PROOF OF INSURANCE (2023 - 2024) CLOSEDCERTIFICATE OF LIABILITY IN�SURANCE
"e" DA'Tr 05t19121023
THIS CERTIFICATE IS ISSUE15 Xg X WITER OF 119F50MR1 ONLY AND CUNFEAS NO 90115 GPM TFMI ZMATIPUTE HOLDER. TRI!g
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 IINSURER(S), AUTHORIZED REPRESENTATIVE
OR PRODUCER AND THE CERTIFICATE HOLDER,
INWORTAW-ff !Ale ce ill OTW is- an, ADD,l 1100RED, the policy(les) must are ADM WKIRMAIR 1ximMillimi "PlWenidorsed.K
SUBiROGATIO,N IS WANED, sull to the terms and, Do A of the poficy, cartain policies may require an ewdo'rsemwl Astaternent on thils,
ceirfificate does not confer riglIts torthe cerfificate tiodder In fley of such enviorsement(s).
PRCDUCFR CONT,14T Nl MM - Bands & PerIorming Gra
K&K Insumince, Group, Inc. vRtwr
800-32,8-2317 2160-459 5502 . ..............
1712 Magnalvoxfty IL
Wayne, IIN
nlertatne�a r nce,com
iFort 46804 . ...........
. . . ......... _ . ........
lNSURER(S) AFFORDING COVERAGE ll III
. . ............ . . . .
00SURED INSURER X Markel Insuranve Cornpn 3970
$MAX IFnlertaunment. INSURER I&
46 vIcdo deffa lil ............................................
NNffiulRlrN
heriderson, NV89011 . ........
A Mlember of the Sports, Leisure & EntertaInment RPG
INSURER E.
INSURER F:
-- --------- ---------------- - - ----------- COVERAGES CERTIFICATE NUNBEll WO246,394 REVISION NUMl
THIS IS TO, CERTIFY THAT THE POLICIES OF INSURANCE LIsTw Bl HAVE SEEN ISSUED TO THE INSURED NAMIED ABOVE FOR THE ll PFrRj(,X) INDICATED
N10TWITHISTAN DIINO ANY REQUIREMENT, TEIRM OR CONDITION M" ANY CONTRACT OR OT'HIER DOCUMENT WITH RESPECT TO W41CH THIS (X RTIFlICATE. NIAY BE
:ISSUED 'OR MAY PFIRTAIN, THE INSURANCE AFFORDED BY rHEPOLICIES DESCRIBED HEROIN IS SIUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF
SUCH FOUCES, LIMITS SHOWN MAY HAVE Hil REDUCED BY PNO rAJUM9,
ADM
LTR TYPE Of INSURANCE INSD W%M POLICY NUMBER Aa Axw7y', E",
MM—M01y"N
X COMMERCIAL 011 LIABILITY x g11-R—PO-001DU0001618010 05(l Sf=.3 OU18ro,1024 FACH ()MJFRENC
quAw- 740 Ill EDT 12r01 AM 7mwCr7rrgrwM� 5...
PREW
[:X] OCCUR SE $1,01010,0001
2_&4_26 LArnm�1__.,
Exdudod i
Pf.'RSOXAL A A0V Excluded
. ....... . . . ....
GENFOL AGQ'4E'0A1E $5,00,01,000
..........
r0f,'Ni'll. AGGRFGArF L IMI T APPLIES PER rRol S COMP01F` AGG $1,01l
. ........ ....... .... . . . ................ . . . .................... ......
POLICY oc PROFESWO", l
RCMY TNJURY.............
PARTICIPAN F ....$1,000,01010
So ro"10MLE UA8401y,
ANY Al TO l IINJORY (Pef fwamm)
M,NFOAMTOS nSCHIEDL)LED
004y, AUTOS ROLXLY INJURY ow jendam)
HIRED NON -OWNED
AUTOS W&Y AUTO$ ONLY acadewO
NOT PROVill WALE uN HAWAA
UMBRELLA UAS _j U FAC11 OCCt MIFNOP,
. . . . . ...............
EXCESS UAR CILMMS-M OCC A ADC A 13,43RE GATE
DED RET N
WORKERS COMPENSATION AND, MIA PER
EMPLOYERVIL)ABILITY ' 07HE R
ANY PROPM17TOIRIPARTNEM Y 1N Eli., FACH AT
OXCUnVE OFFICE)UM"I EMBER
li MSEASE-EA,EW,N,oyrr_
EXCAMLCAO (IlAndrAul
if wo&w7ba under DESCMIPTION1
A 1� MEDICAL PAY'MENI'S FOR PART41FIANTS MIRKWOO(Mill 0&1 W2023 9!WI&2024 rmimmy mrjNGAL
2401 PIM EDT 12,01 AM , CXCICS SM E,0 0CAL,
DESCRIPTION Or OPERATtONS P tooKnol I VEHICLES (ACORD 104, A4040"Al R*M404 90oduil may be aft0ad If more, spow Ns rvqiWwvdl
I'm of (.3l Cell look-abikes, DJS/l Musicians, angers or vocal Non -touring bands (Il vvediding, gal Mil Genre- Classill Country,
Oldies, Popisoft rock" Type of Venue: Auditoriums, Nligh4dubs, Outdoor vwxies
The mWificate h0der is added as an additional Inswed, lbuit onty for l (Aused, in wl or kv ptvl„ by the acts or onissions of the rwl Insured,
CERTIFICATE HOLDER CANCELLATtON
The C .14y, of F1 Segil SHOULD ANY MTRE XWE DESCRIBE5 POEXIM fit MUEEED 11FOR
,150 Main St, THE EXPIRATION DATE THEREOF, NOTICE WILL BE DE"VIERED IN
EJ Segundo, CA 90246 ACCORDANCE WITH T141E POLIC`Y PROVISIONS,
(Eveni Orgarsizer) AUTHORIZED REPREffAITATNE,
cowage Is on Baden CM lo VS, events and acl
- l T01III XAS INSURED&'Me Iraulvi for dw purdiasing Woup l noll be suloml to all Ow Insurwice laws as regulabons of the State of Texas
ACORD 261201161`03)The ACORD name anid Ioga we registered marks of AGOIRD 0 iSSA-201 5 ACORD CORPORATION. AN rIgIl rel
Narrate Of Additional In
The City of El Segundo
350 Wn St.
El Segundo, CA 90'245
Named IInsrured, SMAX Entertainment
rpm-7111r,
COMMERCIAL GENERAL LIABILITY
CG 20 26 04 113
1 "444110 Rol EMI II
n4mWT4_6914"a
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..............
CG 20 2!6 04 13 C) Insurance Services Office, Inc., 2012 Page 1 of 1
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Thiis identification yy, is evidenceof a • for •vehicle. The card is valid ordy as 10 +
liabilityas •
w «: + w tw w w Inspection,
applying for a, driver's l�icense, f ollowing an aiccident or upon a law enforcement off icer's request
copy of M card in yoiurro
For wconvenience,ww wnal copies are avaH ableon w
r:
COVERAGEUSW
NEVADA EVIDENCE OF IMOTOR VE'HIIICLE LIABILITY INSURANCE
# M
INSURANCE.INSLMANCE HAS BEEN APPROVED BY THE NEVADA COMMISSIONER OF
DF CARRIED IN THE
INSURED MOTOR VEHICLE FOR PRODUCTION ON 0EMAW
Effective M^03/16123
Expirstion Date OWIW3
Year Make
Vehicle liclenjillihootion Number
USAA CASUALTY INSURANCE w
CONTACTN
[*a CEO] 24 461:14112 1rw
W
L -�b 11 Main in a ce i: i�ca 0 0 IOM !rs cTM$UY7MXIWn, ISUT
_) I haVe a5b 11 n Ii
of ® Relations as provided for by Laiboir Codie § 3700 for the performance of the work set forth the agreement
with the City of El Segundo.
Policy, No.
04 W1 0
oT me worK Torunlun Me Z19MUMM"Tinn trio Ut3 Or M 517"pi litw �b *Aoultax, Irmy *414kolb I h1bVid
carrier and policy number arei:
Camier Policy Number Expiration Date
Narre of Agent Phone #
01 certify that, in the performance: of the work set forth in the agreement with the City of El Seguindo, I wi!lil not
eimploy any person in any manner so as to become subject to the: workers' compensation l�aws, of California, anidl
agree that�, if I shiould bi the workers� cornpensofio�prov
ocom
immediately compJy witfithou;:X
MORM
Algrelernentfor:
Datied: �-a�
Reviewed
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