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PROOF OF INSURANCE (2020 - 2020) CLOSEDDATE (MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 1 3/27/2019 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 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 P�, CONTACT Bolton &Cord an...MA,ME:.......................................................................................................................................................HONEMM......_w 3475' E.. Foothill Bvd., Suite 100 M rt) ....................__. 799'-7000 IC.No1; (626) L3-1„1 Pasadena, CA 91107 ADDRESS: www.boltonco.com 0008309 INSURED Atkinson, Andelson, Loya, Ruud & Romo 12300 Center Court Drive #300 Cerritos CA 90703 INSURERS AFFORDING COVERAGE NAIL# INSURER A : Vi pant Insurance Com an 20397 INSURER B: Federal Insurance Company 20281 INSURER C : INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 47756464 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE IN POLICY, NUMBER fMMI'DONYYY) IMMIIDDrYYYY'y LIMITS F,COMMERCIALGENERALLIABILITY / 35344557 14/1/2019 4/1/2020 EACH OCCURRENCE $1,000000 1__^^ ,"prA""ut: _._ CLAIMS -MADE OCCUR „PREMISES„(EaoccunanPe)_ $1,000,000 ...........1 1.............................I..........................................................................................................- GE ryN'L AGGREGATE LIMIT APPLIES PER: POLICY ( ( JECT LJ_✓_� LOC N OTHER B AUTOMOBILE LIABILITY 73508514 ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED _ NON -OWNED AUTOS ONLY ' „. AUTOS ONLY B / UMBRELLA LIAB y ,/ OCCUR EXCESS LIAB CLAIMS -MADE DED I U RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANYPROPRI ETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? � N NIA (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below 79757104 MED EXP (Any one person) ......................................................_...._._..�..._._�-..................................................... $10,000.... PERSONAL & ADV INJURY $1 ,000,000 .u.w._—__._..__,._w..........._w__....................... GENERALAGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $Included 4/1/2019 4/1/2020 COMB'INEDSINGLE LIMIT ' _LEa aLdde,ntl $ 1.000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ I'Per accldenl) 4/1/2019 4/1/2020 EACH OCCURRENCE $15,000,000 AGGREGATE $15.000.000 R OT - 71732870 4/1/2019 4/1/2020✓....I..S,TATUTE....L...........LERH................................................................................... E L EACH ACCIDENT $1,000,000 DISEASE - EA EMPLOYEE ..$..,1,,O E L, DISEASE - POLICY LIMIT $1.000,000 U I , DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Client No. 0845 The firm does not own any autos and auto liability applies to hired and non -owned autos only. Additional Insured, The City of EI Segundo, its elected or appointed officers, officials, emptoyees and volunteers Additional Insured(s) named additional insured respecting general liability per the attached form 80-02-2367 (Rev. 5-07) CERTIFICATE HOLDER CANCELLATION Client No. 0845 Clt Clerk, CNt of EI Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Y g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 35 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo CA 90245 AUTHORIZED REPRESENTATIVE I, William A. Lewis ©1988-2015 ACORD CORPORATION. All rights reserved, ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 47756464 1 AALRR 119-20 Master Certificate Matthew Nobriga 13/27/2019 11:27:45 AM (PDT) I Page 1 of 4 C H U B Bm Liability Insurance Endorsement Policy Period Effective Date Policy Number Insured Name of Company Date Issued This Endorsement applies to the following forms: GENERAL LIABILITY Who Is An Insured Additional Insured - Scheduled Person Or Organization Liability Insurance Form 80-02-2367 (Rev. 5-07) 04/01/2019 3534-45-57 WUC ATKINSON ANDELSON LOYA RUUD & ROMO VIGILANT INSURANCE COMPANY Under Who Is An Insured, the following provision is added. Persons or organizations shown in the Schedule are insureds; but they are insureds only if you are obligated pursuant to a contract or agreement to provide them with such insurance as is afforded by this policy. However, the person or organization is an insured only: • if and then only to the extent the person or organization is described in the Schedule; • to the extent such contractor agreement requires the person or organization to be afforded status as an insured; • for activities that did not occur, in whole or in part, before the execution of the contract or agreement; and • with respect to damages, loss, cost or expense for injury or damage to which this insurance applies. No person or organization is an insured under this provision: • that is more specifically identified under any other provision of the Who Is An Insured section (regardless of any 'limitation applicable thereto). • with respect to any assumption of liability (of another person or organization) by them in a contract or agreement. This limitation does not apply to the liability for damages, loss, cost or expense for injury or damage, to which this insurance applies, that the person or organization would have in the absence of such contractor agreement. Additional Insured - Scheduled Person Or Organization Endorsement 47756454 1 AALRR 1 19-20 Master Certificate P Matthew Nobriga 1 3/27/2019 11:27;45 AM (PDT) I Page 2 of 4 continued Page 1 CHUsBm Liability Endorsement (continued) Under Conditions, the following provision is added to the condition titled Other Insurance. Conditions Other Insurance — If you are