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PROOF OF INSURANCE (2019) CLOSED 0 DATE(MMIDD/YYYY) A"�� CERTIFICATE OF LIABILITY INSURANCE 12/31/2018 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 NAME: Mary Strohman Kessler Alair Insurance Services, Inc PHONN Ext); (909)931-1500 FAX NO (909)932-2133 INQ�License # OA 91387 EMAIL ADIDRE$S:mstrohman@kessleralair.com 12487 N. Mainstreet, Ste. 240 INSURER(S)AFFORDING COVERAGE NAIC# Rancho Cucamonga CA 91739 INSURER A:Phi lade 1phia Insurance INSURED INSURER B: Revenue & Cost Specialists, LLC INSURER C: 1519 E. IN C Suite Ave.,Chapman SURER,D,: P � .. INSURER E Fullerton CA 92831-3623 INSURER F: COVERAGES CERTIFICATE NUMBER:2018-19 GL AUTO EX & PROF 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 INS TYPE OF INSURANCE ADbL'SUBR POLICY EFF POLICY EXP LTR IN,�Vn POLICY NUMBER (MMIDDIYYYY) IMMIDD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE X OCC:I-H ro)F�,''iuPhfi E�TrWs�@ o':r;iurr, $ 50,000 I��F*f,EMUVNSE.(,(,c:�aot;irrrerrwrsy X PHSD1308454 12/31/2018 12/31/2019 MED EXP(Any one person) _$ 10,000 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER (�I.::Nt�F�AI, Ac',r,RLc,Ar1. S 2,000,000 PR0_ 1,000,000 X POLICY .PECT LOC PRODUCTS-COMP/OPAGG ,S n I":a(aME AUTOMOBILE LIABILITY Ea m,rc�oerill, RMwfiuB S 1,000,000 'Iv�tGC',�ii�h�Y(„'t,E,u. �i A .. ANY AUTO DOIDII Y INJUI'Y(Por per=son) $ Al I OWNED SCHEDULED PHSD1308454 12/31/2018 12/31/2019 30011 Y INJURY(Ilei accident) S H RTED AUTOS X AUTOS ........X P. AUOTOSWNED ( Rr PROPERTY cid'w5rv)DAMAGE.... X UMBRELLA LAB X (DC,C{q2 EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB AGGREGATE $ 1,000,000 • L,I AIM;•:-NiAl71". DED X RETENTIONS 10,000 PHUB613140 12/31/2018 12/31/2019 $ WORKERS COMPENSATION ' STATUTE Ol'H- AND RS'LIABILITY EY1N TOR/PARTNER/EXECUTIVE E I I ACI I ACCIDENT ER E ANY PROPR E S OFFICER/MEMBER EXCLUDED? NIA "” (Mandatary in NH) EL DISEASE-EA EMPLOYEE "x If yes,describe under I: I'7Ir.;Fr6nF-POLICY Ilitll'1 DESCRIPTION OF OPERATIONS below rS A Professional Liability PHSD1308454 12/31/2018 12/31/2019 Liability Each Claim Incl Exp $1,000,000 Retro Date 04/27/1990 S2,500Ded-Annual Aggregate $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Additional Insured is City of E1 Segundo, it's officers, officials, employees and volunteers as per attached, PI-BP-001 (9-05) , CERTIFICATE HOLDER CANCELLATION pharada@elsegundo.org SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ATTN: Paricia Harada, City Clerks Office ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE Mary Strohman/MARY ©1988-2014 ACORD CORPORATION. All rights reserved„ ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) PI-BP-001 (9105) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESSOWNERS POLICY-ELITE ENHANCEMENT This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM It is understood and agreed that the following extensions only apply in the event that no other specific coverage for the indicated loss exposures are provided under this policy.If such specific coverage applies, the terms,conditions and limits of that coverage are the sole and exclusive coverage applicable under this policy. Throughout this endorsement the words"you"and"your"refer to the Named Insured shown in the Declarations. The words"we",'us'and"our'refer to the Company providing this insurance. Part 1:Property Coveraqe Enhancements. The following amendments are a part of the BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM: 1. Increased Glass Limits Section A.Coverage,item 4.b,is replaced by: b. With respect to glass(other than glass building blocks)that is part of the interior of a building or structure,or part of an outdoor sign,we will not pay more than$3,000 for the total of all loss or damage in any one occurrence. This Limitation does not apply to loss or damage by the"specified causes of loss".except vandalism. 2. Increased t=ire Department Service Charge Section A.Coverage,item 5.c.is replaced by: c. First Department Service Charge When the fire department is called to save or protect Covered Property from a Covered Cause of Loss,we will pay up to$3,000 for your liability for fire department service charges: (1)Assumed by contract or agreement prior to loss:or (2)Required by local ordinance. 3. Reduced Waiting Period and Longer Duration for Civil Authority Coverage Section A.Coverage,item 5.i_is replaced by, 1. Civil Authority We will pay for the actual loss of Business Income you sustain and necessary Extra Expense caused by action of civil authority that prohibits access to the described premises due to direct physical loss of or damage to property,other than at the described premises,caused by or resulting from any Covered Cause of loss. The coverage for Business Income wIN begin 48 hours after the time of that action and will apply for a period of up to three consecutive weeks after coverage begins. Page 1 of 5 Includes copyrighl material or the Insurance Services Omce,Inc used with Its pemUssion. PI-SP-001 (9105) The coverage for necessary Extra Expense will begin immediately after the time of that action and ends: (1) 5 consecutive weeks after the time of that action,or (2) When your Business Income coverage ends;whichever is later. The definitions of Business Income and Extra Expense contained in the Business Income and Extra Expense Additional Coverages also apply to this Civil Authority Additional Coverage. The Civil Authority Additional Coverage Is not subject to the Limits of Insurance. 4.Broadened Personal Property Coverage Section A.Coverage,item 1.b.,the first paragraph is replaced by: b. Personal Property located in or on the buildings at the described premises or in the open(or in a vehicle)within 1,250 feet of the described premises,including: S. Increased limits for Personal Property Off Premises Section A. Coverage, item 61.is replaced by: b. Personal Property Off Premises You may extend the insurance that applies to Business Personal Property to apply to covered Business Personal Property, other than "money" and "securities", "valuable papers and records"or accounts receivable white 4 is in the course of transit or temporarily at a premises you do not own, lease or operate. The most we will pay for loss or damage under this Extension is$10,000. 6. Increased limits for Outdoor Property Section A. Coverage,item 6.c, is replaced by; c. Outdoor Property You may extend the Insurance provided by this policy to apply to your outdoor fences,radio and television antennas(including satellite dishes),signs(other than signs attached to buildings),trees, shrubs and plants,including debris removal expense,caused by or resulting from any of the following causes of loss; (1) Fire; (2) Lightning; (3) Explosion; (4) Riot or Civil Commotion;or (5) Aircraft. The most we will pay for loss or damage under this Extension is$5,000,but not more than $1,000 for any one tree,shrub or plant. 7. Fire Extinguisher Recharge Section A. Coverage,item 6.Coverage Extensions will also include: You may extend the insurance provided by this coverage form to cover expenses you incur to recharge portable fire extinguishers,dry chemical,carbon dioxide,or liquid automatic fire extinguishing systems and the cost of resetting automatic fuel shut-off connections,if any of the above are discharged to fight a fire or are discharged due to a mechanical malfunction. The most we will pay for loss or damage under this extension is$3,000. Page 2 of 5 Includes copyright material or the InsLaatce Servi 01r=,Inc.used vrith It permisalon. PI-BP-001 (8105) No deductible shall apply to this coverage. 8. Business income Enhancement Section A.Coverage,item S.Additional Coverages,section f.Business Income is amended as follows: The reference to"GO days"as the limitation on payroll expenses is replaced by'365 days' 9. Lock Replacement Section A.Coverage,item 6.Coverage Extensions will also include: You may extend the insurance provided by this coverage form to cover necessary expense to repair to replace exterior or interior door locks of a covered building: a) If your door keys are stolen in a covered theft loss;or b) When your property is damaged and your door keys are stolen by the burglars. The most we will pay under this extension of$250 for any one occurrence. 10.Removal of Sewer Backup Exclusion Section B, Exclusions,item g(3)is amended to include: Backups of sewers will not be excluded, but the most we will pay for such losses is$500 in the policy period. Dart 2: Liabilitv Coveraoe Enhancements: The following amendments are a part of the BUSINESSOWNERS LIABILITY COVERAGE FORM: 1.Medical Payments If Medical Payments Coverage(Coverage A.2.)is not otherwise excluded from this Coverage Part= The Medical Expense Limit is changed subject to all the terms of Limits Of Insurance(Section D)to the greater of a. $10,000;or b. The Medical Expense Limit shown in the Declarations of this Coverage Part. 2.Supplementary Payments In the Supplementary Payments—(Coverage AAA): 1. The limit for the cost of bail bonds(item(2))is changed from$250 to$500;and 2. The limit for loss of earnings(item(a))is changed from$250 a day to$500 a day. 3. Blanket Additional Insureds Who is An Insured(Section C)is amended to include the following,but only for liability arising out of the negligence of the Named Insured: Each of the following is also an Insured: a. any Contractor,including contracting governmental entities,who hires you as their subcontractor, b. any person or organization who has an ownership interest in you: c. any lessor of leased equipment,who rents equipment to you,but only with respect to liability arising out of the maintenance,operation,or use by you,provided however that this Page 3 of 5 Includes copyright material of the Insurance Ser-Aces Office,Inc used wtlh Its permission. PI-BP-001 (9105) item c.will not apply to(1)any occurrence which takes place after the equipment lease expires;nr(2)'Bodily Injury"or"Property Damage'arising out of the negligence of the lessor or contractor engaged to operate the leased equipment;and d. any owner, mortgagor, lessor,landlord,condominium association or manager of a premises leased by you,but only for`occurrences'that take place while you occupy the premises,provided however that this item d.will not apply to structural alterations,new construction,or dernoHlion operations;and With regard to parties applicable under items a.through d,above,the Insurer and the Named Insured agree to waive rights of recovery,as provided within the policy. Nothing contained in this section C.shall serve to nullify matters excluded under section B.of the policy. 4. Bodily Injury-Mental Anguish The definition of'bodily injury'is changed to read: 'Bodily Injury': a. Means bodily injury, sickness or disease sustained by a person,and includes mental anguish resulting from any of these;and b. Except for mental anguish,includes death resulting from the foregoing(item a,above)at any time. 5. Uberalization If we revise this endorsement to provide more coverage without additional premium charge,we will automatically provide the additional coverage to all endorsement holders as of the day the revision is effective in your stale. 6. Employee Indemnification Defense Coverage Under SUPPLEMENTARY PAYMENTS—COVERAGES A.i.d.,the following is added: (A)We will pay on your behalf defense costs'incurred by an'employee"in a criminal proceeding, provided,however that you must have a prior written agreement with such"employee' whereby you agree to indemnify the*employee*for such defense costs,and the agreement includes a provision for repayment of defense costs in the event of an adverse judgment.The most we will pay for any"employee"who is alleged to be directly involved In a criminal proceeding is$2,500 regardless of the number of employees,claims or"suits"brought or persons or organizations making claims or bringing"suits." 7. Amendment of Aggregate Limit SECTION 0.4.—Aggregate Limits, item B is replaced by: b. All other injury or damage,including medical expenses,arising from all"occurrences"during the policy period is three times the Liability and Medical Expenses limit This limitation does not apply to"property damage"to premises while rented to you or temporarily occupied by you with permission of the owner,arising out of fire or explosion. 8. Amendment to Watercraft Exclusion Part B-Exclusions,hem g.(2)(a)is amended by the following: The phrase"less than 26 feet"is replaced by'less than 51 feet.* Page 4 of 5 Includes wpyright material or the Insurance Services Office,Inc.used with Its permission PI-BP-001 (9/05) Part 3:Amendment of Conditions: 1.Other provisions of the policy notwithstanding,this policy will be primary for all losses covered herein, and the existence of other insurance MR not serve to reduce our obligation. 2.You will have the righl to waive our rights of recovery prior to a loss with respect to any party.This must be done In writing to aged our rights. Page 6 of 5 Includes copyright matertsi of the Insurance Serwices office,Inc.usW YAM its pernission, CITY OF EL SEGUNDO WORKERS' COMPENSATION DECLARATION WARNING: FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL AND SUBJECTS AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN LABOR CODE § 3706, INTEREST, AND ATTORNEY'S FEES. I affirm under penalty of perjury under the laws of California one of the following declarations: (_) I have and will maintain a certificate of consent of self-insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Labor Code§3700 for the performance of the work set forth the agreement with the City of EI Segundo. Policy No. (J I have and will maintain workers'compensation insurance as required by Labor Code§3700 for the performance of the work for which the agreement with the City of EI Segundo is executed. My workers' compensation insurance carrier and policy number are: Carrier Policy Number Expiration Date Name of Agent Phone# (�, I certify that, in the performs ice t the work set forth in the agreement with the City of EI Segundo, I will not mploy any person in any ma reel so s to become subject to the workers' compensation laws of California, and agree that, if I should bec r suJec to the workers' compensation provisions of Labor Code § 3700 1 must immediately comply with t?a e prov sio s or the agreement will automatically become void. Signature of Applicant f'::: .:.. . .....- Date...... .. .....................:...... ..*..........._.__�. .� JIiPV Agreement for: " , 1 4— Dated: 1�0 Reviewed by; 1