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PROOF OF INSURANCE (2019 - 2019) CLOSED ADMIINC-C1 MPEREZ M- CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY)18 10/09/20 ............................................................ .............. 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 cerci...........'a'"....................................... ficate 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 AgFP�i .S.a 6 799- 000 pvc„No):(626)441-3233 3475 E.Foothill Blvd.,Suite 100 Bolton&Com an onco.com Pasadena,CA 91107 i E-MAIL Ext):Pr(o c s4alt bolt FAx INSURERS)„AFFORDING,COVERAGE NAIC# INSURER A:Sentinel Insurance Co. 11000 INSURED INSURERB:Twin City Fire Insurance Co 29459 AdminSure,Inc. INSURER C:Evanston Insurance Companv 35378 3380 Shelby Street INSURER D;United States Fire Insurance Co. Ontario,CA 91764 INSURER.. ..................................................................... ......................_.......... 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, .....................OWN MAY REDUCED BY PAID CLAIMS. IIII-S EXCLUSIONS TYPE OF INSURANCE ADDLSUBRICONDITIONS OF SUCH POLICIES.LIMITSSH......LICYNUMB........... ,,..... X COMMERCIAL GENERAL LIABILITY lN9D a D POL E "^_..LMS IF2A(.XEFF POLICY EXP LU ION AND A ................ .. R � _/ I.,i(. D/YYYYa LIMITS EACH OCCURRENCE $ 1,000,000 V CLAIMS-MADE .X.. OCCUR X 72SBAUV7737 10/05/2018 10/05/2019 PREMDAME DAMAG E TO RENTED 1,000,000 .«S,IFS 4?G?,/arq�+ce,), .$ MED EXP(Any one.person) ........ 10,000 PERSONAL&ADV INJURY $ 1,000,000 _t",SEN'LAGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000 POLICY -1 JECT � LOC PRODUCTS-COMP/OP AGG $ PRO- 2,000,000............ OTHER _w_.......................................................... $ ..........- A AUTOMOBILE LIABILITY COMBINEDSINGLELIMIT $ 1,000,000 ANY AUTO 72SBAUV7737 10/05/2018 10/05/2019 BODI1LY,INJURY,(Per„person) $ OWNHED AUTOS ONLY AUTOSULED BODI,I Y IN,JU,RY(Per accident) „$ X. HIRED X NON-OWNED .. ........................ .. AUTOS ONLY AUTOS ONLYPPOa PROPERTY l DAMAGE $ $ A UMBRELLA LIAB occuR '72SBAUV7737 10/05/2018 10/05/2019^^..AENCE $ 4,000,000 EXCESS LIAR CLA CC JRR IMS-MAD q AGGREGATE GATE $ ,000,000 A O E DED II X V RETENTION$ 1 .. 0,000 ....._..................... ............. . B WORKERS COMPENSATION _X ( PE�R,T�ITE J OTR,H- __ ANY PROPRIETOR/PARTNER/EXECUTIVE Y.- AND EMPLOYERS'LIABILITY ' I- E L EACH ACCIDENT $ N 72WECNG7400 01/01/2018 01/01/2019 1000,000 ” OFFICER/MEMBER EXCLUDED? _ l N/A 1,000, 000 If yes.describe e cr1,000,000 ON OF OPERATIONS below _ F L DISEASE POLICY $ (X^XMIT OYkk $ _ - ....... • C Errors&Omissions �E0873202 10/05/2018 10/05/2019 Ded.$25K 5,000,000 D Crime 6260367978 10/13/2018 10/13/2019 Ded.$10,000 2,000,000 ................................ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Cyber Liability-Policy#ESH02626480-7/112018-7/1/2019-Limits:$1,000,00'0-Ded:$5,000 Re:Operations of the Named Insured. General Liability Blanket Additional Insured per SS00080405 attached,only if required by written contractlagreement. Additional Insured:City of EI Segundo CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ci Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of EI 9 ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street EI Segundo„CA 90245 _................. _._.AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD BUSINESS LIABILITY COVERAGE FORM (b) Rented to, in the care, custody or b. Coverage under this provision does not control of, or over which physical apply to: control is being exercised for any (1) "Bodily injury" or "property damage" purpose by you, any of your that occurred;or "employees", "volunteer workers", any partner or member (if you are (2) "Personal and advertising injury" a partnership or joint venture), or arising out of an offense committed any member (if you are a limited before you acquired or formed the liability company). organization. b. Real Estate Manager 4. Operator Of Mobile Equipment Any person (other than your"employee"or With respect to "mobile equipment" registered in "volunteer worker"), or any organization your name under any motor vehicle registration while acting as your real estate manager. law, any person is an insured while driving such c. Temporary Custodians Of Your equipment along a public highway with your Property permission. Any other person or organization responsible for the conduct of such person is Any person or organization having proper also an insured, but only with respect to liability temporary custody of your property if you arising out of the operation of the equipment, and die, but only: only if no other insurance of any kind is available (1) With respect to liability arising out of the to that person or organization for this liability. maintenance or use of that property;and However, no person or organization is an insured (2) Until your legal representative has with respect to: been appointed. a. "Bodily injury" to a co-"employee" of the d. Legal Representative If You Die person driving the equipment; or Your legal representative if you die, but b. "Property damage" to property owned by, only with respect to duties as such. That rented to, in the charge of or occupied by representative will have all your rights and you or the employer of any person who is duties under this insurance. an insured under this provision. e. Unnamed Subsidiary 5. Operator of Nonowned Watercraft Any subsidiary and subsidiary thereof, of With respect to watercraft you do not own that yours which is a legally incorporated entity is less than 51 feet