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PROOF OF INSURANCE (2023) CLOSEDA , CERTIFICATE OF LIABILITY INSURANCE 06UAT/09/2023 °"'�"' 023 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 endomement(s). Jeewan'ee Insurance Agency NIAME Zein Jeewanjee CONTACT PRODUCER gy 1494 Hamilton Ave Suite 103 tIt (408) 217-6787 ---m L(r , N!?tw 408-997-7890 San Jose CA 95125 n r '_ 1. support(Monedayevent.com INSURER[S) AFFORDING COVERAGE NA Arch Insurance Comb nv1.....11!...5 50 INSURED Black in Mayberry 755 SHELDON ST EL SEGUNDO CA 90245 rnvGoer_Ge CPI7TIGIr ATF NI IMRFR• 7nn91nRR13 RFVISRI[)N NIIMRFR- 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. ----TYPE O' .. ......... m _...,,_..-._-_ .. ILTRR F INSURANCE SURANCEWWWW � POLICYNUMBER..... MAM YNYFYFY MMOOy. LIMITS LT A COMMERCIAL GENERAL LIABILITY Ir COMMERCIAL GENERAL LIABILITY • 00SNCGL3803800 06/19/2023 06/20/2023 EACHOCCURRENCE $ 1,000,000 TORENTEg— 0 1 000 000 CLAIMS -MADE � OCCUR PR MIS S Ea occurrence) $ .. ,000 ---.......-- Host ligour .......................................................,...........,.�,.......................�.-,..__,-... mmmMED EXP (An. one person) ...-. $ 5,000 PERSONAL BADVINJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000 POL@CY LOC ® E PRODUCTS - COMP/OP AGG .$ --..-_... $ 5,000,000 _ ........... mm OTHER. Deductible $0 AUTOMOBILELIABILITY(Ea SlN LE LIMIT accident) $ ..__................ .. T ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) mm$.............mmm+— AUTOS ONLY AUTOS HIRED NON -OWNED PROPERTY DAMAGE $........... .... AUTOS ONLY AUTOS ONLY Per ark derZ11 UMBRELLA LJAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADElop AGGREGATE $ RETEN710N $ $ WORKERS COMPENSAT10N PER OTH- �STATITE, AND EMPLOYERS' LIABILITY YIN EXCLUDED? ECUTIVE ❑ N/A ..E._.L-.CIDENT ..YEE,...$^_++ ,.,..~ OFICER/MANYPROPREMNEFIREXCLU (Mandatory ) EA..... DISEASEo $ Jy+v^^ If yCdescribe under DESRIPTION OF OPERATIONS below E L. DISEASE -POLICY LIMIT LJ E]El DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space is required) The Certificate Holder shall be an Additional Insured, but only with respect to the operations of the Named Insured, and subject to the provisions and limitations of Form CG 2026 Additional Insured - Designated Person or Organization, but only with respect to JUNETEENTH FESTIVAL from June 19, 2023 through June 20, 2023 CERTIFICATE HOLDER City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo CA 90245 tl ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Produced using Forms Boss Web Software. www.FormsBoss.com (c) Impressive Publishing 800-208-1977