PROOF OF INSURANCE (2021 - 2021) CLOSEDPRESENT OP to: RG
CERTIFICATE OF LIABILITY INSURANCE DATEIMMfDD,YYYY)
1� - 1 0107/2021
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 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),
CONTPRODUCER NAME: Ruth Rodriguez
PIASC Insurance Services, Inc. PHONE -- FAX
Lic. # 0747420 INP, Nq Ext) 323-400-6705 INC, N,):-323-2-48-93.1 0
5800 S. Eastern Ave. Suite 440 ADDR
E-MAIL ss: Ruth@piascins.com
Los Angeles, CA 90040 -- ..
Anthony AMatorre INSURER(S)FF
AORDING COVERAGE _ NA#C #
INSURER A : Travelers Property ✓# Casualty 1, 2J' 674
INSURED Presentation Media, Inc. INSURER B :OmahalPreferred Professional
DBA: Tandem Exhibits
1916 W 144th St INSURER C
Gardena, CA 90249 INSURER D :
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER; REVISION NUMBER:
THIS IS TO CERTIFY THAT IHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PO'-ICY 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,
EXCL USIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NSR'ADDS Sil&Ft, POLICY EFF _ _.PoUCY EXP.
IL7R . TYPE OF INSURANCE INSD:� WVn- POLICY NUMBER,-_ . (MMIDDIYYYYf IMMfDD(YYYYI LIMITS
A Xi COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000
. - DAMAGE'TORtNTEC)._-. -_ ... .. -- •
C'_AiNiS-NIADE�ruR
DY Y 684-sJ205664 0611712024 06!1711
. X OCCUR PREMISES (Ea occurrence),300,
_ S --_- .400
'
MED EXP {Any orae pwsm y s 5,000
X GL BROAD FORM ENI) PERSONAL & ADV INJURY S 1,000,000
GEN'L AGGRP6 ATE LIMIT APPLIES PER ' _GENERAL AGGREGATE ;S S 2,000,000
POIIL"
X
PRO- PRODUCIS-COMP OPAGG S 2,000,000
LOC
__.. -. -
_ . ,IECT ., .
OTHCR. - .Emp Ben. 1,000,000
AUTOMOBILE WA6141TY COMBINED SINGLE LIMIT �S 1,000,000
A XANY AUTO BAI N169604 4611712020 0611712021 ! 8OD1LY IN JURY tPer persnn) c
- ALL OVINED SCHEDULED BODILY IWI-I :Y Ip'.r arx:ident; 4
AUTOS AL ITOS
NON-OV'INED ! '-PRp4'BRTY DAMAGE S
HIRED AUTOS X AUTOS {Per accido.L,
`J{ UMBRELLALIAB I i1
,
, ._.... .
w 00
t(J1 f3000
3,440,44
AExcFssI !ArCUP-6J348780 '06117720200611712021 AGGREGATE
LLAI1s-rcE
DEC RETENTIONS NIA
-g
COMPENSATION t---
' P R
EORr-H-
-
E_1,000
AND EMPLOYERS' LIABILITY YIN ;.s---..... ,B ANY PROPRIETOR PARThEft7EXEC.UTIJF i DN4897342 0610112021E.L- EACH ACCIDENT 44
(ManMEXCLUDED?
datory in NH) PROOF OF COVERAGE ONLY* , 'AEMPloE.._.1,400,00
It ves, describe under !- ,
DESCRIPTION OF OPERATIONS balsw E-L. DISEASE - POLICY LthilT : S 1,000,00
A Errors&Omissions 680-6J205664 0611712020 06/17/2021 ';Limit: 1,000,000
Liability Ded: 1,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attaubed it more space is requiredl
Certificate Holder is named as Additional Insured with respects to work
performed by the named insured.
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,
EI Segundo Police Department
,Iulissa Chavez AUTHORIZED REPRESENTATIVE
348 Main Street .,
EI Segundo, CA 90245
O 1988.2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
NOTEPAD iNSUREWS NAME
Presentation Media, Inc.
APPLICABLE COVERAGE FORMS:
PRESENT
OP ID: RG
-GENERAL LIABILITY Additional Insured When Required by Written Contract,
Written Agreement or permit per Coverage Form CG Dl 05 04 94
-GENERAL LIABILITY Primary & Non Contributory When Required by Contract
per Coverage Form CG DO 37 04 05
-GENERAL LIABILITY Waiver of Subrogation per Coverage Form CG D1 86 11 03
-GENERAL LIABILITY Separation of Insureds per Coverage Form CG 00 01 10 01
-GENERAL LIABILITY BLANKET ADDITIONAL INSURED - MANAGERS OR LESSORS OF
PREMISE Coverage Form CG D1 86 11 03
-BLANKET ADDITIONAL INSURED - LESSOR OF LEASED EQUIPMENT Coverage Form
CG D1 86 11 03
APPLICABLE AUTO COVERAGE FORMS:
--AUTO Additional Insured if Required by Contract per coverage form
-Auto Primary & Non Contributory if Required by Contract per Coverage Form
-AUTO Waiver of Subrogation if required by written contract per Coverage
Form
First Named Insured and Other Named Insureds
Presentation Media, Inc.
dba Classic Letters
dba Colortek Digital
dba Extraordinary Show Productions
dba ESP Exhibits
dba Tandem Exhibits
dba Adage Graphics
INSURED LOCATIONS & PROPERTY VALUES SCHEDULE:
1846 W. Sequoia Avenue, Orange, CA 92868
- BUSINESS PERSONAL PROPERTY LIMIT $423,766
1910-1920 144th Street, Gardena CA 90249
- BUSINESS PERSONAL PROPERTY LIMIT $1,174,570
APPLICABLE:
SPECIAL FORM, REPLACEMENT COST, $1000 DEDUCTIBLE
TRAVELERS PRPERTY CASUALTY COMPANY OF AMERICA (MAIC 25674)
AM BEST RATING A++ (004461)
TRAVELERS CASUALTY INSURANCE COMPANY OF AMERICA (NAIC 19046)
AM BEST RATING A++ (19046)
PAGE 2
Date 01/07/2021
................. ...........
�iNOTEPADINSURED'S NAME PRESEW PAGE 3
OP ID: RG Date 01/07/2021
Presentation Media, Inc.
APPLICABLE COVERAGE FORM WORKERS COMPENSATION:
BLANKET WAIVER OF SUBROGATION - CA FORM WC ON 04 WS A
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC ON 04 WS A
(Ed. 01-19)
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 agfeernent from LIS.)
You MUSt maintain payroll records accurately segregating the remuneration of your employees while engaged in the work
described in the Schedule.
Blanket Waiver: The additional premium for this endorsement shall be 2% of the California workers' compensation premium
otherwise due on such remuneration.
Specific Waiver: The additional premium for this endorsement shall be 5% of the California workers' compensation premium
otherwise due on such remuneration.
Schedule
Person or Organization Job Description
Blanket Waiver of Subrogation As respects to all CA jobs performed by the named insured during the
policy period where by written contract a waiver of subrogation is
required prior to the commencement of work.
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.
(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)
Endorsement Effective: 06/01/2020
Insured Presentation Media, Inc.
Policy No.: ON08973 - 02 Endorsement No.:
Insurance Company Preferred Professional Insurance Company
By