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PROOF OF INSURANCE (2020 - 2020) CLOSEDACCIIIRV DATE (MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 4*.�" 1 8/221201 s YI 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(les) must 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). PRODUCERICONTACT TIB Transportation Ins Brokers AJA; LanderoS EJessica L �Ax 425 West Broadway,Suite 300 DANA No. Ext). o� tAr�no��: 818-246-4690 Glendale CA 9120 E -MAIL fros t bisuran .ca ? INSU, ..._ p .................- ...................................... �tE�Sj AFFORDING, ooVE9SAR3:�NAI .A41C ti _ INSURER A ...........m..........� FN.L....a..N.. -1 Lanc_e. rInsurance Co_n_ _y ..... 26#T7 INSURED inland Empire Stages Ltd .......w... ........ 9567 Eighth Street INSURER C: ,. _ Rancho Cucamonga CA 91730-4504 INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 870274852 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 'OLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. )M TYPE ........_........_....A,O�•, , _ ......................•.•.•POLICY NUMBER ..m.,..Ii$dILiJYI Y1°EFM"FYl I PDIU- C YYYi......_.........................................................................._. L E OF INSURANCE LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y GL15610ON17 B/311/2019 8/31/2020 EACH OCCURRENCE $ X _ bpAF+CL YrSi�FNTLD 5,000.000 .•..........�"Y CLAIMS -MADE .....,,., OCCUR .� •.�RE'M11.�.LI'WL�rel $ 100,000 E (Any one person) $ 5.00 "I PERSONAL&ADV INJURY ..............-.�_...................w...........___......0 .„GENERATSGCOMPIOPAGG $5,00 CI” GAITIITE LIMIT APPLIES PER: .GEPRO- GENERAGREGATE $5.000;000 1 Ol,lr Y JB•MI LOC ,...•. OTHER: $ AUTOMOBILE LIABILITY Y Y BA157040#17 1 8/31/2019 8/31/2020 COMMNED SINGLE d.IN9H ANYAUTO BODILY INJURY (Per person) s m_. ALL OWNED X SCHEDULED AUTOS AUTOS JURY BODILY IN(Per accident) ( $ X NO N - OWNED .'.. HIRED AUTOS ....X AUTOS ..LTIaCLiO.k„).................................$, T UMBRELLA LIAB OCCUR EACH OCCURRENCE ESS LIAB CLAIMS -MADE L...u....D�p...I AGGREGATE $......................................_._...._._.............. �- RETENTION $ . $ WORKERS .. 1 PER 7 . YERS' LIA AND EMPLOYERS' LIABILITY Y❑ E u RH A.TLl;T�..............,G,T........ANY ........,..........w•. RLITnON OFFICER%htlFMBER EXCLU D? ECUTIVE H / A •� E.L. EACH ACCIDENT a (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ I1 yyes, d2ddrbd random ... ....................... m,....,.,.. ........... DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more apace is required) THE CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS, EMPLOYEE'S, AGENTS AND VOLUNTEERS ARE ADDED AS ADDITIONAL INSURED BUT ONLY TO THE EXTENT THAT THE CERTIFICATE HOLDER IS HELD LIABLE FOR THE CONDUCT OF THE NAMED INSURED. ' WWAIVER OF SUBROGATION APPLIES" "THIS POLICY IS PRIMARY AND NON-CONTRIBUTORY" CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Clty of El Segundo Parks & Recreation 350 Main Street Room 5 AUTHORIZED REPRESENTATIVE EI Segundo CA 90245 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: GL156100#17 COMMERCIAL GENERAL LIABILITY CG 20 10 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OW'N'ERS, 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 OrganizationoW City of EI Segundo Parks & Recreation 350 Main Street Room 5 EI Segundo CA 90245 THE CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS, EMPLOYEES, AGENTS AND VOLUNTEERS ARE ADDED AS ADDITIONAL INSURED BUT ONLY TO THE EXTENT THAT THE CERTIFICATE HOLDER IS HELD LIABLE FOR THE CONDUCT OF THE NAMED INSURED. "WAIVER OF SUBROGATION APPLIES"'THIS POLICY IS PRIMARY AND NON-CONTRIBUTORY" Location(s) Of 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) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for 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 or agreement to provide for 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 work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 2 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 of 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. Page 2 of 2 0 Insurance Services Office, Inc-, 2012 CG 20 10 0413 0 POLICY NUMBER: BA157040#17 COMMERCIAL AUTO CA 04 44 110 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF FIGHTS OF RECOVERY AGAINST OTHERS TO U'S(WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM 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 policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Inland Empire Stages, Limited Endorsement Effective Date: 08-31-2019 SCHEDULE Name(s) Of Person(s) Or Organization(s): CITY OF EL SEGUNDO PARKS & RECREATION 350 MAIN STREET ROOM 5 EL SEGUNDO, CA 90245 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. CA 04 44 110 13 C Insurance Services Office, Inc., 2011 Page 1 of 1 THIS PAGE INTENTIONALLY LEFT BLANK POLICY NUMBER:GL156100#17 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF' RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: CITY OF EL SEGUNDO PARKS & RECREATION 350 MAIN STREET ROOM 5 EL SEGUNDO, CA 90245 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or ..your work' done under a contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 0 Insurance Services Office, Inc., 2008 Page 1 of 1 THIS PAGE INTENTIONALLY LEFT BLANK GU 207 (AIP) (Ed. 6-7 8) 1A Z I.