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PROOF OF INSURANCE (2024) CLOSEDSTARCOA-02 .F.RLCh5_R_Q1JHA1 DATE (MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 8/18/2023 . ........... .............._................................................................................................ 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 ndorsement s . this certificate does not confern is tot the certificate older . lieu o such a _.._... ........................................................ PRODUCER C „cT Elle Zbur 2NFIIPPTr per reet Casualty Services, Inc. PHONE ,E>t) (805) 537 0 FAX +;( 1916 1p 5) 579- Simi Va ley, CA 3063 MUSS;�,eU(e zbwrj► �t►m Arc No 80 INSURED Audio Video LA 16117 Grevillea Avenue Lawndale, CA 90260 COVERAGES CERTIFICATE NUMBER: 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. INSR ........, ADDL SUER ,,,,,,,,,,,,,,,, — ... POLICY EFF Pt9 TYPE OF INSURANCE POLICY NUMBER CY POLICY EXP LIMITS _ A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ mm1,000,000 CLAIMS -MADE l� OCCUR US UEN 2762425.23 6/1/2023 6/1/2024 .m. rAMAGF Tiro RENT ... ..............i 000 000 F.hIILS.IG $._.. r�EDmxP/�ri�nepersonl.........._.........._ 10,000 1,000,000 G£N'LAGGR'EG'AT'E LIMIT APPLIES PER: GENFRAI AGGREGATE $ PERSONAL & ADV iN AGGRF.r�ATF $ 2.1)...... X POLICY LOc 2,000,000 PRO- „ , �,.,.,.,, JECT S COMP/OP AGG ' $ PIRODUCT........ . OTHER', �-$..........._....... A AuromoslLE LIABILITY im®INEOSiNGLE iMrT 1,000,000 m6Le .. ....... ANY AUTO US UEN 2762425.23 6/1/2023 6/1/2024 BODILY INJURY Pergerson�. . ........................... 1xx OWNED SCHEDULED AUTEO�SONLY AUITyyOSy�N �OYINJ4�.........................._............_._.._....................AUTppOS ONLY L_xx A7'O 0 id tMA�E............._.$._.$izg&ax/ACV/ Cost of Repair "HAPD Deds $ 1,500 EXCESSUMBRELLA LIAB ...� OCCUR EACH OCCURRENCE ,.. _$........... . $ ... DED..BLA � C IMS-MADE AGGREGATE ., _ RETENTION $ $ A WORKERS COMPENSATION X PER OTH- AND EMPLOYERS' LIABILITY Y-1 N HSW2759037.23 6/1/2023 6/1/2024 T� _R 1,000 000 (Mandatory OFFICER/MEM EREXCLUDED? `I^ NIA EL, DISEASE CI EA„E,MPLCIYEE $,,,,,, ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH (Mandatory in NH) 1 If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L DISEASE -POLICY LIMIT $ A Misc Owned/Rented EQ US UEN 2762425.23 6/1/20 3 . 6%7120 44 Limit __....w_....... .... ----m2 00,000 A Special Form/RC US UEN 2762425.23 6/1/2023 6/1/2024 Deductible 2,500 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Addltforal Remarks Sche(Jude, maybe attached If more space is required) Certificate Holder is included as Additional Insured and/or Loss Payee as required by written contract or agreement but only as respect to operations of the named insured per attached form. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ty 9 ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main St El Segundo, CA 90245 .._..._.___._............... _ _._._._.. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CONTRACTUAL INSURANCE REQUIREMENTS The attached Certificate of Insurance is provided as part of our service to our client, the Insured. If special endorsements have been provided, they also are indicated attached. You may find that these documents do not comply with all the terms and conditions of the underlying contract between the Certificate Holder and the Insured due to the insurance company's insuring conditions, limitations, exclusions, and other terms. If you have any questions, please contact the undersigned. NFP Property & Casualty Insurance Services, Inc. CA LICENSE #OF15715 2450 TAPO ST SIMI VALLEY, CA 93063 TELEPHONE: (805) 579-1900 FAX: (805) 579-1916 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Hiscox Insurance Company Inc. L SC Blanket Additional Insured Endorsement In consideration of the premium charged and on the understanding that all other terms, conditions and exclusions remain unchanged, it is agreed that this endorsement modifies only the terms and conditions of the Coverage Part(s) listed below: COMMERCIAL GENERAL LIABILITY COVERAGE PART Name of Person or Organization (Additional Insured) Persons or Organizations as Described Below It is agreed that WHO IS COVERED is amended to include the following: A. Any person or organization from whom you lease a premises, and with whom you have agreed through a written or oral contract to provide insurance as afforded by this Coverage Part, are added as additional insureds. However: 1. this insurance applies to such additional insured only to the extent of liability arising out of the ownership, maintenance or use of that particular part of such premises leased to you in your on -going operations; and 2. if coverage provided to the additional insured is required by 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 or that which you would have been entitled to coverage under this Coverage Part, whichever is less. This insurance does not apply to: 1. any occurrence that takes place after you cease to be a tenant in the premises or the end of the policy period, whichever comes first; 2. structural alterations, new construction or demolition operations performed by or on behalf of the additional insured; or 3. bodily injury, property damage or personal and advertising injury arising out of the sole negligence of the additional insured. B. Any person or organization from whom you lease equipment or props, sets and wardrobe, and with whom you have agreed through a written or oral contract to provide insurance as afforded by this Coverage Part, are added as an additional insured. However: 1. this insurance applies to such additional insured only to the extent of their liability arising out of the maintenance, operation or use by you or anyone on your behalf of the equipment or props, sets and wardrobe in the performance of your on -going operations; and 2. if coverage provided to the additional insured is required by 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 or that which you would have been entitled to coverage under this Coverage Part, whichever is less. This insurance does not apply to: 1. any occurrence that takes place after the equipment or props, sets and wardrobe rental agreement/lease expires or the end of the policy period, whichever comes first; or 2. bodily injury, property damage or personal and advertising injury arising out of the sole negligence of the additional insured. C. Any: 1. financial institution or any entity that has a financial interest in your business; Includes copyrighted material of Insurance Services Office, Inc., with its permission. EGL E4310 CW (03/15) Page 1 of 2 Hiscox Insurance Company Inc. 40 I SCOX 2. State, Municipality or other Political Subdivision; 3. payroll service; 4. advertising agency and/or advertiser; or 5. distributor for whom you are contractually obligated to provide insurance as afforded by this Coverage Part, are added as insureds. However: 1. if coverage provided to the additional insured is required by 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 or that which you would have been entitled to coverage under this Coverage Part, whichever is less. 2. this insurance does not apply to bodily injury, property damage or personal and advertising injury arising out of the sole negligence of the additional insured. In the case of oral agreements, the agreement must also be evidenced by a certificate of insurance issued for you by us or on our behalf. II. For the purposes of coverage provided by this endorsement only, HOW MUCH WE WILL PAY is amended to include the following: 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: A. required by the contract or agreement; or B. available under the applicable Limits of Insurance stated in the Declarations; whichever is less. Any payments we make under this endorsement will be a part of and not in addition to the applicable Limits of Insurance stated in the Declarations. The title of the endorsement is solely for ease of reference and forms no part of the terms and conditions of coverage. Includes copyrighted material of Insurance Services Office, Inc., with its permission. EGL E4310 CW (03/15) Page 2 of 2