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PROOF OF INSURANCE (2021 - 2021) CLOSEDKOPP&GR-01 JEN IFE ACOR a DATE (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE I 215/2021 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 Breakwater Strategic Insurance Solutions 2251 San Diego Ave,, Ste. B-208 San Diego, CA 92110 780-4600 19)317-0019 I INSURERA:Citizens Insurance Company of America --_ ,01,53,4 INSURED INSU.RF.RB_Gem-inl Insurance Company .108.3.3 Koppel & Gruber Public Finance INSURER c I . 334 Via Vera Cruz, Ste. 256 INSURER D San Marcos, CA 92078 "'"" — — _ E IN"SURER E, ' INSURER F : 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 TYPE OF INSURANCE AD BRI POLICY EFF POLICY EXP IR -............. POLICY NUMBER LIMITS A IX COMMECLAIMRCIAL GENERAL ADE 1 X OCCUR / z4_ X� di�1�VJ7J%X1i 1 R ? I 2,000 000 COMMERCIAL GENERAL LIABILITY I I PAMACw�', r0 RUN"d EIJ L.....,,, X F(L1hxwrx�.II $ _ EACH OCCURRENCE g OB3D426852-04 11/2912020 ` 11/29I2021 Il $ 300,000 5,000 PERSONALBADV INJURY $ ( S' P Included PE .. Rc�DUCT. 000 000 GEP1"LAGGREgATE LIMIT APPLIES PER' GENERAL AGDREP,$TE 4'„ X 1 POL4CY E LOC 1 ,-cclrnPlo�A r S Included OTHER: ... $ A 1 AUTOMOBILE LIABILITY 1 1 I".;OMBINEO SINGLE LIPI[T OB3D426852-04 11/29/2020 11/29/2021 F $ 1,000 000 4 I ANY AUTO ; � UQG�Y IN��RY rPerrw� a $ m ....� �........ SCHEDULED AUTOS ONLY OWNED AUTOS BODILY INJURY leer acqidenll.,$ X... AIJ ONLY X NL'1g� ° P OPERTYJaR,hGF: ALliO�h: Ft�bAprg� $ S _------ _... ........ ........................... ......... UMBRELLA LIAB OCCUR I.- GQRECAT,RREN(.E _ $ .,n. AB CLAIMS -MADE - q - _ "E $ I EXCESS LI .... T ................ ............ , .--..... _ I DED RETENTION $ E I I $ ...... ...........�...,..... .�.�... ] VN RKERS COMPENSATION i PER OTH AND EMPLOYERS' LIABILITY • ' STATUTE_ ER .. ,.,.., _. Y PROPRIETOR/PARTNER/EXECUTIVE I"N� E L EACH ACCIDENT """ $ OF NCER/MEMBER EXCLUDED? NIA "" """"""" ---- �QMsndatory in NH) E L DISEASE EA EMPLOYEE $ -- If yes, describe under ! w ESCRIPTIQ..N.QF.OPERATIQNS,below - E.L DISEASE POLICY LIMIT , 5 "..., B iProfessional Liabili VNPL006782 11/1612020 11/1612011 Occurrence ... i_. 1,000,000 g Professional Liabili NPL006782 11/16/2020 11/16/2021 Aggregate 2,000,000 i .......m�.....,,,.. .. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Adtd'itIonal Remarks Schedule„ may be attached It more space is required) General Liability Policy excludes claims arising our of the performance of professional Services, All Operations of the Named Insured. City of El Segundo, its officers, officials, employees, and volunteers are named additional insured as respects to operations performed by the Named Insured as respects to General Liability SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN tY 9 ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA 90245-3895 — ----- AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015ITACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Policy Number OB3D426852-04 COMMERCIAL GENERAL LIABILITY CG20260413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or O City of El Segundo, its officers, officials, employees & volunteers 350 Main Street El Segundo CA 90245-3895 to complete this Sched A. Section II —Who is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", 'property damage" or "personal and advertising injury" caused; or in part, by your acts or omissions of the of those acting on your behalf 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be boarder than that which you are required by the contract or agreement to provide for such additional insured. will be B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits of Insurance: If coverage provided to the additional insured Is required by a contract or agreement, the most we will pay on whole behalf of the additional insured is the amount of acts or omissions 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declaration: Whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 26 0413 © 150 Properties, Inc., 2012 Page 1 of 1 Policy Number 01331)426852-04 COMMERCIAL GENERAL LIABILITY CG 20 010413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following Is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an additional Insured under your policy provided that: (1) The additional Insured Is a Named insured under such other insurance: and CG 20 010413 4:1Z) Insurance Services Office. inc., 2012 Page i of i Policy Number 013313426852-04 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: City of El Segundo, its officers, officials, employees and volunteers Information if not shown above, will be shown in the The following Is added to Paragraph e. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a conlracl with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. 0 o, cn CG 24 04 05 00 0 Insurance Services Office, Inc., 2008 Page 1 of 1 I] POLICYHOLDER COPY SIP P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 04-01-2020 CITY OF EL SEGUNDO SIP 350 MAIN ST EL SEGUNDO CA 90245-3813 GROUP: POLICY NUMBER: 1824128-2020 CERTIFICATE ID: 69 CERTIFICATE EXPIRES: 04-01-2021 04-01-2020/04-01-2021 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer, We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms,, exclusions, and conditions, of such policy. r Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-01-2006 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2020-04-01 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF EL SEGUNDO ENDORSEMENT #1851 - SCOTT KOPPEL, VICEPRES - EXCLUDED. ENDORSEMENT #1651 - LYNN GRUBER, PRES,SEC - EXCLUDED. EMPLOYER KOPPEL & GRUBER PUBLIC FINANCE (A CORP) SP 334 VIA VERA CRUZ STE 256 SAN MARCOS CA 92078 M0410 PRINTED : 03-17-2020 (REV.7-2014) ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION 1824128-20 RENEWAL SP 7-67-42-43 PAGE 1 HOME OFFICE SAN FRANCISCO EFFECTIVE APRIL 1, 2020 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING APRIL 1, 2021 AT 12.01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME KGPF 334 VIA VERA CRUZ STE 256 SAN MARCOS, CA 92078 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, CITY OF EL SEGUNDO WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, KGPF IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER. IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH EMPLOYEES SHALL BE INCREASED BY 03%. NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: APRIL 6, 2020 AUTHORIZED REPRESENT IV'E PRESIDENT AND CEO SCIF FORM 10217 (REV.4-2018) 2570 OLD DP 217