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PROOF OF INSURANCE (2020 - 2020) CLOSEDCERTIFICATE OF LIABILITY INSURANCE DATE (9//20192019 Y' 10/009 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 ppolicy les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of tfle policy„ certain policies may require an endorsement. A statement on this cert'if'icate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER A/4NTACT ENAME: Mass Merchandising (ANC a5i: ...�.. ....... P, 1 800 328 2317 1-26.. _.. .._ K&K Insurance Group, Inc. 0-459-5502 1712 Magnavox Way f,' E-MAIL info@eventinsurance-kk.com Fort Wayne IN 46804 I[ ADDRESS; PRODUCER CUS'T'OMER. ID: INSURERS) AFFORDING COVERAGE NAIC n INSURED 2001138038 CP# 568 I INSURER A: Nationwide Mutual Insurance Company 23787 Claire M Mills INSURER B: 7901 Ostrom Avenue INSURER C: Lake Balboa, CA 91406 INSURER D: A Member of the Sports, Leisure & Entertainment RPG INSURER E: 06/28/19 06/28/20 INSURER F: COVERAGES CERTIFICATE NUMBER: 2000443832 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 TYPE OF INSURANCE ' ADDL SUBR POLICY NUMBER IVSD WVD POLICY EFF POLICY EXP (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X � 6BRPG0000007005600 06/28/19 06/28/20 EACH OCCURRENCE $1,000,000 CLAIMS -MADE OCCUR 12:01 AM 12:01 AM DAMAGE TO RENTED $1,000,000 PREMISES (Ea Occurrence) � MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY Excluded GE 'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $5,000,000 POLICY F—] PROJECT F—] LOC PRODUCTS—COMP/OP AGG $1,000,000 OTHER: PROFESSIONAL LIABILITY LIABTOPARTICIPANTS $1,000,000 AUTOMOBILE LIABILITY �LEGAL COMBINED SINGLE LIMIT(E'a accident) ANY AUTO BODILY INJURY (Per person) — OWNED SCHEDULED AUTOS ONLYAUTOS BODILY INJURY (Per accident) HIRED NON -OWNED PROPERTY DAMAGE _ AUTOS ONLY AUTOS ONLYI (Per aoaiden0 X Not provided while in Hawaii UMBRELLA LIAB iOCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS -MADE I I AGGREGATE DED n RETENTION WORKERS COMPENSATION N/A �PERSTATUTE�OTHER AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/ Y / N E.L EACH ACCIDENT EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE— EA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below EL DISEASE— POLICY LIMIT A MEDICAL PAYMENTS FOR PARTICIPANTS 06/28/19 06/28/20 PRIMARY MEDICAL $5,000 6BRPG0000007005600 12:01 AM 12:01 AM EXCESS MEDICAL DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Performing as Balloon artist, Face painter (use of non-toxic and FDA compliant ingredients only), Musician/singer/vocalist, Puppeteer The City of EI Segundo, its officers, officials, employees, agents and certified volunteers are added as an additional insured, but only for liability caused, in whole or in part, by the acts or omissions of the named insured. CERTIFICATE HOLDER The City of EI Segundo 350 Main St EI Segundo, CA 90245 Owner/Manager/Lessor of Premises SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 1988.2015 ACORD CORPORATION. All rights reserved. Coverage is only extended to U.S. events and activities. "" NOTICE TO TEXAS INSUREDS: The Insurer for the purchasing group may not be subject to all the insurance laws and regulations of the State of Texas. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 6BRPG0000007005600 COMMERCIAL GENERAL LIABILITY CG 20 26 0413 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 EI Segundo, its officers, officials, employees, agents and certified volunteers 350 Main St EI Segundo, CA 90245 Named Insured: Claire M Mills C P# 568 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 B. With respect to the insurance afforded to these additional insureds, additional insured the person(s) or organization(s) shown in the the following is added to Section III — Limits Of Insurance: Schedule, but only with respect to liability for "bodily injury", If coverage provided to the additional insured is required by a "property damage" or "personal and advertising injury" caused, in contract or agreement, the most we will pay on behalf of the whole or in part, by your acts or omissions or the acts or omissions additional insured is the amount of insurance: 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 broader than that which you are required by the contract or agreement to provide for such additional insured. 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. CG 20 26 04 13 C Insurance Services Office, Inc., 2012 Page 2 of 2 Named Insur Get your digital proof of insurance & membership card on the AAA App >>Download the app. Click AAA.com/app75 Electronic proof of insurance may not be valid as proof in all states. Please keep your hard copy version co hand. Must be a current AAA member and insured through AAA to use this feature. Available for Whol and smartphones for Android- Message, data and uoomung rates may appiq' ------'--------------------------------'--------------^---»----------------------. PROOF OF INSURANCE VEHICLES ON POLICY Interinsurance Exchange of the Automobile Club YEAR MAKE NAIC #: 15598 2005 TYTA PRIUS HYBRID 2015 TYTA PRIUS V HYBRID SW ed Policy Number: CAA062192889 2015 TYTA PRIUS HYBRID 5D 2WD CLAIRE MILLS Effective Date: 01/22/2019 Expiration Date: 01/22/2020 This policy provides at least the minimum amounts of liability insurance required by the CA VEH CODE SECTION 16056 for the specified vehicles and named insureds. Coverage subject to policy terms and limits. w Lu Lu Z DRIVERS ON POLICY R MILLS, CLAIRE 1 ILLINGWORTH, CHRISTOPHER J i VEH I.D. # I JTDKB20U353127140 JTDZN3EU9FJ018344 JTDKN3DU3F0455927 IF YOU II•IAW::.::; AN AC0IIC11EIIT CAUL.. CIU'IIR 2,417 AAA ACCIDEN"'I°' ASSII,ST II 10"rII.....IiNE 1.500 572-5246 After an accident, exchange information with the other party and follow these 5 easy steps: i Step 1: Pull vehicle over to a safe place. Get the names, addresses, 1 and phone numbers of all persons involved in the accident, e.g., ui pedestrians, witnesses, other passengers, etc. w n W r Step 4: Take photos of the vehicles involved, damages and surrounding area of the accident, if it is safe to do so. Step 5: Call our AAA Accident Assist Hotline at 800-672-5246 to Step 2: Take photos of or write down the other person's driver's ° report the loss. If necessary, we will arrange to have your vehicle towed. I i license information and other vehicle's license plate number, o Our provider's tow trucks always display the AAA emblem. v including state of registration. w Do not admit responsibility for or discuss the circumstances of the accident u Step 3: Take photos of or write down the other person's insurance with anyone other than the police or an authorized Auto Club claims u i card information. representative. Do not disclose your policy limits to anyone. For questions or changes to your policy, call 1-877-422-2100, Monday through Friday from 7 a.m to 9 p.m.. or Saturday from 8 a.m. to 5 p.m L--------------------------------------------------------------------- -__---_'__'----'-----------,-.._---..............--------.: Place a Proof of Insurance card in each vehicle insured under your policy. In addition, we suggest that each listed driver carry a card. Under California law, Call our AAA Accident Assist drivers and owners of a motor vehicle must be able to show proof of financial Hotline at 1-800-672-5246 responsibility at all times. These cards become invalid and should be destroyed on the expiration or termination date of the policy. o _--_----__---------_-_------__--_-_'- r-_----_-..... -------..........------------- ...... n PROOF OF INSURANCE ------___-- VEHICLES ON POLICY ~„ Interinsurance Exchangeof the Automobile Club YEAR MAKE VEH I.D. # NAIC M 15,598 2005 TYTA PRIUS HYBRID JTDKB20U353127140 q r 2015 TYTA PRIUS V HYBRID SW JTDZN3EU9FJ018344 " o Named Insured Policy Number: CAA062192889 2015 TYTA PRIUS HYBRID 5D 2WD JTDKN3DU3F0455927 u. r re CLAIRE MILLS I license information and other vehicle's license plate number, r r r ro W I o DRIVERS ON POLICY 0 MILLS, CLAIRE I Effective Date: 01/22/2019 Expiration Date: 01/22/2020 ILLINGWORTH, CHRISTOPHER J p r This policy provides at least the minimum amounts of liability insurance r o required by the CA VEH CODE SECTION 16056 for the specified vehicles and named insureds. Coverage subject to policy terms and limits. r r IF YOU HAVE AN ACCIDENT CALL OUR 24/7 AAA ACCIDENT ASSIST HOTLINE 1-800-672-5246 I I After an accident, exchange information with the other party and o rr follow these 5 easy steps: n aStep 1: Pull vehicle over to a safe place. Get the names, addresses, Step 4: Take photos of the vehicles involved, damages and and phone numbers of all persons involved in the accident, e.g., ui surrounding area of the accident, if it is safe to do so. a pedestrians, witnesses, other passengers, etc. w = Step 5: Call our AAA Accident Assist Hotline at 800-672-5246 to aStep 2: Take photos of or write down the other person's driver's report the loss. If necessary, we will arrange to have your vehicle towed rr I license information and other vehicle's license plate number, 0 Our provider's tow trucks always display the AAA emblem. r including state of registration. d Do not admit responsibility for or discuss the circumstances of the accident r tlStep 3: Take photos of or write down the other person's insurance with anyone other than the police or an authorized Auto Club claims N q card information, representative. Do not disclose your policy limits to anyone. I For questions or changes to your policy, call 1-877422-2100, Monday through Friday from 7 a.m. to 9 p.m. or Saturday from 8 a.m. to 5 p.m. _ -------.__...-----------_..-------------------------------'---------------------------__---------,--------,— LWebP01.CAA w 1 8165 (3119) 1014191419 22 1!I am 1111111111IIIIIIIIIIIIIIollili111111p1YPp1111111�1�IIIIIIJi;�Vl Vlulll°rlVllllll 'oiu111Ylll'j1'Illl��yl 1 IhI�I^illlillllllll rryI11�^I��^11i91'I�II1^u�llll��4�11�� . 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