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PROOF OF INSURANCE (2019) CLOSED Ate" CERTIFICATE I I DATE`MM`2018 ' �Mrr.�^' 08116/2018 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 Tina Cowie NAME Cornerstone Specialty Insurance Services,Inc PHONE Ex'r) (/1"`I'/ /'1 "1)0 I FAXWC,Not (7 14)7`�1 `/`0 JAIC, _...... 14252 Culver Drive,A299 E4aAlu• Tina@cornerstonespecialty corn ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Irvine CA 92604 INSURERA: RLI Insurance Company INSURED INSURER B: Arch Insurance Company J C.CHANG&ASSOCIATES,INC INSURER 385 Van Ness Avenue,Ste 208 INSURER D INSURER E Torrance CA 90501 INSURER F COVERAGES CERTIFICATE NUMBER: 18/19 COVERAGES 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 &T5139'W"aU1nTR' PM Lt's" V YFF POLICY YY S LTR TYPE OF INSURANCE IVSD !3 POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) LIMITS '"" COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE g 2,000,000 ;l r,IVlfr,f•tlral.-i.... OCCUR 1 't'1,,�ETI`Sh"41I,i-, 1 000 000 MAUL 71.��Rrl;t;:.;(Ee rtt:rurrr:,irr,:) s X ADDT'L INSURED/PRIMARY I s 10,000 MED EXP(Any ane person- 5 A BLNKT WVR OF SUBRO Y PSB0001179 08/16/2018 08/16/2019 PERSONAL&ADV INJURY s INCLUDED r,'r'IW'I.A',ClGRl C',R\I I. 1...111f111 Al'I'I 1Fk,I"rli GEPJERALAGGREGATE g 4,000,000 t'RO• 4,000,000 ��,d' ._._..... "OI.IC'Y .._'"""""'I JEL,T El PC„M!iU f: aµ./OPAGG 5 ._..•••• S-COMP C711il:li' w w .................._. .............................._. .. Ea ace CrpP AUTOMOBILE LIABILITY r;tiN'I`d7;^"F'.q..ICd�l t' s 1,000,000 _ _LF. ..�_.. ....._._.......... � ANY/,uru BODILY INJURY(Per person) s A CANNFD :I II ILII FID PSA0001762 08/16/2018 08/16/2019 I.371511...w'IttJ,.IUr'"'(I'a:rrccidrnip 5 AI-!ros CINI Y AIJ E"�f3 . iflRr Y7 N OWN:D E5TQ'z.,IRfM DAMAGE S Pd.r'ri y;;C)NIY .....-... adJ"rG);3(JNI. ................ ...................._......... _.._.._.......�vlU nei l nsureti dlR RENCE ..,000 ............................ occuR EACHoccu/Underinsured s; 1,000,005 .. 1 . 000 UMBRELLA LIAR �. v A X EXCESS LIAB CLAIMS-MADE PSE0001604 08/16/2018 08/16/2019 At✓GIM GA'rP s 1,000,000 ......... , 0 s AND PROPRIETOR/PARTNER/EXECUTIVE �/ PER C71 1-I C�WORKERS COMPENSATION 1 STATUTE I 1 ER LITY Y/N I I'"I FA lI AC'C:IDI..:Nr 5 1,000,000 A OFFICER/MEMBER EXCLUDED? NIA PSW0002101 08/16/2018 08/16/2019 ••••••••••••••--••---••-•--- - (Mandatory in NH) EL DISEASE-EA EMPLOYEE S 1,000,000 If yes,describe under _. 1 000,000 DESCRIPTION OF OPERATIONS below F I ni,,,,l Asi..:-I'o.ICY LIhAdT s ° Each Claim $3,000,000 Professional Liability B Claims Made PAAEP0029001 08/16/2018 08/16/2019 Annual Aggregate $3,000,000 _._._ ........__-._....M....... ... DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of EI Segundo,its officials,and employees are Additional Insured for General Liability but only if required by written contract with the Named Insured prior to an occurrence and as per attached endorsement Coverage is subject to all policy terms and conditions '30 days notice of cancellation,except for 10 days notice for non-payment of premium For Professional Liability coverage,the aggregate limit is the total insurance available for all covered claims reported within the policy period 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-Public Works ACCORDANCE WITH THE POLICY PROVISIONS. Attn:John Gilmour AUTHORIZED REPRESENTATIVE 350 Main Street EI Segundo CA 90245 I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD Policy Number: PSB0001179 RLI Insurance Company Named Insured: J.C. Chang &Associates, Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. RLIPack° FOR PROFESSIONALS BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM- SECTION II—LIABILITY 1. C. WHO IS AN INSURED is amended to include as additional insured under this policy must apply on a an additional insured any person or organization that primary basis, or a primary and non-contributory you agree in a contract or agreement requiring basis,this insurance is primary to other insurance that insurance to include as an additional insured on this is available to such additional insured which covers policy, but only with respect to liability for "bodily such additional insured as a named insured, and we injury", "property damage" or "personal and will not share with that other insurance, provided that: advertising injury" caused in whole or in part by you a. The "bodily injury" or "property damage" for or those acting on your behalf: which coverage is sought occurs after you have a. In the performance of your ongoing operations; entered into that contract or agreement;or b. In connection with premises owned by or rented b. The "personal and advertising injury" for which to you; or coverage is sought arises out of an offense c. In connection with "your work" and included committed after you have entered into that within the "product-completed operations contract or agreement. hazard". 4. The following is added to SECTION III K. 2. 2. The insurance provided to the additional insured by Transfer of Rights of Recovery Against Others to this endorsement is limited as follows: Us — COMMON POLICY CONDITIONS (BUT APPLICABLE TO ONLY TO SECTION II — a. This insurance does not apply on any basis to LIABILITY) any person or organization for which coverage We waive any rights of recovery we may have against as an additional insured specifically is added by any person or organization because of payments we another endorsement to this policy. make for "bodily injury", "property damage" or b. This insurance does not apply to the rendering "personal and advertising injury" arising out of "your of or failure to render any "professional work" performed by you, or on your behalf, under a services". contract or agreement with that person or organization. We waive these rights only where you c. This endorsement does not increase any of the have agreed to do so as part of a contract or limits of insurance stated in D. Liability And agreement with such person or organization entered Medical Expenses Limits of Insurance. into by you before the "bodily injury" or "property 3. The following is added to SECTION III H.2. Other damage" occurs, or the "personal and advertising Insurance — COMMON POLICY CONDITIONS injury" offense is committed. (BUT APPLICABLE ONLY TO SECTION II — LIABILITY) However, if you specifically agree in a contract or agreement that the insurance provided to an ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. PPB 304 02 12 Page 1 of 1 Policy Number: PSA0001762 PPA 300 03 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided un the following: BUSINESS AUTO COVERAGE FORM I. Blanket Additional Insured II. Blanket Waiver Of Subrogation The following is added to the SECTION II— The following is added to the SECTION IV— COVERED AUTOS LIABILITY COVERAGE, BUSINESS AUTO CONDITIONS, A. Loss Paragraph A.1.Who Is An Insured Provision: Conditions, 5. Transfer Of Rights Of Recovery Against Others To Us: Any person or organization that you are required to include as an additional insured We waive any right of recovery we may on this coverage form in a contract or have against any person or organization to agreement that is executed by you before the the extent required of you by a contract "bodily injury" or"property damage" occurs is executed prior to any"accident" or"loss", an "insured"for liability coverage, but only for provided that the"accident" or"loss" arises damages to which this insurance applies and out of the operations contemplated by such only to the extent that person or organization contract. The waiver applies only to the qualifies as an"insured" under the Who Is An person or organization designated in such Insured provision contained in SECTION II — contract. COVERED AUTOS LIABILITY COVERAGE. The insurance provided to the additional insured will be on a primary and non- contributory basis to the additional insured's own business auto coverage if you are required to do so in a contract or agreement that is executed by you before the "bodily injury" or"property damage" occurs. PPA 300 03 13 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_—%of the California workers'compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description All persons or organizations that are party to a Job performed for any person or organization that you contract that requires you to obtain this have agreed with in a written contract to provide this agreement,provided you executed the contract agreement. before a loss 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 08-16-2018 Policy No. PSW0002101 Endorsement No. Insured J.C.Chang&Associates,Inc. Insurance Company RLI Insurance Company