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PROOF OF INSURANCE (2020 - 2020) CLOSEDACOPREF CERTIFICATE OF LIABILITY( INSURANCE 1 DATE iMMtQD/YYYY) 512912019 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 Altex Risk Solutions, Inc. (CB) PttoNE , S00 8Cr7_0390 noy..,630-378-2,508.__ _ Services �... 2850 Golf Road, 5th Floor Christen -8 Brothers 1-1-1 Rolling Meadows IL 60008-4050 aoDss: tNSURER(S) AFFORDING COVERAGE NA{C # � .II3 oRED CHMBRO-14 thers of the Christian Schools &Affiliates LOG #1177028 DAUGHTERS OF CHARITY OF SVOP 1205 Windham 'Parkway Romeoville IL 60446-1679 ._INSURERA:Pennsylvania Manufacturers Assoc .....Inss Co 12262 eINSURER BB mOld Republic Insurance Company 241„47 INSURER C : INSURER D INSURER E _11.INSURER F, COVERAGES CERTIFICATE NUMBER: 890063064 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE I3E,EN 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 WD CLAIMS- I T R Y TYPE OF INSURANCE ADDL j ....... � i+MIDD EFF POLICYEXP � EACH OLt U 3REN^,F S LTR COMMERCIAL GENERAL LIABILITY iM 821900 0998922 NUMBER 6115120x019 t r 6115/2020 LIMITS 4,000,000 ME � DAMAGerfQ RENTLD CLAIMS -MADE L_.I OCCUR REMISFS,(Fso+x••,rrmocr.�SsIncluded D t,xP IAny one pemon) PERSONAL & ADV INJURY $Incl e .......•. ,all.NLAGGREDATFLf%IiTAPPLIES PER: j GENERAL AGGREGATE SNIA _.... -I LOC -OP Incuded CT,nS BGGPC1�3CY f ,V OTHER AUTOMOBILE LIABILITY Y MWTB21543 ...PR�O�DU, 6115/2019 6/15/2020 COMBINED SINGLE f$1,000,00D y ... ANY AUTO BODILY INJURY (Per person) S OWNED i SCHEDULED ry, Y BODS INJURY (Par accident) S AUTOS ONLY B AUTOS HIRED NON -OWNED r . E , S Y„�„_ AUTOS ONLY i� X„ AUTOS ONLY Ptkrt a 5 UMBLLA � OCCUR OCCURRENCE 5...... .,... _.... EXCESS LIAB� CLAIMS -MADE ["AGGREGATE UED RETENTIONS S WORKERS COMPENSATION I STATUTE E,,,,,H- I 8 ANDEMPLO YIN . ANYPR.OPPJFTOF�PAP'TNERFCXECUT{VE CCIDENT $ _................ •...•••••••.. OFFGtMJMEM8EREX0L1UDCD? NIA (Mantl®tory in NH) M E.LDISEASE EMPLOYEE " If es, describe under DESCRIPTION OF OPERATIONS below Y LIMIT S L DISEASE - POLICY E.L. DESCRIPTION OF OPERATIONS t LOCATIONS] VEHICLES (ACORD 191, Additional Ramaria; Schedult, may be aattacti It more apace is M quirad) Only the General Liability CoverageWilli apply on a Primacy and Nora -Contributory basis (.per attached endorsement) if required by fully executed written contract. Certificate Holder is added as Additional Insured (per attached endorsement) for General Liability and Automobile liability coverages Solely, strictly and specifically with regards to: Consultant Services for the Community Development Block Grant Program for Home Delivered Meals. CERTIFICATE HOLDER I CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cit of I Segundo Its Official and Employees ACCORDANCE WITH THE POLICY PROVISIONS, Oflic€; of Oily Clerk, 350 Main Street AUTHORI REPRESENTATIVE EI Segundo CA 90245-3813 USA v ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD PENNSYLVANIA MANUFACTURERS' ASSOCIATION INSURANCE COMPANY Attaching to and forming part of Policy No. 821900 0998922 Named Insured: THE RELIGIOUS AND CHARITABLE RISK POOLING TRUST OF THE BROTHERS OF THE CHRISTIAN SCHOOLS AND AFFILIATES Effective date of this endorsement is June 15, 2019 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY, ADDITIONAL INSURED SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under SECTION 11 INSURING AGREEMENT C, GENERAL LIABILITY COVERAGE defined within the Coverage Agreement SECTION 1: Schedule Fill, arne of Additional Insured Persons(s) or ' Designated Location(s) Of Covered Operations: Organization (s): ANY PERSON OR ORGANIZATION WHEN YOU HAVE AGREED IN A WRITTEN CONTRACT FOR THAT PERSON OR ORGANIZATION TO BE ADDED AS AN ADDITIONAL INSURED ON YOUR POLICY. If no entry appears above, information required to complete this endorsement will be shown in the Certificate, of Coverage as applicable to this endorsement. Section 11 Insuring Agreement C -Name of Insured Amended X Who Is An Insured defined in the General Insurance Agreement is amended to include as an Additional Insured the, person(s) or organization(s ' � shown in the Schedule above, but only with respect to liability in the performance of the Named insured's ongoing operations for the Additional insured(s) at the Location(s) designated in the Suhedule above for "bodily injury" or "property damage", caused in whole or in part, by the Named Insureds acts or omissions which takes place after the execution of a written agreement with the Additional Insured(s). BFor the coverage provided by this endorsement: the following paragraph is added to Section IV —General Conditions, Section 11, Insuring Agreement C -General Liability. This insurance is primary insurance as respects to this coverage to the adclitior4 insured person or organization, wherethe written contract or vtoni1en agreement rpquires that this insurance be primary and noncontributory. In :.hat event. we %vill not seek conlribution from any other insurance policy available to the additional Insured on which the additionat insured person or organization is a Named Insured. C. Who Is An Insured is also amended to include as an additional insured the person(s) or orgar0zaflonj's) shown in thea Schedule, with: respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by the "Named Insured's work" at the location designated and described in the schedule of lhis andorsernent performed for that additional insured and included in the "Producls-completed cper,ations hazard". The most we will pay is the amount of insurance required by the written contract or the amount of applicable limits of insurance under this policy: whichever is less. This Insurance does not apply to any claims or suits seeking damages, including defense, arising out of, directly or indirectly, from any actual or alleged participation in any act of sexual misconduct, sexual harassment, sexual molestation, sexual abuse or any claim sexual in nature, physical or mental, of any person. Except as amended in this endorsement, this insurance is subject to all coverage terms, clauses and conditions in the policy to which this endorsement is attached and only applies to the extent permitted by law. IL 10 (12106) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM SCHEDULE Name of Person(s) or Organization(s): All persons or organizations as required by contract or agreement With respect to COVERED AUTOS LIABILITY COVERAGE, Who Is An insured is changed with the addition of the following: Each person or organization shown in the Schedule for whom you are doing work is an "insured". But only for "bodily injury" or "property damage" that results from the ownership, maintenance or use of a covered "auto" by: 1. You; 2. an "employee" of yours; or 3. anyone who drives a covered "auto" with your permission or with the permission of one of your "employees". However, the insurance afforded to the person or organization shown in the Schedule shall not exceed the scope of coverage and/or limits of this policy. Not withstanding the foregoing sentence, in no event shall the insurance provided by this policy exceed the scope of coverage and/or limits required by the contract or agreement. PCA 001 10 13 .�1+�" CERTIFICATE OF LIABILITY INSURANCE DATE{FAM/DDIYYtYj _ 1 11/25/2018 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 po'licy(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 NO"INE E: CT CtlriSlia..n Breathers Services Artex Risk Solutions, Inc. CB PHt"' a Nit; 53'0-378-2508 2850 Golf Road, 5th Floor t N 800407-0300 Rollin Meadows IL 60008-4050 A aL 9 RESS: _,,.......... _,mr«la/RER s, A''t"oRDaNa COVERAGE � NAIC p ...,,..... '................. ...... ,. - .. suReRe:OldReCuabllr InslrrancB..... .Company 2a1�M _ I Brothers of the Christian Schools & Affiliates _ IN ".... �.� INSURED CHRIBRC-14 Loc #1177028 DOC POW ST VINCENT SENIOR CITIZEN NTR aassuatE,Rc 1205 Windham Barkway INSURER D: .,,,,.._............. Romeoville IL 60446-1679INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 1949040129 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. TYPE OF INSURANCE AW 9WVD POLICY NUMBER............ (MOLICCYErr !BFPO ICOi ................. .�..,........... INSR LIMITS LTR ; ,COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE �, S .T.✓. -` -^-I "11AMAGE T O Ftt^ N tEO II CLAIMS -MADE ..� OCCUR PREM'I'S'E'S Ma;tcu r ncn! .,,1 '$ .................„_,,,_,.,_ _ 9EN'L AGGREGATE LIMIT APPLIES PER: ...� POLICY „..� PJEGRO- ❑LOC _ry II T AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY ,, AUTOS HIRED NON -OWNED AUTOS ONLY V� AUTOS ONLY UMBRELLALIABI OCCUR MED EXP (Army wao'ua,pe�rson)$ INJURY 2ENERALAGGRE6ATI I S......" PRODUCTS -COMPIOPAGGIT S u5 COMBINED SINGLELlMrr f $ _& ..1"IZdrm+rl BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PEiT'Y DAh9 EACH OCCURRENCE $ I DED � RETENTION $ CLAIMS -MADE � AGGREGATE 'WORKERS EXCESS LIAR E LIABILITY YIN Y MWG365399M{CA} 1t9J2619 1/912620 IE.L�EACHLITE ACCIDENT H $ 0l}„6p0 ..,.,.... APER } AND EMPLOYERS' LIABILITY . I ROPRIFTC?-lr7rARTNEM'EXECUTIVE AN N.,, N 1 A I _ a""1•ndat /ry in N14)� �kCLU'DED'�J � E.L DISEASE- EA EMP LIMIT �...� �. dYCDLI (Mandatory m NH) I E._. - If yes, deec;ibe under DESCRIPTION OF OPERATIONS below T $ 1,0D0, _I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 161, Additional Remarks Schedule, may bwr attRehad If more space is required) Wavier of Subrogmion, per the attached endorsement, (where allowed by law) is provided Lender the Work'er's Compensation coverage when required by fully executed written contract. Evidence of Coverage CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DAIS THEREOF, NOTICE WILL BE DELIVERED IN Cityof El Segundo, its officials and employees I ACCORDANCE WITH THE POLICY PROVISIONS. Office of the City Clerk 350 Main St AUTHORIZ REPRESENTATIVE El Segundo CA 90245 I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04.84) POLICY NUMBER: MWC 305311 04 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 0 % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ALL PERSONS OR ORGANIZATIONS WHERE REQUIRED BY WRITTEN CONTRACT DATE OF ISSUE: D1-01-19 @1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB's California Workers' Compensation Insurance Forms Manual@ 1999.