•- 1:4 4 4 This endorsement, effective on 8/31/2019 at 12:01 A.M. standard time,forms a part of Policy No.BA15'7040#17 of the LANCER INSURANCE COMPANY (Name of insurance company) Issued to INLAND EMPIRE STAGES, LTD. by LANCER INSURANCE COMPANY Autized Representative cr It is hereby understood and agreed that the folowing is added as Additional Insured only with respects to operation of the named insured. Name: City of El Segundo Parks & Recreation 350 Main Street Room 5 El Segundo CA 90245 The City of El Segundo, its officers, officials, employees, agents and volunteers are added as additional insured but only to the extent that the certificate holder held liability for the conduct of the named insured. "waiver of subrogation applies" "this policy is primary and non- contributory." ISSUE DATE: 8/31/2019 Page 1 of 1 (Ed.6-78) 11--111111 0 ' CC> CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDNYYY) a 1/13/2020 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 be endorsed. If SUBROGATION IS WAIVED, subject to the meat j BY q ndorsemenL A statement on this certificate does not confer rights to the PRODUCER te s andconditions inllieu of such endorsemeritt policies m require an n policy, �.. Tli� certificate holder ( I West ns Brokers PSM��II:.....0�818.246-280e'._:...... �—.1.F FAX 1 a ... _A.... . 25 Transportation SroadY�a Suite .400 A+ _...�Illl:....m.m..�.� _ 8 ......690 Glendale CA 91204 rrI .. m._.m i MAIL oalanesyan tibinsuranCe. o _. mNSUaaEalsiwT,oRpIPIr CpuErIrAG ._.._.._......... NAIC Yr ......... .......... ...NSURER...Ce Stages Ltd. INLA.- INSURER .INSURER A: �° ' m Co of �rica22179 r95�a7d lrinP,I..... __.�.....................__�_..__..,..,.....mm.�__—.................................... N 1 rNsuRERc. ��.1.lc Inde....... America _._........................... .. Inlan hth Street Rancho lgCucamonga CA 91730-4504 INSURER D: __....... INSURER E : I INSIIRERF: COVERAGES CERTIFICATE NUMBER: 1876877865 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVEFOR 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- pNa.�... POLICY N POLICY EFFPOLICY EkP .......... LTR' TYP......... __ _ __ E OF RANGE �ALICL��J��ik ...............w.... UMBER 4MIHIPN;�PSfYYY'Y'f�f�NNMIDD/"N",YYYtlLIMITS COMMERCIAL GENERAL LIABILITY— EACH p 0............ l' OCCURRENCE CLAIMSWAGERENY0--,_,J.......m.. . ............CLAIMS-MADE OCCUR .,.,.m.... ...�..............----.................... ........�..._—_____......................... MED EXP (Any one person) $ GE,�'L,AGGREGATELIMIITAPPLIESPER ..............�.� GENERAL AGGREGATE Y........ �.__...m__... �,...�„�...............................� .. MPRO- I�RODUC'TS ,.._.....-...�.......,_,....... POLICY C----1 JECT [7 LOC .......... ...._.....:'....... .. G $ OTHER ,... MPP AG Is ikP�elndECD S;IICt.E f.IrIIIT AUTOMOBILE LIABILITY B ..9.1?i IN?P.'4 S..............................................___ ANY AUTO BODILY INJURY (Per person) $ ._ HIRED AUTOS AUTOS . i��....�..�......... ......._.�t) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY R INJURY (Per Y TY DAMA�sE�den°.. $ .,..., flq" EACH OCCURRENC,E....,,��. �,.��� �� ................�_...__._.I ,_ .-...... OCCUR — p......._..._...........TE.. DED REL ARE........... LIAR EXCESS LI AB S CLAIMSa1MDE Gly _. _................. �.�.......�.�.............�.. .... ,AGGRE WORKERS COMPENSATION ANY PROPRIETOR/PARTNEWEXECUTIVE LITY Y! N N / A 15689019 10/1/2019 10/112020 E.L EACii AC MH TDo A 6AN ndIMPryEMNR ISI EXCLUDED' Y �TA'TGJT ACCIDENT �G._ER ............... Dyes, IPTI be under E.L DISEASE - POLICY LIMIT $ 1.0001000 0 ........... 0 D 0�. ESCRIPTP�ON OF OPERATIONS below i, ., I .,.,., .., ., ' DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached H more space is required) Officer Exclusion Applies - Curtis Basey, Nicole Basey CER'T'IFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of EI Segundo Park &Recreational ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main St ROorn 5 AUTHORIZED REPRESENTATIVE EI Segundo CA 90245 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 04-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule State Person or Organization Job Description California City of EI Segundo Operations of insured. Recreation and Parks Department 401 Sheldon St EI Segundo, CA 90245 The premium charge for this endorsement shall be $50. This charge will be billed at the final audit, This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. Republic Indemnity Company of America Company Number Insured ....................... Policy Number Endorsement Number Endorsement Effective Printed On WC 00 03 13 (Ed. 04-84) 1983 National Council on Compensation Insurance. Countersigned by Insured Copy