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PROOF OF INSURANCE (2023 - 2023) CLOSEDDATE (MMIDDIYYYY) CERTIFICATE 4F LIABILITY INSURANCE E11i29i2022 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). (PRODUCER ?k Terri Shumaker Robert Bell Insurance Brokers Inc„ 605 East Alvarado Street Suite 200 Fallbrook CA 92028 INSURED Pico Rents inc., DBA: Pico Party Rents b Sells 4646 E Los Angeles Ave Simi Valley CA 93063 IN COVERAGES CERTIFICATE NUMBER:22-23 MASTER I)-,(760)951-8556 FAXNq,, I�aoI�si-sail terri@roberthellinsurance.com - Axis REVISION NUMBER: 3 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 CONTRACTOR 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. �_ ..... INS POLICPOLICY EXP TYPE OF INSURANCE M POLICY NUMBER MMIDDYYYY IFI' MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A Add A CLAIMS -MADE OCCUR P18E1"6l9 Ea occxaoreracx $ 100,000 MED EXP (Any one person) $ 5,000 X AIPICA001-032992-04 5/1/2022 5/1/2D23 PERSONAL & ADV INJURY $ 2,000,000 GENI AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE '.$ 2,000,000 X POLICY ❑ JPE'R0CT LOC PRODUCTS - COMP/OPAGG S 2,000,000 $ OT'HERt AUTOMOBILE LIABILITY BAED SIN7E.412� IT c r LA $ l,000,aoo BODILY INJURY (Per person) $ X _.. ANYAUTO BODILY INJURY (Per accident) S ALL OWNED SCHEDULED AUTOS AUTOS AlPICA001-032992-04 5/1/2022 5/1/2023 X HIRED AUTOS X NON -OWNED PROPERTY DAMAGE � .._.. AUTOS Gvar arr„c icr,.. S X UMBRELLALIAB X OCIUR EACH OCCURRENCE $ 11000,000 AGGREGATE 5 1,000,000 A EXCESS LIAR CLAIMS -MADE DED RETENTION $ $ A5PICA001-032994-04 5/1/2022 5/1/2023 WORKERS COMPENSATION PER O1'H- AND EMPLOYERS' LIABILITY YIN STATU R ANY PROPRIETORIPARTNERlEXECUTIVE E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? F7 N f A w. (Mandatory in NH) L. DISEASE - EA EMPLOYEE S If yes, describe under DESCRIPTION OF OPERATIONS below El. DISEASE - POLICY LIMIT $ A EQUIPMENT FLOATER AIPICA001-032992-04 5/1/2022 5/1/2023 LIMIT UNLIMITED DEDUCTIBLE $5,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORO 101, Additional Remarks Schedule, may be attached If more space Is required) The City, its officials, and employees are included as Additional Insured with regard to General Liability. Such insurance will be deemed primary such that any other insurance that may be carried by the City will be excess thereto per forms that apply: ARM 30 01 OB 12, CG 20 01 12 19. �I CERTIFICATE HOLDER CANCELLATION City of El Segundo Attn: City Clerk 350 Main St Room 5 El Segundo, CA 90245-3813 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 chael Bell/TAS ©1988.2D14 ACORD reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (2D1401) Additional Named Insureds Other Named Insureds Pico Party Rents & sells I' OFAPPINF (0212007) COPYRIGHT 2007, AMS SERVICES INC I Nalicy Number: AlPIC;AU01-032992-04 GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -- AUTOMATIC STATUS WHEN REQUIRED BY WRITTEN CONTRACT, AGREEMENT OR PERMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Section II —Who Is An Insured is amended to include as an additional insured any person, organization, state or governmental agency or subdivision, or political subdivision when you and such person(s) or organization(s) have agreed in writing in a contract or agreement that such person(s) or organization(s) is to be named as an additional insured on your policy, subject to the following provisions: A. The contract, agreement or permit must be in effect during the policy period shown in the Declarations, and must have been executed prior to the "bodily injury," property damage" or "personal and advertising injury." B. The person, organization, state or governmental agency or subdivision or political subdivision is an insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. The ownership, maintenance or use of that part of the premises leased to you subject to the following additional exclusions: (a) This insurance does not apply to any "occurrence" which takes place after you cease to be a tenant in that premises. (b) This insurance does not apply to any structural alterations, new construction or demolition operations performed by or on behalf of the person or organization added as an insured. 