PROOF OF INSURANCE (2018) CLOSED LEXILLC-01 C'L -
'4'C'" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY)
`.� 07/19/2018
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
RBN Insurance Services PHONE, „„w . 'm'�Nµ,)''mw'I..,w;r(;)ul,„pi FAX,
Nu 312 856-9425
303 E Wacker Dr. Imo. )', ( k� )
Suite 650 E Are�"�AIRulL
Chicago,IL 60601 INSURER(S)AFFORDING COVERAGE NAIC#
INSURERA:Continental Insurance Company 35289
INSURED INSURERS:Hartford Ins Co of the Midwest 37478
Lexipol Holding Company INSURERC.-Hiscox Insurance Co. Inc. 10200
Lexipol,LLC
16755 Von Karman Ave.#250 INSURER D:
Irvine,CA 92606 INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OFM INURS ..ANCE 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.
I,INNSR iADOL,'SUBR' POLICY EFF POLICY EXP
TYPE OF INSURANCE 4WD POLICY NUMBER 1'MMonryYYY1 IMWaDIYYYYI LIMITS
A X COMMERCIAL GENERAL LIABILITY 1,000,00'0
_ EACH OCCURRENCE $
AMAGE TO RENTD
CLAIMS-MADE OCCUR X X 6043284498 08120/2017 08/20/2016 PR'MMS(ED o„»cnE,raxrpce) _g_ 300,000
MEO EXP(Any one pwsen) - _$ 15,000
PERSONAL 8 ADV INJURY S 1,000,000
GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
X POLICY jER& LOC PRODUCTS-COMP/OP AGG $ Excluded
OT14ER $
AAUTOMOBILE LIABILITY COMBINED'SINGLE LIMIT 1,000,000
(ED amdenl) S_
ANY AUTO 6043284484 08/20/2017 08/20/2018 BODILY INJURY(Par person)--A
OWNED SCHEDULED
AUT��OkkyyS ONLY AUUTO�Sr �j _BODILY INJURY(Peas 8=dent) $
X A4IRTC'S ONLY X_. Au9T05 C3N.K f;yRepEoRID AMAGE $
A X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5'000'000
EXCESS LIAR CLAIMS-MADE X 6043284520 08/20/2017 08/20/2018 AGGREGATE $ 5'000'000
II IY.I"'� boli'. d+l' "II Il-Y"II�'pIGO,II,,, ww,IV''!ID(,n� $
B WORKERS COMPENSATION X $ hTUTE 0TH _
AND EMPLOYERS'LIABILITY N N X 83WECBZ5648 06/20/2017 08/20/2018 1,000,000
ANY P'ROPRtETORMARTNERIEXECUTIVE E L EACH ACCIDENT $
igFICERWM fflR,EXCLUDED? N/A
andatory Ma INM,i E.L DISEASE-EA EMPLOYEE $ 1,0010,000
11}Ias,describe undue 1,,000,00'0
DESCRIPTION OF OPERATIONS below E L. DISEASE-POLICY L IMIT S.
C Professional/Media I r UUA 2688184.17 08/20/2017 08/20/2018 Each Cla mlAggregate 5,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 401,Add'll'ional Remarks Schedule,may be attachsd If more space Is regulred)
The City of El Segundo,its officers,officials,employees and volunteers are Additional Insureds as respects General Liability on a primary and
non-contributory basis as required by a written contract or written agreement. A Workers Compensation Waiver of Subrogation In favor of the Additional
Insured applies as required by a written contract or written agreement. Umbrella policy is follow form.
L
.................... .......................
CERTIFIC'AT'E HOLDER CANCELLATION!
u
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Ci of EI Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City 9 ACCORDANCE WITH THE POLICY PROVISIONS.
350 Main Street
EI Segundo,CA 90245-3895
AUTHORIZED R-gEPRESENTATIVE
) ..... .........
(2016/03 �m.
ACORD 25 01988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
.............................. ..........
