SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
INSURER(S) AFFORDING COVERAGE
INSURER F :
INSURER E :
INSURER D :
INSURER C :
INSURER B :
INSURER A : NAIC #
NAME: CONTACT
(A/C, No): FAX
E-MAIL ADDRESS:
PRODUCER
(A/C, No, Ext): PHONE
INSURED
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
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).
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.
OTHER:
(Per accident)
(Ea accident)
$
$
N / A
SUBR WVDADDL
INSD
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. $
$
$
$ PROPERTY DAMAGE
BODILY INJURY (Per accident)
BODILY INJURY (Per person) COMBINED SINGLE LIMIT
AUTOS ONLY
AUTOS ONLY AUTOS NON-OWNED OWNED SCHEDULED
ANY AUTO
AUTOMOBILE LIABILITY
Y / N WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) DESCRIPTION OF OPERATIONS below
If yes, describe under
ANY PROPRIETOR/PARTNER/EXECUTIVE
$
$
$ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEEE.L. EACH ACCIDENT EROTH- STATUTE PER
(MM/DD/YYYY) LIMITS POLICY EXP(MM/DD/YYYY) POLICY EFFLTR TYPE OF INSURANCE POLICY NUMBER INSR
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
EXCESS LIAB
UMBRELLA LIAB EACH OCCURRENCE $ AGGREGATE $
$
OCCUR
CLAIMS-MADE DED RETENTION $
PRODUCTS - COMP/OP AGG $ GENERAL AGGREGATE $ PERSONAL & ADV INJURY $ MED EXP (Any one person) $
EACH OCCURRENCE $ DAMAGE TO RENTED
PREMISES (Ea occurrence) $ COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
CANCELLATION
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03)
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED
AUTOS ONLY
12/19/2022
Arthur J. Gallagher & Co.
Insurance Brokers of CA., Inc.
500 N. Brand Blvd, Suite 100
Glendale CA 91203
Lisa Figueroa 818.539.8620 818.539.8720 [email protected] License#: 0726293 Great American Insurance Company 16691 VENIFAM-01 Great American Insurance Company of NY 22136 Venice Family Clinic
604 Rose Ave.
Venice CA 90291
Great American Alliance Insurance Company 26832 1457726378 A X 1,000,000 X 1,000,000 20,000 1,000,000 3,000,000 X
Y PAC 5603429 16 7/1/2022 7/1/2023
3,000,000
B 1,000,000 X
X X
CAP 8639227 14 7/1/2022 7/1/2023
C
X X
UMB 5603430 16 7/1/2022 7/1/2023
3,000,000 3,000,000 X
10,000 N
A Sexual Misconduct PAC 5603429 16 7/1/2022 7/1/2023 Per Claim Aggregate
$1,000,000
$3,000,000
Excess $3,000,000 per Occurrence/Aggregate limit under the umbrella policy #UMB 5603430 16 provides excess coverage over sexual misconduct liability coverage which makes the total each claim limits $4,000,000 and aggregate limit $6,000,000.
Policy: Cyber Liability
Policy#: QCB-250-CONQ2JUD
Carrier: Palomar Excess and Surplus Insurance Company
Policy Term: 7/1/2022 To 7/1/2023
Limit: $3,000,000 / Retention: $25,000
See Attached...
City of Redondo Beach
Community Services Department
1922 Artesia Blvd
Redondo Beach CA 90278
ACORD 101 (2008/01)
The ACORD name and logo are registered marks of ACORD
© 2008 ACORD CORPORATION. All rights reserved.
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE:
ADDITIONAL REMARKS
ADDITIONAL REMARKS SCHEDULE Page of
AGENCY CUSTOMER ID:
LOC #:
AGENCY
CARRIER NAIC CODE
POLICY NUMBER
NAMED INSURED
EFFECTIVE DATE:
VENIFAM-01 1 1
Arthur J. Gallagher & Co.
Venice Family Clinic
604 Rose Ave.
Venice CA 90291
25 CERTIFICATE OF LIABILITY INSURANCE
Policy: CRIME
Policy#: PAC 5603429 16
Carrier: Great American Insurance Company
Policy Term: 7/1/2022 To 7/1/2023
Employee theft: Limit: $100,000 / Deductible: $5,000
Forgery or alteration: Limit: $100,000 / Deductible: $5,000 Theft of Money and securities: Limit: $100,000 / Deductible: $5,000 Money and securities: Limit: $100,000 / Deductible: $5,000 Computer Fraud & Funds Transfer Fraud: Limit: $100,000 / Deductible: $5,000 RE: Community Development Block Grant; Venice Family Clinic Behavioral Health Services Program.
The City of Redondo Beach, its elected and appointed officials, officers, employees, volunteers, attorneys and agents are additional insured with respect to the operations of the named insured.
Copyright, ISO Properties, Inc., 2012
CG 2 0 1 0 (Ed. 04/13 ) (Page 1 o f 2)
CG 2 0 1 0 (Ed. 0 4 13)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
Schedule
Name of Additional Insured
Person(s) or Organization(s) Location(s) o f Covered Operations Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. SECTION II - WHO IS AN INSURED is amended to include as an additional insured the person(s) o r organization(s) shown in the Schedule, but only with respect to liability f o r "bodily injury", "property damage" o r "personal and advertising injury" caused, in whole o r in part, by:
1. your acts or omissions; or
2. the acts or omissions of those acting on your behalf; in the performance o f your ongoing operations f o r the Additional Insured(s) at the location(s) designated above.
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 broader than that which you are required by the contract o r agreement to provide f o r such additional insured.
B. With respect to the insurance afforded to these Additional Insureds, the following additional exclusions apply:
This insurance does not apply to "bodily injury" or "property damage" occurring after:
1. all wo rk, including materials, parts o r equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf o f the Additional Insured(s) at the location o f the covered operations has been completed; or Named Insured: Venice Family Clinic
Policy number: PAC 5603429 16
Effective Date: 7/1/2022
The City of Redondo
Beach, its elected and
appointed officials,
officers, employees,
volunteers, attorneys
and agents
All insured Premises and operations
Copyright, ISO Properties, Inc., 2012
CG 2 0 1 0 (Ed. 04/13 ) (Page 2 o f 2)
2. that portion o f "your wo rk " out o f which the injury o r damage arises has been put to its intended use by any person o r organization other than another contractor o r subcontractor engaged in performing operations f o r a principal as a part o f the same project.
C. 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 behalf of the Additional Insured is the amount o f insurance:
1. required by the contract or agreement; or
2. available under the applicable Limits of Insurance shown in the Declarations; whichever is less.
This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.