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PROOF OF INSURANCE (2020 - 2020) CLOSED0 DATE (MM/DD/YYYY) AC<?R" CERTIFICATE OF LIABILITY INSURANCE 04/05/2019 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 IINSURED, 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 License# 0751768 CONTACT BOB HADZOR NAME: Robert Hadzor Insurance ServicesINC.E (925) 372-9000 X (925) 372-9003 _ PHONE E .t1° iAFAXC INoY; 3755 Alhambra Ave. Suite 7 AE-MAILDDbob@ hadzorinsurance.com : pp NAIC # Q Martinez, CA 94553 - INSURED E1 Segundo Nursery School P.O. Box 73 300 E. Pine Avenue. INSURER fs T+F'FORDI N G COVERAGE INSURER A:Nonlorofits Insurance Allance O INSURER B INSURER C Markel Insurance Company INSURER D: INSURER E: E1 Segundo CA 90245- INSURER F: I 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR "ADDU. SUYYR'' OF POLICY EFF POLICY EXP LIMITS LTR TYPE INSURANCE INJ, WVD POLICY NUMBER (MM/DWYYYY) (MM/DD/YYYY) ... ...,,, A ..Y GENERAL LIABILITY 2019 -20766 -NPO 09/01/201904/01/2020 EACH OCCURRENCE $ OC 1,000 000 X 4TOMMERCIALGENERALLIABILITY PREM EE�ENTEDnc Y $ 100,000 CLAIMS -MADE � OCCUR / / / / MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,0001 GENERAL AGGREGATE $ 3,000,000 / / / / I PRODUCTS - COMP/OPAGG $ 3,000,000 GEN'LAGGREGATE LIMIT APP'LI'ESPER: PRO '• X POLICY LOC / / / / LIQUOR LIAB $ 1,000,0001 .IFC A AUTOMOBILE LIABILITY 2019 -20766 -NPO 04/01/2019 04/01/2020 (j�`IMBMN'ED SINGLE LIMIT Ea ay:<;Pd'.,0 $ 1, 000 000 ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED / / / / I BODILY INJURY (Per accident) $ AUTOS X X AUTOS NON -OWNED / / / / PROPER" RlDAMAGE $ HIRED AUTOS AUTOS r .. / / / / $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESSLIABCLAIMS-MADE d / / / / AGGREGATE $ QED I p RETENTION$ C WORKERS COMPENSATION rmc0023766-0802/01/2019//02/01/2020 , y � 1WOC�Y I A ITR I IOFB .- ' AND EMPLOYERS' LIABILITY Y / N / / / / ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? � N / A / / / / (Mandatory in NH) E L DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under - DESCRIPTION OF OPERATIONS below / / / / DISEASE - POLICY LIMIT $ - 1,000,000 .,_...-. A PERSONAL PROPERTY 2019 -20766 -Prop 04/01/2019 I04/O1/2020 SPECIAL FORM RC 5,000 A D&O INSURANCE 2019-20766-NPO-D&O 04/01/2019 X04/01/2020 SPECIAL FORM RC 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of E1 Segundo its Officers, Officials, Directors, Employees and Voluteers to be named as additional insured and Also attached is the Waiver of Subrogation for Work Comp policy through Markel Insurance company. Re: Landlord of E1 Segundo Nursery School 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 E1 Segundo its Official and Employees c/o City Clerk AUTHORIZED REPRESENTATIVE 350 Main Street RM 5 E1 Segundo CA 90245-3813 �4 ACORD 25 (2010/05) ©1988. 610 ACORD COR ATI All rights reserved. INS025 (201005) 01 The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 20 11 01 96 INSURED: EL SEGUNDO NURSERY SCHOOL POLICY NUMBER: 2019 -20766 -NPO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES This endorsement modifies insurance provided under the following: City of El Segundo its Official and Employees C/O City Clerk 350 Main Street. RM 5 El Segundo, CA 90245-3813 ISSUED TO: City of El Segundo its Officers, Officials, Directors, Employees and Volunteers RE: Landlord of El Segundo Nursery School SCHEDULE (If no ent.Ty appears above, the information reclaaired to complete this endorsement will be shown in the Declarations as applicable to this cridorsenient.) WHO IS AN INSURED (Section Il) is amended to include as an insured the person or organization shown in the Schedule but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises leased to you and shown in the Schedule and subject to the following additional exclusions: This insurance does not apply to: 1. Any "occurrence" which takes place after you cease to be a tenant in that preirdses. 2. Structural alterations, new constroction or demolition operations performed by or on behalf of the person or organization shown in the Schedule. CG 20 11 01 96 Copyright, Insurance Services Office, Inc., 1994 Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT -CALIFORNIA WC 04 03 06 (Ed. 04-84) 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 5 % of the California workers' compensation premium otherwise due on such remuneration. Work performed by EL SEGUNDO CO-OP NURSERY SCHOOL(NONPROFIT) at: PO Box 73 EI Segundo, CA 90245-0073 Schedule Subrogant Information Class Code Description City of EI Segundo its officials & Employees c/o City Clerk 8868 Colleges/Schools&#8211;private&#8211;professionals 350 Main Street Room 5 EI Segundo, CA 90245 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 02/01/2019 Policy No. MWC0023768-08 Insured: EL SEGUNDO CO-OP NURSERY SCHOOL(NONPROFIT) Insurance Company: Markel Insurance Company Countersigned by. WC04 (Ed. 04-84) m 1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB's California Workers' Compensation Insurance Forms Manual O 2001 18 of 32 Endorsement No. Premiun See Attached) �C� Payroll $0.00