,► CNA PARAMOUNT
General Liability Extension Endorsement
It is understood and agreed that this endorsement amends the COMMERCIAL GENERAL LIABILITY COVERAGE PART
as follows. If any other endorsement attached to this policy amends any provision also amended by this endorsement,
then that other endorsement controls with respect to such provision, and the changes made by this endorsement with
respect to such provision do not apply.
TABLE OF CONTENTS
1. Additional Insureds
2. Additional Insured-Primary And Non-Contributory To Additional Insured's Insurance
3. Bodily Injury—Expanded Definition
4. Broad Knowledge of Occurrence/Notice of Occurrence
5. Broad Named Insured
6. Estates,Legal Representatives and Spouses _
.__..........................
7. Expected Or Intended Injury—Exception for Reasonable Force
S. In Rem Actions
9. Incidental Health Care Malpractice Coverage
..... ......................................
10. Joint Ventures/Partnership/Limited Liability Companies
11. Legal Liability—Damage To Premises
12. Medical Payments
13. Non-owned Aircraft Coverage
14. Non-owned Watercraft
15. Personal And Advertising Injury—Discrimination or Humiliation
16. Personal And Advertising Injury-Contractual Liabillty I�
17. Property Damage-Elevators
18. Supplementary Payments
19. Unintentional Failure To Disclose Hazards
.. ..
20...m........a...Vef..o.. .. .eBlanket
Subrogation
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CNA74679XX(1-15) Policy No: 6043284498
Page 1 of 13 Endorsement No: 4
The Continental Insurance Co. Effective Date: 08/20/2017
Insured Name:LEXIPOL, LLC
Copyrlghl CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office,Inc.,with Its permission.
CNA CNA PARAMOUNT
General Liability Extension Endorsement
............................................................................
--W .
1. I ADDITIONAL INSUREDS
a. WHO IS AN INSURED is amended to include as an Insured any person or organization described in paragraphs
A.through K. below whom a Named Insured is required to add as an additional insured on this Coverage Part
under a written contract or written agreement,provided such contract or agreement:
(1) is currently in effect or becomes effective during the term of this Coverage Part; and
(2) was executed prior to:
(a) the bodily injury or property damage;or ,
(b) the offense that caused the personal and advertising Injury,
for which such additional insured seeks coverage.
b. However, subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer
will not provide such additional insured with:
(1) a higher limit of insurance than required by such contract or agreement; or
(2) coverage broader than required by such contract or agreement, and in no event broader than that described
by the applicable paragraph A.through K.below.
Any coverage granted by this endorsement shall apply only to the extent permissible by law.
A. Controlling Interest
Any person or organization with a controlling interest in a Named Insured, but only with respect to such person or
organization's liability for bodily injury,property damage or personal and advertising Injury arising out of:
1. such person or organization's financial control of a Named Insured;or
2. premises such person or organization owns, maintains or controls while a Named Insured leases or
occupies such premises;
provided that the coverage granted by this paragraph does not apply to structural alterations, new construction or
demolition operations performed by,on behalf of,or for such additional insured.
B. Co-owner of Insured Premises
A co-owner of a premises co-owned by a Named Insured and covered under this insurance but only with respect
to such co-owner's liability for bodily injury, property damage or personal and advertising Injury as co-owner
of such premises.
C. Grantor of Franchise
Any person or organization that has granted a franchise to a Named Insured, but only with respect to such
person or organization's liability for bodily injury, property damage or personal and advertising injury as
grantor of a franchise to the Named Insured.
D. Lessor of Equipment
Any person or organization from whom a Named Insured leases equipment, but only with respect to liability for
bodily injury, property damage or personal and advertising injury caused, in whole or in part, by the Named
Insured's maintenance, operation or use of such equipment, provided that the occurrence giving rise to such
bodily injury, property damage or the offense giving rise to such personal and advertising injury takes place
prior to the termination of such lease.
. ................................................. ...
CNA74879XX(1-15) Policy N0: 6043284498
Page 2 of 13 Endorsement No: 4
The Continental Insurance Co. Effective Date: 08/20/2017
Insured Name:LEXIPOL, LLC
Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office,Inc.,with Its permission.
rrr CNA PARAMOUNT
General Liability Extension Endorsement
E. Lessor of Land
Any person or organization from whom a Named Insured leases land but only with respect to liability for bodily
Injury, property damage or personal and advertising injury arising out of the ownership, maintenance or use
of such land, provided that the occurrence giving rise to such bodily injury or property damage, or the offense
giving rise to such personal and advertising injury, takes place prior to the termination of such lease. The
coverage granted by this paragraph does not apply to structural alterations, new construction or demolition
operations performed by,on behalf of,or for such additional insured.
F. Lessor of Premises
An owner or lessor of premises leased to the Named Insured, or such owner or lessor's real estate manager, but
only with respect to liability for bodily injury, property damage or personal and advertising Injury arising out of
the ownership, maintenance or use of such part of the premises leased to the Named Insured, and provided that
the occurrence giving rise to such bodily Injury, property damage or the offense giving rise to such personal
and advertising injury takes place prior to the termination of such lease. The coverage granted by this
paragraph does not apply to structural alterations, new construction or demolition operations performed by, on
behalf of,or for such additional insured.
G. Mortgagee,Assignee or Receiver
A mortgagee, assignee or receiver of premises but only with respect to such mortgagee, assignee or receiver's
liability for bodily Injury, property damage or personal and advertising injury arising out of the Named
Insured's ownership, maintenance,or use of a premises by a Named Insured.
The coverage granted by this paragraph does not apply to structural alterations, new construction or demolition
operations performed by, on behalf of,or for such additional insured.
H. State or Governmental Agency or Subdivision or Political Subdivisions—Permits
A state or governmental agency or subdivision or political subdivision that has issued a permit or authorization,
but only with respect to such state or governmental agency or subdivision or political subdivision's liability for
bodily injury,property damage or personal and advertising Injury arising out of:
1. the following hazards in connection with premises a Named Insured owns, rents, or controls and to which
this insurance applies:
a. the existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings,
canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoistaway openings, sidewalk
vaults,street banners, or decorations and similar exposures; or
b. the construction, erection, or removal of elevators; or
c. the ownership, maintenance or use of any elevators covered by this insurance;or
2. the permitted or authorized operations performed by a Named Insured or on a Named Insured's behalf.
The coverage granted by this paragraph does not apply to:
a. Bodily injury, property damage or personal and advertising injury arising out of operations performed
for the state or governmental agency or subdivision or political subdivision;or
b. Bodily injury or property damage included within the products-completed operations hazard.
=" With respect to this provision's requirement that additional insured status must be requested under a written
contract or agreement, the Insurer will treat as a written contract any governmental permit that requires the
Named Insured to add the governmental entity as an additional insured.
CNA74879XX(1-15) Policy No: 6043284498
Page 3 of 13 Endorsement No: 4
The Continental Insurance Co. Effective Date: 08/20/2017
Insured Name: LEXIPOL, LLC
Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Off Ice,Inc.,with Its permission.
CNA CNA PARAMOUNT
General Liability Extension Endorsement
1. Trade Show Event Lessor
1. With respect to a Named Insured's participation in a trade show event as an exhibitor, presenter or
displayer, any person or organization whom the Named Insured is required to include as an additional
insured, but only with respect to such person or organization's liability for bodily Injury,property damage or
personal and advertising Injury caused by:
a. the Named Insured's acts or omissions;or
b. the acts or omissions of those acting on the Named Insured's behalf,
in the performance of the Named Insured's ongoing operations at the trade show event premises during the
trade show event.
2. The coverage granted by this paragraph does not apply to bodily Injury or property damage included
within the products-completed operations hazard.
J. Vendor
Any person or organization but only with respect to such person or organization's liability for bodily injury or
property damage arising out of your products which are distributed or sold in the regular course of such person
or organization's business, provided that:
1. The coverage granted by this paragraph does not apply to:
a. bodily injury or property damage for which such person or organization is obligated to pay damages by
reason of the assumption of liability in a contract or agreement unless such liability exists in the absence
of the contract or agreement;
b. any express warranty unauthorized by the Named Insured;
c. any physical or chemical change in any product made intentionally by such person or organization;
d. repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the
substitution of parts under instructions from the manufacturer, and then repackaged in the original
container;
e. any failure to make any inspections, adjustments,tests or servicing that such person or organization has
agreed to make or normally undertakes to make in the usual course of business, in connection with the
distribution or sale of the products;
f. demonstration, installation, servicing or repair operations, except such operations performed at the such
person or organization's premises in connection with the sale of a product;
g. products which,after distribution or sale by the Named Insured, have been labeled or relabeled or used
as a container, part or ingredient of any other thing or substance by or for such person or organization;or
h. bodily injury or property damage arising out of the sole negligence of such person or organization for
its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this
exclusion does not apply to:
(1) the exceptions contained in Subparagraphs d.or f.above;or
(2) such inspections,adjustments, tests or servicing as such person or organization has agreed with the
Named Insured to make or normally undertakes to make in the usual course of business, in
connection with the distribution or sale of the products.
2. This Paragraph J.does not apply to any insured person or organization,from whom the Named Insured has
acquired such products, nor to any ingredient, part or container, entering into, accompanying or containing
such products.
6NM7487"9XX(1-15) Policy No: 6043284498
Page 4 of 13 Endorsement No: 4
The Continental Insurance Co. Effective Date: 08/20/2017
Insured Name:LEXIPOL, LLC
Copyright CNA All Rights Reserved. Includes copyrighted materiel of Insurance Services Office,Inc.,with Its permisslon.
...........................................
AM CNA PARAMOUNT
General Liability Extension Endorsement
3. This Paragraph J.also does not apply:
a. to any vendor specifically scheduled as an additional insured by endorsement to this Coverage Part;
b. to any of your products for which coverage is excluded by endorsement to this Coverage Part;nor
c. if bodily injury or property damage included within the products-completed operations hazard is
excluded by endorsement to this Coverage Part.
If K. Other Person Or Organization
Any person or organization who is not an additional insured under Paragraphs A. through J. above. Such
additional insured is an Insured solely for bodily injury, property damage or personal and advertising injury
for which such additional insured is liable because of the Named Insured's acts or omissions.
The coverage granted by this paragraph does not apply to any person or organization:
1. for bodily injury, property damage, or personal and advertising injury arising out of the rendering or
failure to render any professional service;
2. for bodily injury or property damage included within the products-completed operations hazard; nor
3. who is specifically scheduled as an additional insured on another endorsement to this Coverage Part.
2. ADDITIONAL INSURED-PRIMARY AND NON-CONTRIBUTORY TO ADDITIONAL INSURED'S INSURANCE
A. The Other Insurance Condition in the COMMERCIAL GENERAL LIABILITY CONDITIONS Section is amended
to add the following paragraph:
If the Named Insured has agreed in writing in a contract or agreement that this insurance is primary and non-
contributory relative to an additional insured's own insurance, then this insurance is primary, and the Insurer will
not seek contribution from that other insurance. For the purpose of this Provision 2., the additional insured's own
insurance means insurance on which the additional insured is a named insured.
B. With respect to persons or organizations that quality as additional insureds pursuant to paragraph I.K. of this
endorsement,the following sentence is added to the paragraph above:
Otherwise, and notwithstanding anything to the contrary elsewhere in this Condition, the insurance provided to
such person or organization is excess of any other insurance available to such person or organization.
3. BODILY INJURY—EXPANDED DEFINITION
Under DEFINITIONS the definition of bodily injury is deleted and replaced by the following:
Bodily injury means physical injury,sickness or disease sustained by a person, including death, humiliation, shock,
mental anguish or mental injury sustained by that person at any time which results as a consequence of the physical
injury,sickness or disease.
4. BROAD KNOWLEDGE OF OCCURRENCE/NOTICE OF OCCURRENCE
Under CONDITIONS,the condition entitled:Duties in The Event of Occurrence,Offense,Claim or Suit is amended
to add the following:
A. BROAD KNOWLEDGE OF OCCURRENCE
The Named Insured must give the Insurer or the Insurer's authorized representative notice of an occurrence,
offense or claim only when the occurrence,offense or claim is known to a natural person Named Insured, to a
partner,executive officer, manager or member of a Named Insured, or to an employee designated by any of the
above to give such notice.
B. NOTICE OF OCCURRENCE
CNA74879XX(1-15) Policy No: 6043284498
Page 5 of 13 Endorsement No: 4
The Continental Insurance Co. Effective Date: 08/20/2017
Insured Name:LEXIPCL, LLC
Copyright CNA All Fights Reserved. Includes copyrighted material of Insurance Services of Ice,Inc.,wllh Its permission.
NA CNA PARAMOUNT
General Liability Extension Endorsement
not be deemed to be damages for personal and advertising injury and will not reduce the limits of
insurance.
D. This PERSONAL AND ADVERTISING INJURY - LIMITED CONTRACTUAL LIABILITY Provision does not
apply if Coverage B—Personal and Advertising Injury Liability is excluded by another endorsement attached
to this Coverage Part.
17. PROPERTY DAMAGE—ELEVATORS
A. Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled
Exclusions is amended such that the Damage to Your Product Exclusion and subparagraphs(3),(4)and(6)of
the Damage to Property Exclusion do not apply to property damage that results from the use of elevators.
B. Solely for the purpose of the coverage provided by this PROPERTY DAMAGE— ELEVATORS Provision, the
Other Insurance conditions is amended to add the following paragraph:
This insurance is excess over any of the other insurance, whether primary, excess, contingent or on any other
basis that is Property insurance covering property of others damaged from the use of elevators.
18. SUPPLEMENTARY PAYMENTS
The section entitled SUPPLEMENTARY PAYMENTS—COVERAGES A AND B is amended as follows:
A. Paragraph 1.b.is amended to delete the$250 limit shown for the cost of bail bonds and replace it with a$5,000.
limit; and
B. Paragraph 1.d. is amended to delete the limit of $250 shown for daily loss of earnings and replace it with a
$1,000. limit.
19. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS
If the Named Insured unintentionally fails to disclose all existing hazards at the inception date of the Named
Insured's Coverage Part,the Insurer will not deny coverage under this Coverage Part because of such failure.
20. AIVER OF SUBROGATION-BLANKET
Ir N
VUnder CONDITIONS, the Transfer Of Rights Of Recovery Against Others To Us Condition is amended to add the
following:
The Insurer waives any right of recovery the Insurer may have against any person or organization because of
payments the Insurer makes for injury or damage arising out of:
1. the Named Insured's ongoing operations; or
2. your work included in the products-completed operations hazard.
However, this waiver applies only when the Named Insured has agreed in writing to waive such rights of recovery in
a written contract or written agreement, and only if such contract or agreement:
1. is in effector becomes effective during the term of this Coverage Part;and
2. was executed prior to the bodily Injury, property damage or personal and advertising Injury giving rise to the
claim.
All other terms and conditions of the Policy remain unchanged.
This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers,takes
effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below,
and expires concurrently with said Policy.
CNA74879XX(1-15) Policy No: 6043284498
Page 13 of 13 Endorsement No: 4
The Continental Insurance Co. Effective Data: 08/20/2017
Insured Name:LEXIPOL, LLC
Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office,Inc.,with Its permission.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF OUR RIGHT TO RECOVER FROM
OTHERS ENDORSEMENT - CALIFORNIA
Policy Number: 83 WEC BZ5646 Endorsement Number:
Effective Date: 06/20/17 Effective hour is the same as stated on the Information Page of the policy,
Named Insured and Address: LEXIPOL, LLC
16755 VON KARMAN AVE STE 250
IRVINE, CA 92606
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 2 % of the California workers' compensation
premium otherwise due on such remuneration.
SCHEDULE
Person or Organization Job Description
ANY PERSON OR ORGANIZATION ALL CALIFORNIA OPERATIONS
FROM WHOM YOU ARE REQUIRED BY
WRITTEN CONTRACT OR AGREEMENT
TO OBTAIN THIS WAIVER OF
RIGHTS FROM US.
V,✓ . ..
Countersigned by
Authorized Representative
Form WC 04 03 06 (1) Printed in U.S.A.
Process Date: 06/23/17 Policy Expiration Date: 08/20/18