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PROOF OF INSURANCE (2023 - 2023) CLOSEDCERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 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 ri hts to the certificate holder in lieu of such endorsement(s). PRODUCER d an FAX Liberty United Insurance Services, Inc CONTACT PrAi ........ s167s 6666� � � --,,,,,,,,,,,,,,,,, __ Y 704 S Victory Blvd, Suite 204 E-MA NO:88826T56889 Burbank, CA 91502 6ortyun License #:: OF89841 ADD � NSIIRER�S� AFFORDING COVERAGE m ..... ..........Irtn..........NAIC 9 INSURERA: Lr In n 1, e. L. INSURED INSURERS: Elite Special Events, Inc INsoRERc................................ 11278 Los Alamitos Boulevard #101 INSuBERD: Los Alamitos CA 90720 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 00001977-49954 REVISION NUMBER: 361 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, R--------- ------ ------- INS7ituBPOLICY EFF POLICY EXP LTRTYPE OF INSURANCE POLICY NUMBER Immlognm (MwP&f= LIMITS A COMMERC_.:.pIAL GENERAL LIABILITY Y N ZISMB1499 01 05/07/2022 05/07/2023 MAN -MADE occuR �M�sE� ��� 300000P MED EXP (Any one person) $ ......................_..__ _. PERSONAL & ADV INJURY ..mmm...""m....,m..,m......^^......." GEN'L AGGREGATE LIMIT APPLIES PER: .....$.............1..9-0-01M., GENERAL AGGREGATE $ 2000,000 ITx. PRO - POLICY PRO- LOC .`PRODUCTS COMP/OPAGG _$ 2,000,000 OTHER': $ AUTOMOBILE LIABILITY COMBINED ..L 0 flp�.�`..>I.I tl�IC�, L I I'.M41.,.. $................................................. ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) �C7AMAisE:...... $ ............................... HIRED NON -OWNED PR'OP'Eh1'1'Y $ AUTOS ONLY AUTOS ONLY p(, P DII ....... UMBRELLA LIAB OCCUR _ EACH OCCURRENCE ..AGGREGATEE........................................... ..$ $ ".. EXCESS LIAB CLAIMS -MADE RETENTION $ $ WORKERS COMPENSATION PER C1TH- TE.. AND EMPLOYERS' LIABILITY YIN ..,„,„ .. ,T'.4f„, .....,,�,,,,��, ANY PRA EXCLUDED? N / A E EACH Mandatory in NH) E„L.L. - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L DISEASE -POLICY LIMIT $ A Accident/Medical ZISMB1499 01 05/07/2022 05/07/2023 $10,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of El Segundo, its officers, officials, employees, agents, and volunteers are named additional insured SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of El Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 250 Main Street El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE ISM: ©1988-2015 ACORD CORPORATION. All rights reserved.. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Printed by SMS on 04/10/2023 at 04:31 PM DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 04/10/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND 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 CONTACT NAME: Jim MCAnany Nielsen McAnany Insurance Services, Inc. PHONE (80) 379-8805 (805) 204-4501 IC No Ekt A/C Nc 4165 E. Thousand Oaks Blvd -MAtl_ A : Suite 325 INSURER(S) AFFORDING COVERAGE NAIC # Westlake Village CA 91362 INSURERA: California Auto Insurance 38342 INSURED INSURER B : ELITE SPECIAL EVENTS, INC. INSURER C r 404 N Sparks St INSURER D r INSURER E ;. Burbank CA 91506-1963 INSURERF COVERAGES CERTIFICATE NUMBER: CL2292908998 REVISION NUMBER: THIS IS TO CERTIFY THATTHE 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. CY LTIR TYPE OF INSURANCE SO POLICY NUMBER MMLQ.D..CY M(MM,PI��M1?JrM'1"YP1° � LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE @R $ KtN I LU CLAIMS -MADE F-1 OCCUR PREMISES (Ea occurrence) $ MED EXP (Any, one person) $. PERSONALBADVINJURY $ GENERAL AGGREGATE $ GEN'LAGGREGATE LIMIT APPLIES PER: POLICY ❑ JECT LOC PRODUCTS - COMP/OPAGG $ 1 $ OTHER: AUTOMOBILE LIABILITY C'O'Eefi'B'INEC1 S NGLF. tl.VMhT Ea acs4dentY $ 1,000,000 ANY AUTO BODILY INJURY (Per person) �'.. $ A OWNED X''AUTEDULED AUTOSONLY 1XI BA040000023533 08/31/2022 08/31/2023 BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PRP DAMAGE rdmnti $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ ''.. EXCESS LIAB CLAIMS -MADE AGGREGATE $ ''. DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER 4:Y'TH- STATUTE [R. ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? El NIA EL, EACH ACCIDENT $ El. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below I I EL, DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of El Segundo, its officers, officials, employees, agents, and volunteers are named additional insured. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of El Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 250 Main street AUTHORIZED REPRESENTATIVE ElSegundo CA 90245 J. MCAnany ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD HOME OFFICE SAN FRANCISCO ANNUAL RATING ENDORSEMENT IT IS AGREED THAT THE CLASSIFICATIONS AND RATES PER $100 OF REMUNERATION APPEARING IN THE CONTINUOUS POLICY ISSUED TO THIS EMPLOYER ARE AMENDED AS SHOWN BELOW. HERE ARE YOUR NEW RATES FOR THE PERIOD INDICATED. IF YOUR NAME OR ADDRESS SHOULD BE CORRECTED OR IF INSURANCE IS NOT NEEDED FOR NEXT YEAR, PLEASE TELL US. IMPORTANT THIS IS NOT A BILL CONTINUOUS POLICY 9304403-22 SEND NO MONEY UNLESS STATEMENT IS ENCLOSED THE RATING PERIOD BEGINS AND ENDS AT 12:01AM PACIFIC STANDARD TIME RATING PERIOD 8-26-22 TO 8-26-23 ELITE SPECIAL EVENTS, INC DEPOSIT PREMIUM 11278 LOS ALAMITOS BLVD #101 MINIMUM PREMIUM LOS ALAMITOS, CALIF 90720 PREMIUM ADJUSTMENT PERIOD NAME OF EMPLOYER- ELITE SPECIAL EVENTS, INC (A CORP) (A CORPORATION) CODE NO. PRINCIPAL WORK AND RATES EFFECTIVE FROM 08-26-22 TO 08-26-23 PREMIUM BASE BASIS RATE $0.00 $1,400.00 QUARTERLY R SC INTERIM BILLING RATE* 9095-1 EVENT MARKET, FESTIVAL OR TRADE SHOW 18000 8.42 9.10 OPERATION --ALL EMPLOYEES--N.O.C. ********BUREAU NOTE INFORMATION******** FEIN 260747948 TOTAL ESTIMATED ANNUAL PREMIUM $1,638 COL N �S,TgMD AND4�ISSUED AT SAN FR SN�I� OPLEASEI AUGUST 29, 2022 POLICY L PAGE 1 OF 3 HOME OFFICE SAN FRANCISCO ANNUAL RATING ENDORSEMENT IT IS AGREED THAT THE CLASSIFICATIONS AND RATES PER $100 OF REMUNERATION APPEARING IN THE CONTINUOUS POLICY ISSUED TO THIS EMPLOYER ARE AMENDED AS SHOWN BELOW. HERE ARE YOUR NEW RATES FOR THE PERIOD INDICATED. IF YOUR NAME OR ADDRESS SHOULD BE CORRECTED OR IF INSURANCE IS NOT NEEDED FOR NEXT YEAR, PLEASE TELL US. IMPORTANT THIS IS NOT A BILL CONTINUOUS POLICY 9304403-22 SEND NO MONEY UNLESS STATEMENT IS ENCLOSED THE DATING PERIOD BEGINS AND ENDS AT 12:01AM PACIFIC STANDARD TIME RATING PERIOD 8-26-22 TO 8-26-23 * INTERIM BILLING RATES WILL BE USED ON PAYROLL REPORTS. THEY TAKE INTO ACCOUNT RATING PLAN CREDITS (OR DEBITS) WHICH WILL APPLY AT FINAL BILLING AND AN ESTIMATE OF YOUR PREMIUM DISCOUNT AS DETAILED BELOW. RATING PLAN CREDITS (DEBITS) EFFECTIVE FROM 08-26-22 TO 08-26-23 RATING PLAN MODIFIER ESTIMATED PREMIUM DISCOUNT MODIFIER 1.08100 COMPOSITE FACTOR APPLIED TO BASE RATES TO DERIVE INTERIM BILLING RATES 1.08100 ********************************************************************************* * * PREMIUM DISCOUNT SCHEDULE EFFECTIVE FROM 08-26-22 TO 08-26-23 * ESTIMATED MODIFIED PREMIUM IS DISCOUNTED ACCORDING TO THE FOLLOWING SCHEDULE: * FIRST ABOVE * $5,000 $5,000 * 0.0$ 11.3% * ********************************************************************************* THE ESTIMATED PREMIUM DISCOUNT IS BASED ON AN ESTIMATE OF YOUR PAYROLL. ACTUAL PREMIUM DISCOUNT APPLIED AT FINAL BILLING WILL BE BASED ON THE ACTUAL PAYROLL REPORTED ON YOUR POLICY AND SUBJECT TO AUDIT. COUNTE15S,�G3NEDvAND a�ISSUED AT SAN FRANC�OVEROPLEASE) AUGUST 29, 2022 POLICY L PAGE 2 OF 3 HOME OFFICE SAN FRANCISCO ANNUAL RATING ENDORSEMENT IT IS AGREED THAT THE CLASSIFICATIONS AND RATES PER $100 OF REMUNERATION APPEARING IN THE CONTINUOUS POLICY ISSUED TO THIS EMPLOYER ARE AMENDED AS SHOWN BELOW. CONTINUOUS POLICY 9304403-22 IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT YOUR LOCAL STATE FUND OFFICE BELOW: CSC — POLICY AT MONTEREY PARK 900 CORPORATE CENTER DRIVE MONTEREY PARK , CA 91754 (877) 405-4545 Nothing herein contained shall be held to vary, alter, Waive or extend any of the terms, conditions agreements or limitations of the Policy other than as herein stated. When countersigned by a duly authorized officer or representative of the State Compensation Insurance Fund, these declarations shall be valid and form part of the Policy. vac. AUTHORIZED REPRESENTATIVE PRESIDENT AND CEO COUNTERSIGNED AND ISSUED AT SAN FRANCISCO AUGUST 29, 2022 POLICY L PAGE 3 OF 3 SCIF FORM 10963A (REV.7-2014)