ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED?
INSR ADDL SUBR
LTR INSD WVD
PRODUCER CONTACT NAME: PHONE FAX
(A/C, No, Ext): (A/C, No): E-MAIL ADDRESS:
INSURER A :
INSURED INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
POLICY NUMBER POLICY EFF POLICY EXP TYPE OF INSURANCE (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
AUTOMOBILE LIABILITY
UMBRELLA LIAB
EXCESS LIAB WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
AUTHORIZED REPRESENTATIVE
EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO- POLICY JECT LOC PRODUCTS - COMP/OP AGG OTHER: $ COMBINED SINGLE LIMIT
(Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $
$ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION $ PER OTH- STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $
If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT INSURER(S) AFFORDING COVERAGE NAIC #
COMMERCIAL GENERAL LIABILITY
Y / N
N / A
(Mandatory in NH)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
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.
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).
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
CERTIFICATE HOLDER CANCELLATION
ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
$
$
$
$
$
The ACORD name and logo are registered marks of ACORD
6/11/2024
(626) 799-7000 (626) 441-3233
11000
Liebert Cassidy Whitmore, A Professional Corporation
6033 W. Century Blvd 5th Floor
Los Angeles, CA 90045
20281
39217
A 2,000,000
X 72SBAAK0318 12/14/2023 12/14/2024 1,000,000
10,000
2,000,000
4,000,000
4,000,000
A 2,000,000
72SBAAK0318 12/14/2023 12/14/2024
A 4,000,000
72SBAAK0318 12/14/2023 12/14/2024 4,000,000
10,000
B
2571750595 4/1/2024 4/1/2025 1,000,000
1,000,000
1,000,000
C Professional Liabili LAW2163901 12/10/2023 Each Claim/Aggregate 5,000,000 General Liability forms apply to Automobile as written in the policy.
GL Additional Insured applies per SS 00 08 04 05 attached, only if required by written contract/agreement.
Additional Insured(s): City of Redondo Beach Human Resources Department City of Redondo Beach Human Resources Department
415 Diamond St.
Redondo Beach, CA 90277
LIEBCAS-C1 ACARDARAS
IMA, Inc. - Pasadena
3475 E. Foothill Boulevard
Suite 100
Pasadena, CA 91107
Sentinel Insurance Company, Ltd.
Federal Insurance Company
QBE Insurance Corporation
X
12/10/2024
X
X
X X
X
X
X
BUSINESS LIABILITY COVERAGE FORM
F. OPTIONAL ADDITIONAL INSURED 3. Additional Insured - Grantor Of Franchise COVERAGES WHO IS AN INSURED under Section is C.
amended to include as an additional insured If listed or shown as applicable in the Declarations, the person(s) or organization(s) shown in the one or more of the following Optional Additional Declarations as an Additional Insured - Insured Coverages also apply. When any of these Grantor Of Franchise, but only with respect to Optional Additional Insured Coverages apply, their liability as grantor of franchise to you. Paragraph (Additional Insureds When Required 6. by Written Contract, Written Agreement or Permit) 4. Additional Insured - Lessor Of Leased of Section , Who Is An Insured, does not apply C. Equipment to the person or organization shown in the a. C. WHO IS AN INSURED under Section is Declarations. These coverages are subject to the amended to include as an additional terms and conditions applicable to Business insured the person(s) or organization(s) Liability Coverage in this policy, except as shown in the Declarations as an Additional provided below: Insured – Lessor of Leased Equipment,
1. Additional Insured - Designated Person Or but only with respect to liability for "bodily Organization injury", "property damage" or "personal
and advertising injury" caused, in whole or WHO IS AN INSURED under Section is C. in part, by your maintenance, operation or amended to include as an additional insured use of equipment leased to you by such the person(s) or organization(s) shown in the person(s) or organization(s). Declarations, but only with respect to liability for "bodily injury", "property damage" or b. With respect to the insurance afforded to "personal and advertising injury" caused, in these additional insureds, this insurance whole or in part, by your acts or omissions or does not apply to any "occurrence" which the acts or omissions of those acting on your takes place after you cease to lease that behalf: equipment.
