Loading...
PROOF OF INSURANCE (2022) CLOSEDA CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 07/15/2022 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 Gary E. Krouse Insurance Services, Inc. 920 Topanga Canyon Place, Unit H Chatsworth, CA 91311 NAIC # Phone No. 818 407 5300 _ Fax No. (818) 407-5308 INSURER A: AGL-American Guarantee and Liabilit)_Insurance Company 26247 . INSURER INSURED INsuRERBwwww� I -Zurich American Insurance Comp_an�r 16535 EL SEGUN DO ART WALK, LLC 142 RICHMOND ST INSURERC. El Segundo, CA 90245 INSURER Dt INSURER E : Phone No. 213 804-0044 Fax No. I INSURER F : COVERAGES CERTIFICATE NUMBER: 975386 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. IN5R ........... XWE su._. ......._.�_ BR .�. POLICY EFF POLNCY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MPoMN, D 'YY MWDDIYYYY ZAI X COMMERCIAL GENERAL LIABILITY FLM4010492-00 08/26/2022 08/28/2022 EACH OCCURRENCE $ 1 000.000 .......x ............ CLAIMS -MADE 7X OCCUR X X _.ffAVAr.r:'Tf RE PREMISES_(„Ea raccgETnce„ _„_, $ 100.OQ0.... X Host Liquor MED EXP (Any one person) $ M0 X Full Llquor(1,000,000,A;g,g(,OCglIT_„ PERSONAL & ADV INJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE , POLICY REor ❑ LOC PRODUCTS -COMPIOP AGG ._...._2,00000 $ 1 000,000 X OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE UMET t~a up.rcYdenrl $ .... ANY AUTO BODILY INJURY (Per person) ''. $ ...... OWNED SCHEDULED BODILY INJURY (Per accident) I� $ AUTOS ONLY AUTOS NON -OWNED TY ANr1AGF $ AUTOS ONLY ''AUUTOS ONLY (Per aFcdc�u nt'HIRED Per AC UMBRELLA LIAR X OCCUR SXS1182894-00 08/26/2022 08/28/2022 EACH OCCURRENCE $ ,,1 QQ OOO X EXCESS LIAB CLAIMS -MADE AGGREGATE $ 1.900 OOO DED ''.. RETENTION $ $ WORKERS COMPENSATIONPER STATUTE EORH AND EMPLOYERS' LIABILITY YIN ANYPROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NIA E,L. EACH ACCIDENT mmmmmmmmmmw _ $ """"' '....(Mandatory inNH) E,L.DISEASE - EA EMPLOYEE .... ..M ........ $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L.. DISEASE- POLICY LIMIT $ I Inland Marine FLM4010492-00 08/26/2022 08/28/2022 See Attached DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES Coverage Location: United States & Canada Event: EL SEGUNDO ART WALK Certificate holder is named as additional insured and loss payee as their interest may appear. Coverage is primary and non-contributory. All coverages expire at 12:01 a.m. Standard Time. The actual event dates may be limited_ Please review the Scheduled Events form attached to this certificate. CERTIFICATE HOLDER CANCELLATION CITY OF EL SEGUNDO 350 MAIN STREET EL SEGUNDO, CA 90245 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. United States Of America AUTHORIZED REPRESENTATIVE �. Phone No. I Fax No, ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD This certificate of insurance does not affirmatively or negatively amend, extend, or alter the coverage afforded by the insurance policy. DATE (MM/DD/YY) ADDITIONAL COVERAGE DETAILS 07/15/2022 INSURED EL SEGUNDO ART WALK, LLC The following is attached to and made part of certificate number 975386. Policy Details Coverage Limit Deductible Inland Marine Company: Zurich American Insurance Company Policy Number: FLM4010492-00 *Period: 08/26/2022 - 08/28/2022: 2 Day(s) Equipment, props, sets, wardrobe (rented) 10,000 1,000 Equipment, Props, Sets, Wardrobe (owned) Excluded Rented Furs, Jewelry, Art & Antiques Coverage Excluded Extra Expense Excluded Third Party Property Damage 10,000 1,500 Hired/Non-Owned Physical Damage -Aggregate