PROOF OF INSURANCE (2023) CLOSEDJAMETHO-01 'M
CERTIFICATE OF LIABILITY INSURANCE �,..........D
A1.0.')..
(MM/DDfYYYY)
/11/2022
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 endorsementfs),
PRODUCER �Ivwl roc" up a I V I Q $
Momentous Insurance Brokerage, A Marsh & McLennan Agency LLC
Company
5990 Sepulveda Blvd., #550
Van Nuys, CA 91411
INSURED
James Thomas Productions Event & Entertainment, Inc.
1300 Highland Avenue #200
Manhattan Beach, CA 90266
INSURER 0;
MA,
8181933-2700 trAIC N.148181933-2701
New York Marine and General Insurance
COVERAGES CERTIFICATE NUMBER:
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 AD"6L'!S bb"R
-LiR TYPE OF INSURANCE ... POLICY NUMBER ....
POLICY EFF POLICY FXP
1NIMMP_/nyy2___ LIMITS
A X COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE S
I 000,0010
CLAIMSAAADE X_J OCCUR PK202200001202
512/2022 5/2/2023 0 AMAGE 7 OR EN TED
1 11 1
1 00e.,000
I X X
occp�rvn*_ S ........................
........ .. _ , , " _
5,000
MEDEXP (Any one person, S
1,000,000
PERSONAL & ADV INJURY S
2,000,000
GENL AG(3RECA7ELIMIH APPLIES PER
X POLICY 7, LOC
GENERAL AGGREGATE S
U COMP/OP AGG S
1,000,000
QrHER
AUTOMOBILE LIABILITYC0M5UqEDSft.3LE
�PK202200001202
I W1
. ....................00
1,000,000
ANYAUI0 X X
5/2/2022 5/2/2023 B DJI.YJN,U
OWNED SCHEDULED
AUTOS ONLY AU.I OS
(DPI YINJURY (G er aepce _Q9_ S
............................... . ......
X HIRED X NON 0VVNI -1)
rXIROPERTYDAMAGE
A I rOS ONLY Au ro., oKL�
S
9!1u_1111____ ll S
x I iii ed AiAo PD
Deductible
1,000
B UMBRELLA LIAB X OCCUR
EACI d OCCURRENCE S
5,000,000
X EXCESS LIAB CLAIMS -MADE X X MKLM5EUL100297
5/212022 5/212023 AGGREGATE
6,000,000
DED REliENIIONS
A WORKERS COMPENSATION
y PER OTH.
TUj E F R�
AND EMPLOYERS' LIABILITY YIN X WC202200009207
'
....... _J, . . ..........
5/2/2022 5/2/2023
1,000,000.
ANY PROPRIETOR/PARTNER/EXECUTIVE
EXCLUDED" Y NIA
'a4�
E L EACH ACODENT - — --- -
—
,XEWMEMBER
I in NH}
1 000,00 0
a ory
E I EA ENIPLOYEE"S
,
If yes, describe under
1 1
1,000,006
E L OSEASE -POLICY OWT 5
DESCRIPTION; OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addiflonal Remarks Schedule, maybe attathed if more space is required)
The City of EI Segundo, its officers, officials, employees, agents, and volunteers are included as additional insured as required by written contract
The City of El Segundo, its officers, officials, employees,
agents, and volunteers
350 Main Street
El Segundo, CA 90425
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
-�(,Wk Oiert"
ACORD 25 (2016/03)
@ 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD