ACORD®
� CERTIFICATE OF LIABILITY INSURANCE I DATE
10/23/2024
(MM/DD/YYYY)
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 Alex Eshraghi NAME:
Bayshield Insurance Services ritJgN
�o Extl: 408-840-4402 I FAX
(A/C Nol: 408-484-107 4
itDAJ�ss: [email protected]
19200 Von Karman Ave #400 INSURER($) AFFORDING COVERAGE NAIC# Irvine CA 92612 INSURER A: ACE Property and Casualty Insurance Company 20699 INSURED INSURER B: Sequoia Insurance Company 22985
Evan Brooks Associates, Inc INSURER C:
INSURER D:
750 E Green St Ste 301 INSURER E:
Pasadena CA 91101 INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
A
A
B
A
TYPE OF INSURANCE
X � COMMERCIAL GENERAL LIABILITY
f--□ CLAIMS-MADE [X] OCCUR
�
f--GEN'L AGGREGATE LIMIT APPLIES PER:
P9 □ PRO- POLICY JECT
OTHER:
f--AUTOMOBILE LIABILITY
�
ANY AUTO �
DLoc
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED X NON-OWNED
AUTOS ONLY AUTOS ONLY
UMBRELLA LIAB H � OCCUR
EXCESS LIAB CLAIMS-MADE
DED I I RETENTION$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y/N
ANYPROPRIETOR/PARTNER/EXECUTIVE
OFFICER/
(Mandatory
MEMBER
in NH)
EXCLUDED? □
If yes, describe under
DESCRIPTION OF OPERATIONS below
Errors & Omissions
ADDL
,.,.,n
N/A
SUBR POLICY EFF POLICY EXP
W\/n POLICY NUMBER IMM/DD/YYYYl IMM/DD/YYYYl LIMITS
EACH OCCURRENCE $ 4,000,000
DAMAGE TO RENTED
PREMISES !Ea occurrence\ $ 1,000,000
MED EXP (Any one person) $ 5,000
D96154483 05/24/2024 05/24/2025 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000
PRODUCTS - COMP/OP AGG $ 4,000,000
$
COMBINED SINGLE LIMIT $ 2,000,000 IEa accident\
BODILY INJURY (Per person) $
D96154483 05/24/2024 05/24/2025 BODILY INJURY (Per accident) $ iP���;c
�Je;,fi
AMAGE $
$
EACH OCCURRENCE $
AGGREGATE $
$
XI �ffruTE I I OTHER
05/24/2024 05/24/2025 E.L. EACH ACCIDENT $ 1,000,000
E.L. DISEASE - EA EMPLOYEE $ 1,000,000
E.L. DISEASE - POLICY LIMIT $ 1,000,000
D98403899 01/20/2024 01/20/2025 Single limit of Ins. $ 2,000,000 Aggregate Limit $ 2,000,000
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THIRTY (30) DAYS’ NOTICE OF
CANCELATION WILL BE DELIVERED TO THE CERTIFICATE HOLDER IN ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
I
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Y
Y
Y Y
City of Redondo Beach
415 Diamond Street
Redondo Beach CA 90277
QWC1362122
DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Blanket additional insured applies to the entities listed below per attached blanket additional insured endorsement when required per written agreement
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D96154483
COMIVERCIAL GENERAL LIABILITY
CG 20370704
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED-OWNERS, LESSEES OR
CONTRACTORS -COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Location And Des cription Of Completed Operations
All locations which are afforded coverage under this policy N ame Of Additional Insured Person(s) Or
Organization(s):
As required by written contract or agreement.
Information required to complete this Schedule if not shown above will be shown in the Declarations.
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'' or "property damage" caused, in whole or in part, by "your work'' at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products-completed
operations hazard".
CG 20 370704 © ISO Properties, Inc., 2004 Page 1 of1
D96154483
COMERCIAL GENERAL LIABILITY
0G24040IOI
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
Ttia endorsement modifies ln&ll'8nce provided under the follQMll:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
FROOUCTS.{:OMPLETEDOPERATIO\ISLIABILITYCOVERAGE PART
SCHEDULE
As required by written contract or agreement.
