PROOF OF INSURANCE (2025)OP ID: LM
,�►�~ rr �a CERTIFICATE OF LIABILITY INSURANCE DATE 11/05/2024Y)
11105/2024
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 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 endorsements .
CONTACT PRODUCER NAME Julie Sllvls
Petra Risk Solutions PHOEBE 562 219-4128 tA� 00-494-6829
www.PetraR!skSolutions.com com
Drivety PROD o k E ELS 1 —
DoUgA s IC770 The I�Douthlt � Ste 1500 �������J��BeS PetraRlskSolutrons ._ .� ._ � ^—
INSr�RERIS) A�FFOrx �NGG CO RAGE
_NAICIS
. �. ....
Los Angeles
INSURED Embass�m` Suites � s
Y 9
A Everest National Insurance Co
INSURER ..._..— �...�—__ .. —... .... ......
_..,.,.,_ ....,.. ...
10120
..._� ..
International Airport South
INSURER B „ Allied World_ Assurance
19489
1440 E. Imperial Avenue
INSURER Steadfast Insurance
. 7
El Segundo, CA90245
"yNSURER'r Aspen Special Insurance Co
1071 7 ---
INSURERE COlumbla Ca� ualt Com an a
p
I3112 7 ...._.
an Ins. Co.
INSURER F . Great American
16691
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...r._---
F SUCH
TIONS Q....._._..—_
POLICIES.
LIMITS SHOWNCYNUMBER VE
BEEN REDUCEDonao�
PAIDCLAIMS.
-iNSR
LTR I
.....
TMPDOFQINSDUIRANCE
Ad
,crll—
�B
Y �'
LIMITS
GENERAL LIABILITY
OCCURRENCE
$
2.,000 00
A
LX
LIABILITY
I"tM1GL00012-241
01/30/2024
EACH
01130/2025rMIE qEa occnwrrencep
$
1w000r00'.
..... COMMERCIAL GENERAL
N/
CLAIMS -MADE X y OCCUR
�....__N
MED EXP (APX one PCrl9Gn;
$
X.....T .
rrorism Incl
PERSONAL & AD) INJURY
$ �-
1+
— ,
X Liquor Liability
GENERAL AGGREGATE
$
4,000,000
GEf�'LAG R'EGA7ELIMITAPPLIESPER.. ...,.
PRODUCTS - COMP/OP AGG
� ...$
$ ---�
4,,000,00
....
�I
PRO-
POLICY X LOC
E m Ben.
,000„000
,0
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
(Ea accident)
$
3,000,000
A
., .....
'' X ANY AUTO
....
_
RMICAOOOO4 241
01/30/20 24
01/30/20 5 .. ....r
BODILY INJURY (Per person)
......�
$
..�.._...— .............
ALL OWNED AUTOS
_
BODILY INJURY (Per accident)
SCHEDULED AUTOS
PROPERTY DAMAGE
( PER ACCIDENT)
HIRED AUTOS
NON -OWNED AUTOS
...... ........._"..
..._.. .......
.UMBRELLA LU1B
X X occuR
EACH OCCURRENCE
�
$
100,00000
''� EXCESS LIAB
1,.CLAIMS-MADE��X
SE, NOTEPAD FOR SCHEDULE
2 24
01/30/ 0
AGGREGATE
01/30/2025.— '" 'T
"���
�y
100,000,000
'
FOIIOW Form
DEDUCTIBLE
X RETENThON $ 10,000
ATU i,7TFi
S
WORKERS COMPENSATION
ER
TO.F,$"d'91x�-��---�---
AND EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNER/EXECUTIVE Y'I"""""I
E .L. EACH ACCIDENT
$
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
N I A
E-
EASE EA EMPL YE E
�L.DIS,.._— .,..�.r_
$
_-....
lRyyds doscrllaeuolo.,
DESCRIPTION OF OPERATIONS bellow
r
E.L DISEASE -POLICY LIPwBTT
'.
A
Liquor Liability
RMi1IGL00012-241
0V30/2024
01/30/2025 Per Oce
1,000 000
e
Aggregate
2,000,000,
DESCRIPTION OF OPERATIONS LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if if more space is required)
Hotel"s Ins. is prima s for any bodily!injury or property damage caused by
the sole negligent a r of the Hotel, its employees, agents„ or
subcontrac ors, as covered by the policies..
Event: Cq of El Sel undo Holiday Party 12112/24
CERTIFICATE HOLDER
CANCELLATION
CITY068
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of El Segundo
350 Main Street
AUTHORIZED REPRESENTATIVE
EI Segundo, CA 90245
0 1988-2009 ACORD CORPORATION. All rights reserved.
O
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
EMELS-1 PAGE 2
NOTEPAD INSURED'SNAME Embassy Suites Los Angeles OP ID: LM Date 11/05/2024
Excess Liability/Umbrella Coverage - Effective. 01/30/24 to 01/30/25
Allied World Assurance Company A.M. Best: A XV
Policy #0309-5702
$10,000,000 Lead Umbrella
Steadfast Insurance Company A.M. Best: A+ XV
Policy # AECO530759-02
$15,000,000 excess of $10,000,000
Aspen Specialty Insurance Company A.M. Best: A XV
Policy # CX00Q5E24
$15,000,000 p/o $75,000,000 excess of $25,000,000
Columbia Casualty Company A.M. Best: A XV
Policy # FFX7018252519
$15,000,000 p/o $75,000,000 excess of $25,000,000
Great American Alliance Insurance Company A.M. Best: A+ XV
Policy # EXC5202934
$15,000,000 p/o $75,000,000 excess of $25,000,000
Everest Indemnity Ins. Co. A.M. Best: A+ XV
Policy # XC5E'X01542-241
$10,000,000 p/o $75,000,000 excess of $25,000,000
Indian Harbor Insurance Company A.M. Best: A+ XV
Policy # SXS006074702
$10,000,000 p/o $75,000,000 excess of $25,000,000
Lexington Insurance Company - Boston A.M. Best: A XV
Policy # 011170568
$10,000,000 p/o $75,000,000 excess of $25,000,000
Policy cancellation provides 60 days cancellation, except for non-payment
of premium, which provides 10 days notice of cancellation.