2. Your acts or omissions, or the acts or omissions of those acting on your behalf, in the performance of your ongoing operations for the additional insured(s), subject to the following additional exclusions: (a) This insurance does not apply to "bodily injury" or "property damage" occurring after 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) has been completed. (b) This insurance does not apply to "bodily injury" or "property damage" occurring after 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. (c) This insurance does not apply to "bodily Injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: (i) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (ii) Supervisory, inspection, architectural or engineering activities. I. The maintenance, operation or use of equipment leased to you by such person(s) or organization(s). This insurance does not apply to any "occurrence" which takes place after the equipment lease expires. 4. Operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization, subject to the following provisions: ARAX 30 01 08 12 Includes copyrighted material of the Insurance Services Office, Inc. used with its permission Page 1 of 2 (a) This insurance does not apply to "bodily injury," "property damage," or "personal and advertising injury" arising out of the operations performed for the federal government, state or municipality. (b) This insurance does not apply to "bodily injury" or "property damage" included within the "products - completed operations hazard." 5. Their liability as a grantor of a franchise to you. 6. Their liability as a grantor of a license to you. A person(s) or organization(s) status as an additional insured under this provision ends when: (a) The license granted to you by such person(s) or organizations(s) expires; or (b) Your license is terminated or revoked by such person(s) or organizations(s) prior to expiration of the license as stipulated by the contract or agreement. ARAX 30 01 08 12 Includes copyrighted material of the Insurance Services Office, Inc, used with its permission Page 2 of 2 I Vlll y 1YV341VGl. P 11 IS r'kvv i-VJLJOL-V"f COMMERCIAL GENERAL LIABILITY CG 20 01 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. CG 20 01 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 ZV9 " CERTIFICATE OF LIABILITY INSURANCE ClATeI11 l30/2030/20f"r`YrYp 22 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 13ETWEEN 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 fl hts to the certificate holder in lieu of such endorsements . PRODUCER CONTACT AON RISK SERVICES SOUTH INC NAME: AOn Risk Services, Inc of Florida 3550 LENOX ROAD NORTHEAST PHONE 1 X SUITE 1700 AfG',No, Ertl" 8,335D5.154 .,._- "m'PwC.No'..-....... ATLANTA GA 30326 INS�URERISI AFFORDING COVERAGE NAIC A INSURER A: ACE American Insurance Company 22667 INSURED TdNel HR II Hol6nVgy. Inc. L!C/F Pico Rents Inc DBA Pico Party Rents INSURER B : - 1 Park Place, $Ae 60'0 INSURER C Dublin, CA 9456E-7983 - - INSURER D , INSURER E INSURER F ; COVERAGE' CERTIFICATE NUMBER: 15599307 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. I14SR, TYPE OF INSURANCE ADOL. 3UBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR __._ INSR WVO MIIAIODfYYYY mWoofYYYY COM74kiERt:gAP GENERAL LIABILITY CLAIMS -MADE � OCCUR EACH OCCURRENCE $ DAMAGETORENTEO PREMISES Ea occurrence $ MED EXP (Any one arson $ .... PERSONAL & ADV INJURY .,§ GEN1 AGGREGATE LIMIT APPLIES PER: POLICY ] PROJECT E] LOC GENERAL AGGREGATE $ PRODUCTS - COMPIOPAGG $ _ S OfH'ER AUTOMCIBIE...E. LIABILITY �' w.._ OMB01 NEO f)NGL�E LI M IT (Ea accident) $ ANY AUTO BODILY INJURY Per erson. $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Peraccidenl $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR I CLAIMS -MADE AGGREGATE $ DEC RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILfTY Y! N OTH-. X I PER STATUTE ER A ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICEWMEMBEREXCLUOED7 N � INlA WLR C7115i323 - 03/01/2022 03101/2023 EL FJr.CHACCIDlANT $ 2.... - E.L., DISEASE - EA EMPLOYEE $ 2'000,000 —•---••-•---•••- ,000,000 (Mandatory in NH) r yes, dascnbe under � DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT b 2,000,000 DESCRIPTION OF OPERATIONS f LOCATIONS! VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Workers Compensation coverage is limited to worksite employees of Pico Rents Inc DBA Pico Party Rents through a co -employment agreement with TriNel HR II -A, Inc.. CERTIFICATE HOLDER CANCELLATION City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn: Julie Todd THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 401 Sheldon Street ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE eon 0R13k i6etvic"'60uth 2Rc OO 1988-2015 ACORD CORPORATION, All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD