018 IClai...�......... 1,0 ., DESCRIPTION OF OPERATIONS below DISEASE-POLICY LIMIT $ m 00,000 Retro Date 11/1612004 IAgg 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) General Liability Policy excludes claims arising our of the performance of professional services. All Operations of the Named Insured. City of E1 Segundo, its officers, officials, employees, and volunteers are named additional insured as respects to operations performed by the Named. Insured . as respects to General Liability per forms CG2026, CG2001 6 C2404 attached. W",I, CERTIFICATE HOLDER CANCELLATION CITYESE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ci of EI Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City g ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street EI Segundo,CA 90245-3895 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSPIRED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART ``II SCHEDULE ` Name Of Additional Insured Person(s Or Organization(s) City of EI Segundo, its officers, officials, employees and volunteers 350 Main Street EI Segundo CA 90245-3895 Information required to complete this Schedule, if not shown above,will be shown in the Declarations. Section II — Who Is An Insured is amended to in- clude as an additional insured the person(s) or organi- zation(s) shown in the Schedule, 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 omis- sions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 ©ISO Properties, Inc., 2004 Page 1 of 1 D POLICY NUMBER: OB3D426852 COMMERCIAL GENERAL LIABILITY CG 20 010413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this Insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the additional Insured. This Insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance*,and CG 20 01 04 13 O Insurance Services Office, Inc.,2012 Page 1 of 1 POLICY NUMBER: OB3D426852 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: AUTOMATIC STATUS - COPIES OF EACH CERTIFICATE ISSUED IS ON FILE WITH THE INSURANCE COMPANY AND/OR THEIR LEGAL REPRESENTATIVE Information reouiMd to comolete this Schedule. if not shown above. will boshown in the Declarations. The following is added to Paragraph 8.Transfer Of Rights Of Recovery Against Others To Us of Section IV—Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above 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 organization and included in the "products- completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 0 Insurance Services Office, Inc., 2008 Page 1 of 1 POLICYHOLDER COPY SP STATE P.O. BOX 8192, PLEASANTON, CA 94588 FUND , CERTIFICATE OF WORKERS' CONFENSATION INSURANCE ISSUE DATE: 08-01-2018 GROUP: POLICY NUMBER: 1824128-2018 CERTIFICATE ID 88 CERTIFICATE EXPIRES: 04-01-2018 04-01-2018/04-01-2018 CITY OF EL SEGUNDO SP 350 MAIN ST EL SEGUNDO CA 90245-3813 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an Insurance policy and does not amend, extend or after the coverage afforded by the policy listed herein. Notwithstanding any requirement,, terra or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative President and CEO EMPLOYE'R'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT 02005 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-01-2008 IS ATTACHED TO AND FORMS A PART OF THIS POLICY_ ENDORSEMENT 02570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2018-08-01 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: i`" CITY OF EL SEGUNDO ENDORSEMENT 01880 - SCOTT KOPPEL VICEPRES - EXCLUDED. ENDORSEMENT 01850 - LYNN GRUBER PRES,SEC - EXCLUDED. EMPLOYER KOPP'EL & GRUBER PUBLIC FINANCE (A CORP) SP 334 VIA VERA CRUZ STE 288 SAN MARCOS CA 92078 [P1 D,SDI (REV.7-2O14) PRINTED 08-01-2018 ENDORSEMENT AGREEMENT NAIVER OF SUBROGATION 1824128-18 STATE RENEWAL SP FUNO 7-67-42-43 PAGE 1 HOME OFFICE SAN FRANCISCO EFFECTIVE AUGUST 1, 2018 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING APRIL 1, 2019 AT 12.01 A.M. AT 1201 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME KGPF 334 VIA VERA CRUZ STE 256 SAN MARCOS, CA 92078 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, CITY OF EL SEGUNDO WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, KGPF IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAINVYp exp PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION " OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE ^ `'s ,�J EMPLOYER. , IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH EMPLOYEES SHALL BE INCREASED BY 03$. NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: AUGUST 3, 2018 2570 AUTIOItI2ECF FCEI�RESI NT IVE PRESIDENT AND CEO SCIF FORM 10217 (REV.4-2018) OLD OP 217