long and is not being used of which you own a financial interest of to carry persons for a charge, any person is an more than 50% of the voting stock on the insured while operating such watercraft with effective date of this Coverage Part. your permission. Any other person or The insurance afforded herein for any organization responsible for the conduct of subsidiary not shown in the Declarations such person is also an insured, but only with as a named insured does not apply to respect to liability arising out of the operation injury or damage with respect to which an of the watercraft, and only if no other insured under this insurance is also an insurance of any kind is available to that insured under another policy or would be person or organization for this liability. an insured under such policy but for its However, no person or organization is an termination or upon the exhaustion of its insured with respect to: limits of insurance. a. "Bodily injury" to a co-"employee" of the 3. Newly Acquired Or Formed Organization person operating the watercraft;or Any organization you newly acquire or form, b. "Property damage" to property owned by, other than a partnership, joint venture or rented to, in the charge of or occupied by limited liability company, and over which you you or the employer of any person who is maintain financial interest of more than 50% of an insured under this provision. the voting stock, will qualify as a Named 6. Additional Insureds When Required By Insured if there is no other similar insurance Written Contract, Written Agreement Or available to that organization. However: Permit a. Coverage under this provision is afforded The person(s) or organization(s) identified in only until the 180th day after you acquire Paragraphs a. through f. below are additional or form the organization or the end of the insureds when you have agreed, in a written policy period, whichever is earlier; and Form SS 00 08 04 05 Page 11 of 24 BUSINESS LIABILITY COVERAGE FORM contract, written agreement or because of a (e) Any failure to make such permit issued by a state or political inspections, adjustments, tests or subdivision, that such person or organization servicing as the vendor has be added as an additional insured on your agreed to make or normally policy, provided the injury or damage occurs undertakes to make in the usual subsequent to the execution of the contract or course of business, in connection agreement, or the issuance of the permit. with the distribution or sale of the A person or organization is an additional products; insured under this provision only for that (f) Demonstration, installation, period of time required by the contract, servicing or repair operations, agreement or permit. except such operations performed However, no such person or organization is an at the vendor's premises in connection with the sale of the additional insured under this provision if such product; person or organization is included as an additional insured by an endorsement issued (9) Products which, after distribution by us and made a part of this Coverage Part, or sale you, have been labeled including all persons or organizations added or relabeled used a as additional insureds under the specific container, part orr ingredient oof f any other thing or substance by or for additional insured coverage grants in Section F.—Optional Additional Insured Coverages. the vendor; or a. Vendors (h) "Bodily injury" or "property Any person(s) or organization(s) (referred to damage" arising out of the sole negligence of the vendor for its below as vendor), but only with respect to own acts or omissions or those of "bodily injury' or "property damage" arising its employees or anyone else out of"your products" which are distributed acting on its behalf. However,this or sold in the regular course of the vendor's exclusion does not apply to: business and only if this Coverage Part provides coverage for "bodily injury" or (i) The exceptions contained in "property damage" included within the Subparagraphs (d)or(f); or "products-completed operations hazard". (ii) Such inspections, adjustments, (1) The insurance afforded to the vendor tests or servicing as the vendor is subject to the following additional has agreed to make or normally exclusions: undertakes to make in the usual course of business, in This insurance does not apply to: connection with the distribution (a) "Bodily injury" or "property or sale of the products. damage" for which the vendor is (2) This insurance does not apply to any obligated to pay damages by insured person or organization from .reason .of the assumption of whom you have acquired such products, liability in a contract or agreement. or any ingredient, part or container, This exclusion does not apply to entering into, accompanying or liability for damages that the containing such products. vendor would have in the absence of the contract or agreement; b. Lessors Of Equipment (b) Any express warranty (1) Any person or organization from unauthorized by you; whom you lease equipment; but only with respect to their liability for bodily (c) Any physical or chemical change injury", "property damage" or in the product made intentionally 'personal and advertising injury" by the vendor; caused, in whole or in part, by your (d) Repackaging, except when maintenance, operation or use of unpacked solely for the purpose of equipment leased to you by such inspection, demonstration, testing, person or organization. or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; Page 12 of 24 Form SS 00 08 04 05