ACORD® DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
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 INSURERS), 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 endorsements).
CONTACT Natalia Dionela
Arthur J. Gallagher Risk Management Services, LLC
500 N Brand Boulevard, Suite 100 (AC, No. Ext): 818.539.8633 E-MAIL
Glendale CA 91203 ADDRESS: Natalia [email protected]
INSURERS) AFFORDING COVERAGE NAIC#
License#: 0D69293 INSURER A: Service American Indemnity Company 39152 INSURED CRISIS1701 INSURER B: Berkley Regional Insurance Company 29580 1736 Family Crisis Center, A California
Nonprofit Public Benetit Corporation INSURER C :
2116 Arlington Ave. Ste #200 INSURER D:
Los Angeles CA 90018 INSURER E:
INSURER F:
CERTIFICATE NUMBER: 326845724 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
X | COMMERCIAL GENERAL LIABILITY HHS 8530162-12 S1.000,000
DAMAGE TO RENTED
CLAIMS-MADE OCCUR PREMISES (Ea occurrence) $ 500,000
MED EXP (Any one person) $20,000
PERSONAL & ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000.000 PRO
X POLICY JECT LOC PRODUCTS - COMP/OP AGG 33.000000
OTHER:
AUTOMOBILE LIABILITY Y HHS 8530162-12 4/1/2023 4/1/2024 OMBINED SINGLE LIMI $ 1,000,000 Ta accider
ANY AUTO BODILY INJURY (Per person)
OWNED SCHEDULED
AUTOS ONLY AUTOS
T HIRED NON-OWNED PAT GRIN DAMAGE
AUTOS ONLY AUTOS ONLY
UMBRELLA LIAB X HHS 8530162-12 4/1/2023 4/1/2024 EACH OCCURRENCE $5.000.000 OCCUR
X EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000
RETENTIONS
WORKERS COMPENSATION SATIS0428702 4/1/2023 4/1/2024 I STATUTE
AND EMPLOYERS' LIABILITY Y/ N
N/ A E.L. EACH ACCIDENT $1,000.000
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $1,000,000 f yes, describe under
DÉSCRIPTION OF OPERATIONS belov E.L. DISEASE - POLICY LIMIT $1.000,000 Professional Liabllity HHS 8530162-12 4/1/2023 4/1/2024 Per Claim ,000,0 Aggregate 3,000,0
ESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additlonal Remarks Schedule, may be attached If more space is requirec buse or Molestation Liability coverage is under policy # HHS 8530162-12. It is also an underlying coverage under the Excess Liability portion of policy# HF 8530162-12
Policy: HS 85012-1200
See Attached...
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS
City of Redondo Beach
1922 Artesia Blvd.
Redondo Beach CA 90278 AUTHORIZED REPRESENTATIVE
Melisa Cury
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CRISIS1701
LOC#:
ACORD® ADDITIONAL REMARKS SCHEDULE Page 1 of 1
AGENCY NAMED INSURED
Arthur J. Gallagher Risk Management Services, LLC
POLICY NUMBER
CARRIER NAIC CODE
EFFECTIVE DATE:
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Policy: Directors & Officers Liability / Employment Practices Liability Policy#: LPP704481
Carrier: Landmark American Insurance Company
olicy Term: 4/1/2023 To 4/1/2024
er Claim: $1,000,000 / Aggregate: $2,000,000
D&O Retention: $100,000
EPL Retention: $150,000
Policy: Crime
Policy#: HHS 8530162-12
arrier: Berklev Recional Insurance Company
olicy Term: 4/1/2023 To 4/1/2024
Employee Theft: Limit: $500,000 & Deductible: $1,000
Forgery or Alteration: Limit: $500,000 & Deductible: $1,000 Computer And Funds Transfer Fraud: Limit: $500,000 & Deductible: $1,000 The City of Redondo Beach, its officers, elected and appointed officials, employees, and volunteers are named additional insured on General liability and Auto Liability with respect to the operations of the named insured. Workers compensation coverage is evidence only. The insurance provided in the General Liability policy is primary and any other insurance shall be excess only, and not contributing. Written notice shall be provided at least ten (10) days in advance of cancellation for non-payment of premium and thirty (30) days in advance for any other cancellation or policy change.
ACORD 101(2008/01) © 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
COMMERCIAL AUTO
CA 83 07 10 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement.
This endorsement changes the poly effective on the inception date of the policy unless another date is indicated Endorsement Effective: 4/1/2023 Countersigned By:
Named Insured: 1736 Family Crisis Center (Authorized Representative)
SCHEDULE
Name and Address of Additional Insured:
The City of Redondo Beach, its officers, elected and appointed officials, employees, and volunteers (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.)
A. Se shedule, but only vith respect a tele ga naile or adored too lo are on are, Coverage is afforded under this policy.
B. The policy or lanet om the inity. Sty elem pean an any of read a i for ere or are., C. Yetaring to this in turant for the additional insured named in the Schedule or Declarations in all matters ). We will mail the additional insured named in the Schedule or Declarations notice of any cancellation of this olicy. If we cancel, we will give ten (10) days notice to the additional insured E. The additional insured named in the Schedule or Declarations will retain any right of recovery as a claimant under this policy.
THIS ENDORSEMENT MUST BE ATTACHED TO A CHANGE ENDORSEMENT WHEN ISSUED AFTER THE POLICY IS WRITTEN.
CA 83 07 10 13 Includes material copyrighted by Insurance Services Office, Inc., Page 1 of 1 with its permission
: OMMERCIAL GENERAL LIABILIT
CG 20 01 04 1:
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY AND NONCONTRIBUTORY -
OTHER INSURANCE CONDITION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
Primary And Noncontributory Insurance
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 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: HHS 8530162-12 COMMERCIAL GENERAL LIABILITY CG 20 26 04 1:
Berkley Regional Insurance Company
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 Organization(s):
The City of Redondo Beach, its officers, elected and appointed officials, employees, and volunteers
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) or
organization(s) shown in the Schedule, but only
with respect to liability for "bodily injury", "property damage" or "personal and advertising injury
aused. in whole or in part, by vour acts o
omissions or the acts or omissions of those acting
on your behalf: 1. Required by the contract or agreement; or
1. In the performance of your ongoing operations; 2. Available under the applicable Limits of Insurance shown in the Declarations;
2. In connection with your premises owned by or whichever is less. rented to you.
However: This endorsement shall not increase the
applicable Limits of Insurance shown in the
1. The insurance afforded to such additional Declarations. insured only applies to the extent permitted by
law; and
will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured
CG 20 26 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1