Loading...
PROOF OF INSURANCE (2023 - 2023) CLOSEDDATE(M MIDD/YYYY) AC<>R0 CERTIFICATE OF LIABILITY INSURANCE 12/02/2022 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 ONTA T Kathy Tran NAME: The Empire Company PHONE ...... ........._....._. _.._�.....___A� 'A4, Ncer'i; 550 North Park Center Drive ADDRESS: KTran@empire co com Suite 205 INSURER(S) AFFORDING COVERAGE NAIL # ................................................................... _... �.......... ..... _. Santa Ana CA 92705 INSURERA: Landmark American Ins. Co. ._........................................................ INSURED INSURER B • CompWest Insurance Company 12177 Bar None Group, Inc., DBA: Pacific Coast Entertainment 7601 Woodwind Drive INSURER C : INSURER D : INSURER E: Huntington Beach CA 92647 INSURERF: COVERAGES CERTIFICATE NUMBER: 22/234th UPDTMASTIC ;R 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 .................................................... OLICY POLICY EXP LTR TYPE OF INSURANCE INSD i WVD POLICY NUMBER MWDDIYYYY, (MMIDDIYYYY ......._....__ LIMITS ................... �r.......................................................... rrM' COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1 000,000 100,000 CLAIMS -MADE OCCUR PREMISES (Ea occurrence) S MED EXP (Any one person) S 5'000 A LFIA141833 03/08/2022 03/08/2023 PERSONAL aaDVINJURY $ 1,00a,0a0 ._..._ 304' 1CGREGATE: LIMIT APPLIES PER: GENERAL AGGREGATE S 2 o0a,aoo PRG•° 2 000,000 POLICY ,iEC•f LUC PRODUCTS - COMPtOP AGO $ OT 18E4"f,, $ AUTOMOBILE LIABILITY T; 4'40IKLD SINGLE LAW $ ..•_.• QFa Wn:ndaalt¢ _ .................. ANYAUTO BODILY INJURY (per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS .......... HIRED NON -OWNED '.., PROPERTY DAMAGE $ AUTOS ONLY _ITITIT__ AUTOS ONLY .Per accident) ...... ... ...... UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2000,a00 A x EXCESS LIAB CLAIMs MADE LHA253374 03/08/2022 03/08/2023 AGGREGATE, $ 2 000,000 .._ ON$ $ ................................._..�......,_.,� .......... WORKERS COMPENSATION 1NORI{ERS COMPENSATION I /® �TATIJTF.._�...... AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE B Y NIA CVWVCP100062143-01 10/01/2022 10/01/2023 E L EACH ACCIDENT ••••••------• S 1,aaa,aaa OFFICERIMEMBEREXCLUDED7 1,000,000 (Mandatory in NH) E L DISEASE- EA EMPLOYEE S If yes, describe under 1 000,000 DESCRIPTION OF OPERATIONS below E L. DISEASE - POLICY LIMIT $ ....__...._..._............ ._._._�._.._.. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) ......................... Excess liability includes general liability as underlying coverage,. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo Recreation and Parks Department ACCORDANCE WITH THE POLICY PROVISIONS. 401 Sheldon Street AUTHORIZED REPRESENTATIVE EI Segundo CA 90245 q-r, ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 00048609 ............. _. LOC ft: ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED The Empire Company Bar None Group, Inc , DBA: Pacific Coast Entertainment ....... .... ........................ POLICY NUMBER CARRIER I NAIC CODE EFFECTIVE DATE: ►DDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance: Notes ...... Certificate Holder continued: City of El Segundo, its officials and employees er^non ini r9nnrtmi% © 2008 ACORD CORPORATION. All riahts reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: LHA141833 COMMERCIAL GENERAL LIABILITY CG 20 10 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES O 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 Organization(s) Locations Of Covered Operations ANY PERSON(S) OR ORGANIZATION(S) REQUIRED BY WRITTEN CONTRACT OR AGREEMENT AND AS PER PARAGRAPHS A., B., AND C. BELOW 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 CG 20 10 12 19 C Insurance Services Office, Inc., 2018 Page 1 of 2 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. 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; whichever is less. This endorsement shall not increase the applicable limits of insurance. CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 2 of 2 Policy Number: LHA141833 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 LANDMARK AMERICAN INSURANCE COMPANY This Endorsement Changes The Policy. Please Read It Carefully. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE FORM SCHEDULE Name of Person or Organization: Any Person or Organization As Required By Written Contract The following is added to SECTION IV — CONDITIONS, 8. TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US: We waive any right of recovery we may have against the person or organization shown in the SCHEDULE above because of payment we make for injury or damage arising out of your ongoing operations, "your product' or "your work" done under a written contract with that person or organization and included in the "product -completed operations hazard". This waiver applies only to the person or organization shown in the SCHEDULE above. This endorsement effective 3/1/2022 forms part of Policy Number LHA141833 issued to Bar None Group Inc by Landmark American Insurance Company RSG 14048 1008 Includes copyrighted material of Insurance Services Office, Inc. 1992 with its permission. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 03 13 C (Ed. 7-09) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT — CALIFORNIA 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be $ 500 Schedule Any person or organization that you perform work for that is liable for an injury, covered by this policy, that prior to the injury has written contract requiring a waiver of our right to recover from them. Person or Organization Job Description 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 10 / 01 / 2 021 Policy No. WCV 5504556 Endorsement No. 0 01 Insured BAR NONE GROUP, INC. Insurance Company COMPWEST INSURANCE COMPANY Countersigned by WC990313C (Ed. 7-09)