obligated, pursuant to a contractor agreement, to provide the person or organization Primary, Noncontributory shown in the Schedule with primary insurance such as is afforded by this policy, then in such case Insurance — Scheduled this insurance is primary and we will not seek contribution from insurance available to such person Person Or Organization or organization. Schedule PERSONS OR ORGANIZATIONS THAT YOU ARE OBLIGATED, PURSUANT TO WRITTEN CONTRACT OR AGREEMENT BETWEEN YOU AND SUCH PERSON OR ORGANIZATION, TO PROVIDE WITH SUCH INSURANCE AS IS AFFORDED BY THIS POLICY; BUT THEY ARE "INSUREDS" ONLY IF AND TO THE MINIMUM EXTENT THAT SUCH CONTRACT OR AGREEMENT REQUIRES THE PERSON OR ORGANIZATION TO BE AFFORDED STATUS AS AN "INSURED". HOWEVER, NO PERSON OR ORGANIZA"I"ION IS AN "INSURED" UNDER THIS PROVISION WHO IS MORE SPECIFICALLY DESCRIBED UNDER ANY OTHER PROVISION OF THE WHO IS AN INSURED SECTION OF THIS POLICY (REGARDLESS OF ANY LD IITATION APPLICABLE THERETO). All other terms and conditions remain unchanged. Authorized Representative Liability Insurance Additional Insured - Scheduled Parson Or Organization Form 80-02-2387 (Rev. 5-07) Endorsement 47756464 1 AALRR 1 19-20 Master Certificate I Matthew Nobriga 1 3(27/2019 11:27:45 AM (PDT) I Page 3 of 4 /astpage Page 2 WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WC 99 03 04 (Ed. 7-08) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy.) This endorsement, effective on 04/01/2019 at 12:01 A. M. standard time, forms a part of (DATE) Policy No. 71732870 of the Federal Insurance Company (NAME OF INSURANCE COMPANY) Issued to Atkinson, Andelson, Loya, Ruud & Romo Endorsement No. Authorized Representative 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. The additional premium for the blanket waiver offered by this endorsement shall be 1.00% of total California premium. Schedule Person or Organization BLANKET WAIVER - ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER WC 99 03 04 (Ed. 7-08) Job Description ALL CALIFORNIA OPERATIONS 47756464 1 AALRFI I L4 20 Master Cert i elcate I Mat Lhew Nobviga 1 3/27/2014 1!:27:45 ANN (PDT) I Page 4 of 4 N 261111�294111V (MMIDDIYY DATE YY) CERTIFICATE OF LIABILITY INSURANCE Y 08/07/2019 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 N REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. p IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED„ subject to r4 the terns 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 endo'rsemeni PRODUCER 1^847-335-6'800 CONNA ECT Rob Herchert cc Integro Insurance Brokers PHONE ......................_..........m..... 847-385-6800 P,I. 9 Nar.Exd1; (APC,.N.'..)............................ ... �..... 111 West Campbell PSOCerts@lemme.com A ,G_RSB; 4th Floor Arlington Heights, IL 60005 .. ... .. ......•,,,,.,., ._IrU,,S,,,!UCt C, S1AF'FORDING COVERAGE ..,,,,,.. NAIC,# INSURERA; Scottsdale Ins Co and various insurers ........m .. .. .. .... ..... ... ......... ......, ._.. �. ...... ._._._ ...�. __'__ .....,.._. INSURED INSURER B ....................................................................................................................................................... Atkinson, Andelson, Loya, Ruud & Romo, PC INSURERC: 12800 Center Court Drive INSURER D: Suite 300 Cerritos, CA 90703 INSURER E; INSURER F: COVERAGES CERTIFICATE NUMBER: 56913493 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 ADDL BURR' POLICY EFF PO'LIC'Y EXP LTR TYPE OF INSURANCE INSR WVn POLICY NUMBER I'MMVDDIYYYYYI (MM/DDi1fYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ ....�. COMMERCIAL GENERAL L..............�.�............�.....mm......�.. IASULITY EgFr�o...._....$ ........ CLAIMS -MADE... .... ..... m OCCUR MED EXP (Anyone ..................m..,..............,,........,..........�...P,E,R,S,O,N,AL....&,,,,A,DV,,,,I„NJ,URV......w..�...�.�,..................m..................... ____ _____- ..GENERAL,AGGREGAT,E.............m.,.$....................,_...-........................... GEN"L AGGREGATE "6ry LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ ... PFO POLICY V I. LOC $ AUTOMOBILE LIABILITY COMBINEDSIN (LE LIMIT n BODILYdINJURY Per pelso Ipl $ ANY AUTO i $ ALL OWNED SCHEDULED BOD u Per accident) $ AUTOS AUTOS ............... ...................,.... PROPERTYDAMAGE CRY.(. G HIRED AUTOS AUTOS dP...... ...........................)...ww.....w_.................................................... F.NON-OWNED .PY -� UMBRELLA LIAB OCCUROC ...................... I . EXCESS LIAB CLAIMS -MADE AGGREGATERRENOE ...................................... ......$......................................................., WORKERS COMPENSATION Y WC STATU•I..,.,.,.,..�"...ER_ IOTH. AND EMPLOYERS' LIABILITY Y d N ..... ,.75��RY.�LdMi�dS .............................................................�, ANY C CCIDENT OFFICERIMEMSER EXCLUDED? N I A ••E.L...DE-.EA................$......... O ICERIMdatory In NHR/PARTNERIEXECUTIVE SEAS EMPLOYEE $ I If yes, describe under DESCRIPTION OF OPERATIONS below E L, DISEASE - POLICY LIMIT $ A Protessionai. Liability LWSODUU736 U8/'U8/1S 08/08/20'Eacn Claim 1,UU0,U00 Aggregate 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace Is required) Client No. 0845 CERTIFI'CA'TE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Clerk, City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street AUTHORIZED REPRESENTATIVE fi//n//��`II 11 I�n^ I El Segundo, CA 90245 ?~ V v " r LYl` q USA �I LL���' VVV ���' ..�' �1' ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Patty.BaxendaleQintegrogroup.com_LEM 56913493