The follQMll ia added to Paragraph 8. lnlnsf• Of
fights OI Racov.-y Against Olhars To Us of
8actlon IV-Conditions:
We waive arr, rtght d reoovery we may have against
the person or organization ahoWn in the Schedule
above because of payments we make for injury or
damage art&illJ out of yru OllJOil'g operations or
� WCJk" done under a contract with that person
or organization and Included In the "productacon,>leted operations hazard". Ttia waiver applies only to the person or organization ahoWn in the
Schedule above.
CG24040IOI O Insurance Services Office, Inc., 2008 Paga1 of1 UGCA 35 99 01 07
COMMERCIAL AUTO
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED ENDORSEMENT
BUSINESS AUTO COVERAGE FORM
This endorsement modifies insurance provided under the following:
SCHEDULE
Name Of Person Or Organization:
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person An additional premium of $ is fully earned at the time of issue. or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. The inclusion of additional interest or interests will not operate to increase the limit of our liability.
UGCA 35 99 01 07 ISO Copyrighted Material Included Page 1 of 1 Number:
As required by written contract or agreement.
05/24/2024
POLICY NUMBER: D96154483 001\tMERaAL AUTO
CA04440310
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US (WAIVER OF SUBROGATION)
Thia endcnement modifiea inallllnce provided under the following:
BUSINESS AUTO COVERAGE FORM
BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM
GARAGE COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
TRUO<ERS COVERAGEFORM
With. reacect to coverage �ided by thia endoraement, the proviaiona c:I the Coverage Form apply unleaa modi-fled by the endoraement J"hl� endcnement changea the policy effective on the lnceJ:tlon date of the policy unleaa another date la indicated below.
SCHmJLE
As required by written contract or agreement.
The Transfer a Rights a Recovery AgU1st others To Us Condition doe& not apply to the peraon(a) or organization(&) ahown in the SChedue, but only t::J
the extent that <rcgation ia waived prior to the ''accidert' or the •,oaa" under a contract with that pe111on or organization.
CA04440310 C lnaurance Service& Office, Inc., 2009 Page1 of1 C Evan Brooks Associates, Inc
Endorsement Effective Data: 05/24/2024
Per written contract or agreement
05/24/2024 QWC1362122
D96154483
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CANCELLATION
This endorsement modifies insurance provided under the following:
OUTPUT POLICY COVERAGE PART
COMMERCIAL AUTOMOBILE COVERAGE PART
COMMERCIAL GENERAL LIABILITY COVERAGE PART
COMMERCIAL INLAND MARINE COVERAGE PART
COMMERCIAL LIABILITY UMBRELLA COVERAGE PART
COMMERCIAL PROPERTY COVERAGE PART
CRIME AND FIDELITY COVERAGE PART
EMPLOYMENT-RELATED PRACTICES LIABILITY COVERAGE PART
EXCESS LIABILITY POLICY
FARM COVERAGE PART
FARM UMBRELLA LIABILITY POLICY
LIQUOR LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
PROFESSIONAL LIABILITY COVERAGE PART
Paragraph A. 2. Cancellation of the COMMON POLICY CONDITIONS is deleted and replaced by the following:
2. We may cancel this policy by mailing or delivering to the first Named Insured written notice of cancellation at least:
a. 1 0 days before the effective date of cancellation if we cancel for one or more of the following reasons:
(1) nonpayment of premium or failure to pay a premium when due; (2) conviction of an insured of a crime arising out of acts increasing the hazard insured against;
(3) violation of any local fire, health, safety, building or construction regulation or ordinance which increases the hazard insured against under the policy; (4) any willful or reckless act or omission by an insured increasing the hazard insured against;
(5) omission or concealment of fact relating to an insurance application, rating, claim or coverage under this policy;
(6) failure or refusal of an insured to:
(a) provide information necessary to confirm exposure or determine the policy premium; or
(b) comply with underwriting requirements;
(7) a substantial change in the risk covered by the policy; (8) loss of reinsurance or substantial decrease in reinsurance; (9) the cancellation is for all insureds under such policies for a given class of insureds; or (10) any reason determined by the insurance commissioner. b. 30 days before the effective date of cancellation if we cancel for any other reason.
ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED.
U 173AS-0708 Includes copyrighted material of Insurance Services Office, Inc., with its permission.