Loading...
PROOF OF INSURANCE (2024) CLOSEDCERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 8/15/2023 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 this certificate does not confer rights to the certificate holder in lieu of such endorsementfsl. PRODUCER Workers Insurance Agency LLC 228 Park Ave S. #36206 New York NY 10003 INSURED Glia Productions, LLC. 1630 SHELL AVE VENICE CA 90291-3857 Darrell Rivers 1332-240-2886 INSURER S AFFORDING COVERAGE . ,..,..,.,.,-------,.,.n„-.n....--..,...,- .................................--..,..____...... ......................... INSURER A: NEW YORK MARINE & GENERAL INS CO. GLIAPRO-01 INSURER B ; INSURER C ; INSURER D ; INSURER E ; INSURER F : COVERAGES CERTIFICATE NUMBER: 1334447379 REVISION NUMBER: NAIC # 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 .... ADD%.r$':U R ----- -� ....... POLICY EFF POLICY EXP .......,,,...�...�.-............. ... LTR TYPE OF INSURANCE POLICY NUMBER MM M DD. LIMITS A X COMMERCIAL GENERAL LIABILITY Y PK202300025585 5/6/2023 3/7/2024 EACH OCCURRENCE $1,000,000 CLAIMS -MADE LEI OCCUR ...PRI�.MISEP.(f.I3 qufr +s .l_......,$100 000 ........... ............ .,� �,,, ....... ...., -... ... _., .............................. MED EXP Any one Berson) $ 5 000 PERSONAL & ADV INJURY $1.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2.000,000 X ...�� �R��,���,� �������,��, mmOMPlO.„AG.......,-.,.1....0....... POLICY JRO- LOC ....................�................,,. QD CTS m.0 . P.... G $ ..,000.000 .-.- ... .... .. -. . OTHER.. $ A AUTO MOBILELIABILITY Y PK202300025585 5/6/2023 3!7/2024 COMBINED SINGLE LIMIT $1,000,000 ANY AUTO BODILY INJURY (Per person) $ 1,000,000 OWNED SCHEDULED -BODILY INJURY accident) $1,000,000 AUTOS ONLY AUTOS ,(Per ......----._.,,.,,.. x HIRED NON -OWNED X... PR Or AUTOS ONLY AUTOS ONLY aged n)).A.M.a................$.1000,U00 ....-7,. X I i Auto PD Auto P D Deductible $10%; 2,500,500 UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DE D RETENTION $ $ A WORKERS COMPENSATION WC202300024533 3/7/2023 3(7/2024 X SPTER FIR AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? I,, Y / NA EACH ACCIDENT $ 1.000,000 _E.L. ...` ."" (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE'. $ 1,000,000 ....................-.......... If yes, describe under DESCRIPTION OF OPERATIONS below E.L.. DISEASE - POLICY LIMIT $ 1,000,000 A Inland Marine Y PK202300025585 5/6/2023 3/7/2024 Misc. Equipment 1,000,000 Rented EQ: $1M Props, Sets, Wardrobe 1,000,000 Deductible: $2500 3rd Party Prop. Dmg. 1,000,000 DESCRIPTION OF OPERATIONS / 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 as their interests may appear. This insurance is primary and non-contributory. ,T'E 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 City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Director of Finance 350 Main St., Room 5 AUTHORIZED REPRESENTATIVE El Segundo CA 90245-3813 /Arm //pllvlerf (� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD INSURED: Glia Productions, LLC. POLICY NUMBER: PK202300025585 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED --OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization: THE CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS, EMPLOYEES, AGENTS & VOLUNTEERS (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement). WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" for that insured by or for you. This insurance will be deemed "primary" such that any other insurance that may be carried by City of El Segundo will be excess thereto. This insurance will be on an "occurrence", not a "claims made," basis or equivalent. It is agreed that this insurance will not be canceled, not renewed or the limits of coverage in any way reduced without at least (30) days advance written notice ten (10) days for non-payment of premium sent by certified mail, return receipt requested to: CITY OF EL SEGUNDO CITY CLERK ATTN: BUSINESS SERVICES DIVISION 350 MAIN ST., ROOM 5 EL SEGUNDO, CA 90245-3813 BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 05/09/2023 forms a part of Policy No. WC 013-75-9931 Issued to Takeone Network Corp. By A I U INSURANCE COMPANY We have a right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against any person or organization with whom you have a written contract that requires you to obtain this agreement from us, as regards any work you perform for such person or organization. The additional premium for this endorsement shall be 2.00 % of the total estimated workers compensation premium for this policy. t an WC040361 Countersigned by-__.______,rv..-_____-_,_.__w___- -��� (Ed. 11/90) Authorized Representative