Excluded Hired/Non-Owned Physical Damage -Per Vehicle Excluded Rental Cost Reimbursement Excluded Waiver of Subrogation Excluded Coverage Extension Endorsement Coverage Extension Endorsement Excluded Terrorism Included General Liability Company: Zurich American Insurance Company Policy Number: FLM4010492-00 *Period: 08/26/2022 - 08/28/2022: 2 Day(s) General Aggregate 2,000,000 Products / Completed Operations 1,000,000 Personal/ Advertising Injury 1,000,000 Each Occurrence 1,000,000 Fire Legal 100,000 Medical Payments 5,000 Blanket Additional Insureds (other than city/special certs & Included waivers) City / Other Special Certificates Included Waiver of Subrogation Included Host Liquor Included Liquor Liability -Aggregate 1,000,000 Liquor Liability -Each Common Cause Limit 1,000,000 Abuse & Molestation -Aggregate Excluded Abuse & Molestation -Each Claim Excluded Abusive Act Alleged Participant Supplemental Coverage - Excluded Aggregate Abusive Act Alleged Participant Supplemental Coverage - Excluded Occurrence Participant Legal Liability -Aggregate Limit Excluded Participant Legal Liability - Occurrence Limit - Bodily Injury Excluded Participant Legal Liability - Occurrence Limit - Property Damage Excluded Terrorism Included *All coverages expire at 12:01 a.m. Standard Time. APM-CERT-DETAILS 1009 Certificate Number 975386 Scheduled Events Certificate Number: 975386 Event Type Venue Dates Attendees EL SEGUNDO ART WALK Block parties (over 100 attendees) EL SEGUNDO ART WALK LOCATIONS 08/26/2022 - 08/28/2022 at 12:01 am 212 EUCALYTPUS DR AND PARKING LOT OF 314 MAIN STREET EL SEGUNDO, CA 90245 200 Participants 3,000 Spectators ABANEV-SCHD(05/06) Page 1 of 1 DATE (MM/DDNY) SCHEDULE OF FORMS 07/15/2022 Insured: EL SEGUNDO ART WALK, LLC This Schedule of Forms is attached to and made part of certificate number 975386, as of 07/15/2022 at 12:39 PM PT, and lists the forms included in the policy(s) and subsequent endorsement (s) at the time this certificate was issued. Form # Ed. Name Special Event Package Notices U-GU-319-F 0109 Important Notice - In Witness Clause U-GU-874-A 0611 Notice of Disclosure for Agent and Broker Compensation UGU873ACW 0611 Disclosure Statement U-GL-1197-A CW 0104 Asbestos Exclusion Endorsement U-GU-1191-ACW 0315 Sanctions Exclusion Endorsement Common UGU727ACW 0806 Commercial Insurance Policy UGUD310A 0193 Common Policy Declarations UGU619ACW 1002 Schedule of Fors and Endorsements UGU621ACW 1002 Schedule Of Named Insured(s) UGU618ACW 1002 Schedule Of Locations IL0017 1198 Common Policy Conditions U-GU-1223-B CA 0916 Revised Definition Of Spouse Endorsement UABI100ACW 0117 Schedule Of Productions UABI101ACW 0117 Definition Of Employee UAB100ACW 0117 Minimum Earned Premium Endorsement IL0270 0720 California Changes - Cancellation and Nonrenewal Endorsement IL0003 0908 Calculation of Premium U-GU-630-ECW 0120 Disclosure of Important Information Relating to Terrorism Risk Insurance Act Inland Marine UABMD104ACW 0117 Commercial Inland Marine Declarations Entertainment Program UGU619ACW 1002 Schedule of Forms and Endorsements CM0001 0904 Commercial Inland Marine Conditions UABM133ACW 0117 Common Conditions, Exclusions And Definitions UABM105ACW 0117 Miscellaneous Equipment Coverage Form UABM106ACW 0117 Props, Sets And Wardrobe Coverage Form UABM109ACW 0117 Third Party Property Damage Coverage Form UABM103ACW 0117 Loss Payable Endorsement UABM128ACW 0117 Excluded Property Endorsement UABM114ACW 0117 Unscheduled Production, Presentation Or Event Exclusion UABM100ACW 0117 Stunt, Animal Exposure And Pyrotechnic Exclusion U-GU-767-BCW 0115 Cap on Losses From Certified Acts of Terrorism General Liability UABLD10OBCW 0119 Commercial General Liability Coverage Part Declarations UGU619ACW 1002 Schedule of Forms and Endorsements UABI110ACW 1020 Schedule of Events CG0001 0413 Commercial General Liability Coverage Form CG2011 1219 Additional Insured - Managers of Lessors of Premises CG2012 1219 Additional Insured - State or Governmental Agency or Subdivision or Political Subdivision - Permits or Authorizations CG2026 1219 Additional Insured - Designated Person or Organization CG2028 1219 Additional Insured - Lessor of leased equipment CG2404 1219 Waiver of Transfer of Rights of Recovery Against Others to Us U-GL-1327-BCW 0413 Other Insurance Amendment - Primary And Non- Contributory UABL128ACW 0117 Additional Insured - Owners Or Lessees Scheduled Person Or Organization Primary and Noncontributory Coverage UABL121ACW 0117 Limited Stationary Aircraft Coverage CG2106 0514 Exclusion -Access or Disclosure of Confidential or Personal Information and Data -Related Liability - With Limited Bodily Injury Exception U-GL-1171-B-CW 0719 Fungi Bacteria Exclusion U-GL-1178-A-CW 0703 Asbestos Exclusion CG2147 1207 Employment Related Practices Exclusion U-GL-1517-BCW 0413 Collection or Distribution of Material or Information in Violation of Law Exclusion UABL131ACW 0117 Non -Performing Animal Exclusion UABL102ACW 0117 Property Damage To Rented Premises Exclusion UABL129ACW 0117 Assault And Battery Exclusion UGL1250ACW 0905 Abusive Act Liability Exclusion UABL122ACW 0117 Newly Acquired Or Formed Entity Exclusion UABL107ACW 0117 Exclusion - Insureds Conducting Media, Entertainment, Or Internet Type Operations UABL130ACW 0117 Informational Content Exclusion UABL135ACW 0117 Media Content Exclusion UABL137ACW 0117 Cross Suits Exclusion UABL138ACW 0117 Personal And Advertising Injury - Exclusion Of False Arrest, Detention, Imprisonment, Libel, Slander, Right Of Privacy, Advertising Idea, And Copyright, Trademark Or Trade Secret UABL106ACW 0117 Unscheduled Production, Presentation Or Event Exclusion UABL103ACW 0117 Stunt, Pyrotechnic And Animal Exposure Exclusion UABL144ACW 1019 Event Conditional Exclusion CG2132 0509 Communicable Disease Exclusion UABL146ACW 1019 Unscheduled Products Exclusion UABL145ACW 1019 Hazardous Activities, Pyrotechnic Activities and Animal Exposure Exclusion UABL147ACW 1019 Loss Arising Out of Participation in a Sports or Athletic Event, Competition, Contest or Exhibition Exclusion UABL143ACW 1019 Moshing Exclusion APA-C ERT-FORM LIST 0914 Certificate Number. 975386 Page 1 of 2 DATE (MWDD/YY) SCHEDULE OF FORMS 07/15/2022 Insured: EL SEGUNDO ART WALK, LLC This Schedule of Forms is attached to and made part of certificate number 975386, as of 07/15/2022 at 12:39 PM PT, and lists the forms included in the policy(s) and subsequent endorsement (s) at the time this certificate was issued. Form # Ed. Name UABL150ACW 1019 Camping Conditional Exclusion UGLD1036BCW 0904 Liquor Liability Coverage Part Declarations CGO033 0413 Liquor Liability Coverage Form IL0021 0908 Nuclear Energy Liability Exclusion Endorsement (Broad Form) UABL105ACW 0117 Commercial General Liability Changes U-GU-767-BCW 0115 Cap on Losses From Certified Acts of Terrorism Excess Liability Policy Excess Liability Notices U-GU-1191-ACW 0315 Sanctions Exclusion Endorsement U-GU-874-A 0611 Notice of Disclosure for Agent and Broker Compensation Forms U-SXS-104-ACW 