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PROOF OF INSURANCE (2019) CLOSED 0 I DATE(MMIDDIYYYY) ACCOR" CERTIFICATE OF LIABILITY INSURANCE 41V � 11/09/201e 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 Richard Pedevillano 9VAME HON (626).96.7 9581... .. ... Parties Insurance Associates, Inc. I AtlC,No Q62 PHONE, 7_ l IAX ) P.O. Box r4155 ance Brokers, Inc. EMAIL SSpi certifioatest�pkinsnrance.co 1s4„_. 6) 967- Covina CA 91723 INSURER(S)AFFORDING COVERAGE m N AIC# SURERA:Ohio Security ,Insurance Co. 34082 INSURED (7140 879-S666IN' ......... �' ..................... ........66 HDL Coren & Cone ire 120 S. State College Blvd. INSURER C:Twin1Citycan Fcasualty Fire Insurance Co, 29459 ......... Suite #200 INSURER Di Brea, CA 92821 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:cert ID 4158 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. POLIIS.R.......................... ......................, ! ---L' YLTR TYPE OF INSURANCE MSD WVD POLICY NUMBER (MMADYYMMODPYYYt LIMITS S. .......,. .....� A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE �,$ 2,000,000 CLAIMS-MADE X OCCUR Y BZS56380327 11/15/2018 11/15/2019AM�"�,+a"I"I"OE�"L(^kIL I . ..... . PRCfAI"rS(Fa(Icurq;nc ) .`$ 2,000.000 MED E(P(Any one person) $ -�--- ...... .......... PERSONALBADV ^ INJURY $ Included GEN'L.AGGREGATE LIMITAPPLIESPER: GENERAL AGGREGATE $ 4,000,000 OI PRO- ❑LOC PRODUCTS-COMP/OP AGG 4,000,00-0---, www.. C,CYMBUINE.O SflNi(.r8.(.LN�,tlN)' $mm PJECT OTHER �IECRY _ AUTOMOBILE LIABILITY _(f:a)lq_14.S:(!'I)....................................... .�_.1t .00.(.... .� ANY AUTO BAS(19)56380327 11/15/201811/15/2019 BODILY INJURY(Per person) $ X.. _ OWNED ILI.^_.._._... SCHEDULED BODILY Df Pitro"'f C7R�YM(Per .. AUTOS ONLY AUTOS HIRED AUTOS ONLY XAUUTOS ONLY ... $ .......................................�......... $ -- ............. L..........�CLAIMS-MADE' AGGREGATE REN ..............,.._$ 1,1 000 ..'.� OO..0....... 00 0 B X UMBRELLA LABIAB X USA(19)56380327 11/15/2018 11/15/2019 Q E DED I X RETENTION$ 10,000 Prod-Comp Coos $ l'000'000 ,000,000 A OFF NIA RPARTN IE ECUTIVE YIN NIA Y XWS(19)56380327 11/15/201811/15/2019„EL,,,ACHA ACCIDENT �$ 1,000,000 WORKERS COMPENSATION ANYPRO AND EMPLOYERS'LIABILITY AEMP. 110001000 Fes, L............. Mandato m NH E L.DISEASE-„E„ ...1........ If yes,describe under qq DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT IJ$ 1,000,000 _ 0 C Professional Liability 72PGO260349 11/15/2018 11/15/2019 Each Claim 6. 1,000,000 Aggregate $ 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of El Segundo, its officers, officials, and employees and volunteers are named Additional Insured per End. attached with regard General Liability policy. With regard to Workers' Compensation policy, Waiver of Subrogation End. is attached. 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 El Segundo 350 Main St AUTHORIZED REPRESENTATIVE .1 Segundo CA 90245 I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Page 1 of 1 � POLICY NUMBER: BUS|NES8OVVNERS BPV44g0713 | THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. � A����������� U��������� - DESIGNATED ��������� [ ADDITIONAL ^ � | OR ORGANIZATION This endorsement modifies Insurance provided under the following: � | BUB|NESSOWNERG COVERAGE FORM | SCHEDULE / N Name Of Additional Insured Person(s) Or Orgombzation(s), / Blanket ' | 1340 Valley Vista Road, Suite 2$0 / � 8 | DIAMOND BAR, Cu 91765 | Information required to complete this Schedule, If not shown above, will be shown in the Oen|omU000. � | Section || ~ UobO|ty Is amended as follows: B. With respect to the insurance afforded to � Q A. The following is added to Paragraph C. Who these additional insureds, the following is | Is An Insured: added (o Paragraph D. ���b�b�� And 00e���m} oun* / ' � 3' Any person(s) or organization(s) shown Expenses Unita Of Insurance: ' � in the 8nhenu|a is also an additional If coverage provided to the additional in- insured, but only with respect to UubU' sunsd is required by a contract or og/e* | |b/ for "bodily injury''. "property dam- ment, the most we will pay on behalf of the mQm" or "personal and advertising in' additional insured is the amount of insur- ju/y" caused, in whole or in par. by ance'' your eoba or omissions o, the acts or 1' Required by the contract or agreement; ' | omissions of those ooUnQ on your be- or / / half in the performance of your ongoing 2. Available under the applicable Umba Of ' operations or in connection with you, |nauomcu shown in the Declarations; | premises owned by or rented to you, whichever is |pwn. � 0 However: This endorsement mho|| not increase the ap' | � m. The Insurance afforded to such ad- p|icob(e Limits Of Insurance shown in the d|U000{ insured only applies to the Declarations. extent permitted by |ow| and � b. If coverage provided to the odd!- i tiuna) insured is required by a con- tract or agreement, the Insurance afforded to such additional Insured will not he broader than that which you are required by the oprdroot or agreement to provide for such addi- tional insured, | EPQ44807 13 «Nnounanon Swnd*mo Offioa. Inc., 2012 Page 1mf I WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 79 (Ed. 01-13) 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 en- gaged In the work described in the Schedule. The additional premium for this endorsement is$ Schedule Person or Organization Job Description 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 Endorsement No, 0008 Policy Effective 1111512018 Premium State Policy No. XWS (19) 56 38 03 27 Insured HOL GOREN& CONE Insurance Company Ohio Security Insurance Company 19291 Countersigned by WC 99 06 79 (Ed. 01-13) 0 2013 Liberty Mutual insurance Includes copyrtghted material of WCIRBwith its permission.