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PROOF OF INSURANCE (2020) CLOSEDACS 8/13/22019019 CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/Y) 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 g this certificate does not confer rights to the certificate holder in lieu of such endorsements) @CIAME: Aimee Guesno PRODUCER I ' PHONE 714 731-7700 _.FAX, Noi. (714) 731-7750 Cornerstone Specialty Insurance Services, Inc, Arc tXtl, ( ) 14252 Culver Drive, A299 E" AIL aimee@cornerstonespecialty.com ADDRESS: _ INSUREIR(SN AFFORDING COVERAGE ,NAIC # Irvine . CA 92604 INSURERA: RLI Insurance Company 13056 ........... INSURED _._ INSURER B: Arch Insurance Company11150 J . CHANG &ASSOCIATES, INC. INSURER C; 385 Van Ness Avenue, Ste. 208 INSURER D : INSURER E: Torrance CA 90501 INSURER F: u 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, NOTVVITHSTANDING ANY REQUIREMENT„ TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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, ".. . POLICY EFF POLICY -EXP I TYPE OF INSURANCE A DL POLICY NUMBER IIINSID WVD QMIQl PO1YYYY) IMMOWYYYYI LIMITS -LTR °"" COMMERCIAL GENERAL LIABILITY I N PLOYERS' LIABI AND EMPLOYERS' S' L YIN A'YPROP' VETORIPAR'Pif,IEIRdEXECIATIVE' EACH OCCURRENCE p S 2,000,000 V ❑ fes, describe under Dt,SCRIP'TION OF OPERATIONS below Da`ti�l�l',AGE10REWED PRC:9�pISE';S (Eo arr:currerrr�r �- 1000,000 $ ' CLAIMS -MADE OCCUR EACH CLAIM $3,000,000 PROFESSIONAL LIABILITY B 1 10,000 ADDT'L INSURED/ PRIMARY Claims Made MED EXP (A(W orw Person $ A BLNKT WVR OF SUBRO Y PSB0001179 08/16/2019 08/16/2020 PERSONAL 8ADV INJURY I $ INCLUDED reported within the policy period, V GENER,ALAGGREGA`rtE $ 4,000,000 GEN'ILAGGREGATE LIMIT APPLIES PER: POLICY � PRO- 0 LOC JECT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE I PROOkDC9'S • COh9P/OPAGG $ 4,000,000 $ OTHER ACCORDANCE WITH THE POLICY PROVISIONS. I 'O aLc:Ilcf;denl) SINGLE LIMIT _ $ 1,000,000 AUTOMOBILE LIABILITY AUTHORIZED REPRESENTATIVE N CA 90245 ANY AUTO ©1988-2015 ACORD CORPORATION. All rights reserved. BODILY INJURY (Per person) $ A OWNED SCHEDULED PSA0001762 08/16/2019 08/16/2020 BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON -OWNED PR'0'I�I=rV�i'Y DAMIWG'E' IF& ecridentl $ AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCAS MADC EACH OCCURRENCE q, 1 000,000 X OCCUR A EXCESISUAB PSE0001604 08/16/2019 1 08/16/2020 AGGREGATE $ 1,000,000 DED RE. EN N ......E PE OT ION SATLITY S V ErEki I N PLOYERS' LIABI AND EMPLOYERS' S' L YIN A'YPROP' VETORIPAR'Pif,IEIRdEXECIATIVE' _ 1,000,000 CH AT E,L, EACH PSW0002101 08/16/2019 08/16/2020 AC S �q NIA P OFFICERYMEMBER EXCLUDED? I (Mandatory+' In BE EL - EA EMPLOY'E,E , $ 1,000,000 fes, describe under Dt,SCRIP'TION OF OPERATIONS below E L DISEASE' 1,000,000 EASE _ 4'.rOt,VCW'LIM�VT S _ EACH CLAIM $3,000,000 PROFESSIONAL LIABILITY B PAAEP0029002 08/16/2019 08/16/2020 ANNUALAGGREGATE $3,000,000 Claims Made _..... .... ....... _. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of EI Segundo, its officials, and employees are Additional Insured for General Liability but only if required by written contract with the Named Insured prior to an occurrence and as per attached endorsement. Coverage is subject to all policy terms and conditions. *30 days notice of cancellation, except for 10 days notice for non-payment of premium For Professional Liability coverage, the aggregate limit is the total insurance available for all covered claims reported within the policy period, 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 EI Segundo -Public Works 350 Main Street AUTHORIZED REPRESENTATIVE EI Segundo CA 90245 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Policy Number: PS130001179 RLI Insurance Company Named Insured: J.C. Chang & Associates, Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. RLIPack° FOR PROFESSIONALS BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM - SECTION II — LIABILITY C. WHO IS AN INSURED is amended to include as an additional insured any person or organization that you agree in a contract or agreement requiring insurance to include as an additional insured on this policy, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused in whole or in part by you or those acting on your behalf: a. In the performance of your ongoing operations; b. In connection with premises owned by or rented to you; or c. In connection with "your work" and included within the "product -completed operations hazard". 2. The insurance provided to the additional insured by this endorsement is limited as follows: a. This insurance does not apply on any basis to any person or organization for which coverage as an additional insured specifically is added by another endorsement to this policy. b. This insurance does not apply to the rendering of or failure to render any "professional services". c. This endorsement does not increase any of the limits of insurance stated in D. Liability And Medical Expenses Limits of Insurance. 3. The following is added to SECTION III H.2. Other Insurance — COMMON POLICY CONDITIONS (BUT APPLICABLE ONLY TO SECTION II — LIABILITY) However, if you specifically agree in a contract or agreement that the insurance provided to an additional insured under this policy must apply on a primary basis, or a primary and non-contributory basis, this insurance is primary to other insurance that is available to such additional insured which covers such additional insured as a named insured, and we will not share with that other insurance, provided that: a. The "bodily injury" or "property damage" for which coverage is sought occurs after you have entered into that contract or agreement; or b. The "personal and advertising injury" for which coverage is sought arises out of an offense committed after you have entered into that contract or agreement. 4. The following is added to SECTION III K. 2. Transfer of Rights of Recovery Against Others to Us — COMMON POLICY CONDITIONS (BUT APPLICABLE TO ONLY TO SECTION II — LIABILITY) We waive any rights of recovery we may have against any person or organization because of payments we make for "bodily injury", "property damage" or "personal and advertising injury" arising out of "your work" performed by you, or on your behalf, under a contract or agreement with that person or organization. We waive these rights only where you have agreed to do so as part of a contract or agreement with such person or organization entered into by you before the "bodily injury" or "property damage" occurs, or the "personal and advertising injury" offense is committed. ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. PPB 304 02 12 Page 1 of 1 Policy Number: PSA0001762 PPA 300 03 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided un the following: BUSINESS AUTO COVERAGE FORM I. Blanket Additional Insured II. Blanket Waiver Of Subrogation The following is added to the SECTION 11— COVERED AUTOS LIABILITY COVERAGE, Paragraph A.I. Who Is An Insured Provision: Any person or organization that you are required to include as an additional insured on this coverage form in a contract or agreement that is executed by you before the "bodily injury" or "property damage" occurs is an "insured" for liability coverage, but only for damages to which this insurance applies and only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in SECTION II — COVERED AUTOS LIABILITY COVERAGE. The insurance provided to the additional insured will be on a primary and non- contributory basis to the additional insured's own business auto coverage if you are required to do so in a contract or agreement that is executed by you before the "bodily injury" or "property damage" occurs. The following is added to the SECTION IV — BUSINESS AUTO CONDITIONS, A. Loss Conditions, 5. Transfer Of Rights Of Recovery Against Others To Us: We waive any right of recovery we may have against any person or organization to the extent required of you by a contract executed prior to any "accident" or "loss", provided that the "accident" or "loss" arises out of the operations contemplated by such contract. The waiver applies only to the person or organization designated in such contract. PPA 300 03 13 Page 1 of 1 WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) 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 engaged in the work described in the Schedule. The additional premium for this endorsement shall be % of the California workers' compensation premium otherwise due on such remuneration. Person or Organization All persons or organizations that are party to a contract that requires you to obtain this agreement, provided you executed the contract before a loss Schedule Job Description Job performed for any person or organization that you have agreed with in a written contract to provide this agreement. 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 08-16-2019 Policy No. PSW0002101 Endorsement No. Insured J.C. Chang & Associates, Inc. Insurance Company RLI Insurance Company