0911 Straight Excess Liability Policy (Jacket) UGU621ACW 1002 Schedule Of Named Insured(s) U-SXS-D-100-ACW 0911 Straight Excess Liability Policy Declarations U-SXS-101-ACW 0911 Schedule of Underlying Insurance U-SXS-103-ACW 0911 Schedule of Forms & Endorsements U-GU-630-ECW 0120 Disclosure of Important Information Relating to Terrorism Risk Insurance Act U-SXS-100-ACW 0911 Straight Excess Liability Policy U-GU-767-BCW 0115 Cap on Losses From Certified Acts of Terrorism U-SXS-117-BCW 0514 Professional Liability Limitation Endorsement U-EXS-115-CCW 0411 Communicable Disease Exclusion UEXS319CCW 0514 Liquor Law Liability And Alcohol Consumption Health Hazards Exclusion UEXS101BCW 0411 Abuse Or Molestation Exclusion UEXS107ACW 0499 Athletic Participants Exclusion U-GU-1223-B CA 0916 Revised Definition Of Spouse Endorsement U-EXS-312-FCW 0514 Exclusion - Recording and Distribution of Material or Information in Violation of Law U-EXS-178-BCA 0411 California Cancellation and Nonrenewal U-SXS-120-A CW 0911 Total Pollution Exclusion with Hostile Fire Exception Disclaimers This Certificate of Liability Insurance includes the Type of Insurance, Limits, and Schedule of Forms in effect as of 07/15/2022 at 12:39 PM PT. It does not affirmatively or negatively amend, extend, or alter the coverage afforded by the insurance policy nor confer any rights upon the certificate holder. You may be required to request an updated certificate in the event of subsequent policy modifications. The information included in this certificate that has been provided by Abacus Insurance Brokers, LLC is for your information only, and does not create a contract or agency relationship between the certificate holder or any insured and Abacus Insurance Brokers, LLC. By accepting this certificate the certificate holder acknowledges that Abacus Insurance Brokers, LLC is not the agent of the certificate holder or any insured, but is solely the agent of the listed carder(s). Abacus Insurance Brokers, LLC makes no representation whether the coverages listed herein are appropriate for the certificate holder or any insured. Please review the listed coverages carefully and direct any questions to your broker. For a complete listing of coverages, terms, conditions and exclusions, please view the referenced Policy(s). APA-CERT-FORMLIST 0914 Certificate Number: 975386 Page 2 of 2 Certificate Verification Insured: EL SEGUNDO ART WALK, LLC Abacus provides an efficient website lookup tool for certificate holders to verify the authenticity of certificates of insurance. 1. Navigate to the website and input the verification code OR Scan the QR code. 2. The actual certificate issued through the Abacus Platform will download. 3. Compare the details of the downloaded certificate to the certificate presented by the client. Website Verification Code www.abacus.net/verify-certificate 0804KTWCM2 About Certificates Issued through the Abacus.net Platform Date (MM/DD/YYYY) 07/15/2022 • Abacus requires that all certificates be issued through the Abacus Platform. Certificates issued outside of the Abacus Platform are invalid. • Certificates may be issued through the Abacus Platform by either the named insured (if registered through the Abacus Platform) or their Abacus registered insurance broker. • Certificates with any stray marks, cross outs or alterations of any sort are invalid. • Each certificate is numbered and correlates to the document issued through the Abacus Platform. APA-CERTVER 0917 Certificate Number: 975386 Page 1 of 1