a. 5. Additional Insured - Owners Or Other In the performance of your ongoing operations; or Interests From Whom Land Has Been
Leased b. In connection with your premises owned
by or rented to you. a. C. WHO IS AN INSURED under Section is amended to include as an additional 2. Additional Insured - Managers Or Lessors insured the person(s) or organization(s) Of Premises
shown in the Declarations as an Additional
a. C. WHO IS AN INSURED under Section is Insured – Owners Or Other Interests From amended to include as an additional insured Whom Land Has Been Leased, but only the person(s) or organization(s) shown in the with respect to liability arising out of the Declarations as an Additional Insured - ownership, maintenance or use of that part Designated Person Or Organization; but only of the land leased to you and shown in the with respect to liability arising out of the Declarations. ownership, maintenance or use of that part of b. With respect to the insurance afforded to the premises leased to you and shown in the these additional insureds, the following Declarations. additional exclusions apply: b. With respect to the insurance afforded to This insurance does not apply to: these additional insureds, the following additional exclusions apply: (1) Any "occurrence" that takes place after you cease to lease that land; or This insurance does not apply to:
(2) Structural alterations, new (1) Any "occurrence" which takes place construction or demolition operations after you cease to be a tenant in that performed by or on behalf of such premises; or person or organization. (2) Structural alterations, new 6. Additional Insured - State Or Political construction or demolition operations Subdivision – Permits performed by or on behalf of such person or organization. a. C. WHO IS AN INSURED under Section is amended to include as an additional
insured the state or political subdivision
shown in the Declarations as an Additional
BUSINESS LIABILITY COVERAGE FORM
Insured – State Or Political Subdivision - (e) Any failure to make such Permits, but only with respect to inspections, adjustments, tests or operations performed by you or on your servicing as the vendor has agreed behalf for which the state or political to make or normally undertakes to subdivision has issued a permit. make in the usual course of business, in connection with the b. With respect to the insurance afforded to distribution or sale of the products; these additional insureds, the following additional exclusions apply: (f) Demonstration, installation, servicing or repair operations, This insurance does not apply to:
except such operations performed
(1) "Bodily injury", "property damage" or at the vendor's premises in "personal and advertising injury" connection with the sale of the arising out of operations performed for product;
the state or municipality; or
(g) Products which, after distribution
(2) "Bodily injury" or "property damage" or sale by you, have been labeled included in the "product-completed or relabeled or used as a operations" hazard. container, part or ingredient of any
7. Additional Insured – Vendors other thing or substance by or for a. WHO IS AN INSURED under Sect C. the vendor; or ion is amended to include as an additional (h) "Bodily injury" or "property insured the person(s) or organization(s) damage" arising out of the sole (referred to below as vendor) shown in the negligence of the vendor for its Declarations as an Additional Insured - own acts or omissions or those of Vendor, but only with respect to "bodily its employees or anyone else injury" or "property damage" arising out of acting on its behalf. However, this "your products" which are distributed or exclusion does not apply to:
sold in the regular course of the vendor's (i) The exceptions contained in business and only if this Coverage Part Subparagraphs (d) or (f); or provides coverage for "bodily injury" or
(ii) Such inspections, "property damage" included within the adjustments, tests or servicing "products-completed operations hazard". as the vendor has agreed to
b. The insurance afforded to the vendor is make or normally undertakes subject to the following additional exclusions: to make in the usual course of (1) This insurance does not apply to: business, in connection with the distribution or sale of the (a) "Bodily injury" or "property products. damage" for which the vendor is obligated to pay damages by (2) This insurance does not apply to any reason of the assumption of insured person or organization from liability in a contract or agreement. whom you have acquired such This exclusion does not apply to products, or any ingredient, part or liability for damages that the container, entering into, vendor would have in the absence accompanying or containing such of the contract or agreement; products.
(b) Any express warranty 8. Additional Insured – Controlling Interest unauthorized by you; WHO IS AN INSURED under Section C. is (c) Any physical or chemical change amended to include as an additional insured in the product made intentionally the person(s) or organization(s) shown in the by the vendor; Declarations as an Additional Insured – Controlling Interest, but only with respect to (d) Repackaging, unless unpacked their liability arising out of: solely for the purpose of inspection, demonstration, testing, or the a. Their financial control of you; or substitution of parts under b. Premises they own, maintain or control instructions from the manufacturer, while you lease or occupy these premises. and then repackaged in the original container;
Form SS 00 08 04 05 Page 19 of 24
BUSINESS LIABILITY COVERAGE FORM
This insurance does not apply to structural The limits of insurance that apply to additional alterations, new construction and demolition insureds are described in Section D. – Limits Of operations performed by or for that person or Insurance. organization. How this insurance applies when other insurance
9. Additional Insured – Owners, Lessees Or is available to an additional insured is described in Contractors – Scheduled Person Or the Other Insurance Condition in Section E. – Organization Liability And Medical Expenses General a. WHO IS AN INSURED under Sect C. Conditions.
ion is
amended to include as an additional G. LIABILITY AND MEDICAL EXPENSES insured the person(s) or organization(s) DEFINITIONS
shown in the Declarations as an Additional
1. "Advertisement" means the widespread public Insured – Owner, Lessees Or Contractors, but only w dissemination of information or images that ith respect to liability for "bodily has the purpose of inducing the sale of goods,
injury", "property damage" or "personal
and adverti products or services through: sing injury" caused, in whole or in part, by your acts or omissions or the a. (1) Radio; acts or omissions of those acting on your (2) Television; behalf: (3) Billboard; (1) In the performance of your ongoing (4) Magazine; operations for the additional (5) Newspaper; insured(s); or
b. The Internet, but only that part of a web (2) In connection with "your work" site that is about goods, products or performed for that additional insured services for the purposes of inducing the and included within the "products- sale of goods, products or services; or completed operations hazard", but only if this Coverage Part provides c. Any other publication that is given coverage for "bodily injury" or widespread public distribution. "property damage" included within the However, "advertisement" does not include:
"products-completed operations
a. The design, printed material, information hazard".
or images contained in, on or upon the
b. With respect to the insurance afforded to packaging or labeling of any goods or these additional insureds, this insurance products; or
does not apply to "bodily injury", "property b. An interactive conversation between or damage" or "personal an advertising among persons through a computer network. injury" arising out of the rendering of, or
2. "Advertising idea" means any idea for an the failure to render, any professional archi "advertisement". tectural, engineering or surveying services, including: 3. "Asbestos hazard" means an exposure or (1) The preparing, approving, or failure to threat of exposure to the actual or alleged prepare or approve, maps properties of asbestos and includes the mere , shop draw presence of asbestos in any form. ings, opinions, reports, surveys, field orders, change orders, designs or 4. "Auto" means a land motor vehicle, trailer or drawings and specifications; or semi-trailer designed for travel on public (2) Superv roads, including any attached machinery or isory, inspection, architectural or engineering act equipment. But "auto" does not include ivities. "mobile equipment". 10. Additional Insured – Co-Owner Of Insured Premises 5. "Bodily injury" means physical:
WHO C. a. Injury; IS AN INSURED under Section is
amended to include as an additional insured b. Sickness; or the person(s) or Organization(s) shown in the c. Disease Declarations as an Additional Insured – CoOw sustained by a person and, if arising out of the ner Of Insured Premises, but only with above, mental anguish or death at any time. respect to their liability as co-owner of the premises shown in the Declarations. 6. "Coverage territory" means: