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PROOF OF INSURANCE (2025 - 2025)tie DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE .11 /14/2024 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 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 endorsement(s). Ed ewood Partners Insurance Center PHONE " Hernandez, CIC PRODUCER M1NAME Christina 619-4 J2e..... . ., w . _ ... .... ..... E-MAIL q T CONTAC 425 California Street, Suite 2400Ertl I tAIp Ne) San Francisco CA 94105 ADDLES_$ chrp 4sna hpmande qpa cbrr Coker com FAx THIS IS TO CERTIFY THAT THE POLICIES OF I11 NSURANCE 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. ...��.,.,,........_ .....„....,. ....., ... , ,. Y �........P09�JOYNUMBER ... ... f.....MMCDC4f'" .................. nLT �.......... ...... TYPE OF INSURANCE......... �ABSDL+'US',.'.. I POLICY EFFY...i..P'1.VCDYE.XP i LIMITS INSD A X COMMERCIAL GENERAL LIABILITY Y Y 8750003550000 9/25/2024 9/25/2025 EACH OCCURRENCE $ 1 000 000 ... [ 0AMX606ke rEfo X...� .. .I ErFk ... 500 000 CLAIMS -MADE, OCCUR ImIwJ,.$. $.I(W.;arLrvrre.,ro,„�.� .. $.........,, .....Y MED EXP (Arvy one Pcrostrnp $ 15 000 PERSONAL & ADV INJURY $ 1,000,0100 �..... .... ..... GENERAL AGGREGATE $ 2,000 000 .. - T GENE E LIMIT APPLIES PER: i i X PRO- LOC ff .................__. 000 000 POLICY �. JECT RODUCTS -COMP/OP AGG $ ?, LILY I ,- _ $ A AUTOMOBILELIABILITY Y 7100396780004 9/25/2024 COMBINED SINGLE n.dMl 9/25/2025 I COT Ea rcidano $1,000 000 . M.... ! ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED f �. INJURY (Per accident) BODILY INJU $ AUTOS ONLY {— w AUTOS HIRED NON -OWNED X X -_ tPanr woaP .AMAGE $ �! .... AUTOS ONLY AUTOS ONLY 44�v)� $ Included I A CV �PIer,aa clal Dery A X UMBRELLA LIAR X � OCCUR Y Y 8730004880000 9/25/2024 9/25/2025 EACH OCCURRENCE $ 3,000,000 11 EXCESS LIAB CLAIMS -MADE AGGREGATE $ 3,000 0100 .. T" ...�. DFD RETEN"IION3.. ...- i $ B WORKERS COMPENSATION Y CWWCP100094053 5/25/2024 5/25/2025 X PER OTH R - AND EMPLOYERS' LIABILITY Y F N jj 000 000 J $ 1- ANYPROPRIETOR/PARTNER/EXECUTIVE OFF ICEWMEMBER EXCLUDED? NIA E.L.EACH ACCIDENTE CA. EP�NPLESkrEE $ 1,000 00'0 (Mandatory in NH) ..._.., E.L.DISEASE _. _ l yes, describe under DESCRIPTION OF OPERATIONS below IMIT B- POLICY LIMIT E1. DISEASE $.1,000„000 A Misc, Equipment ''. 7100410500003 9/25/2024 9/25/2025 Limit Deductible $310,000 $2,500 Rented/Owned DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holder is included as Additional Insured on the General Liability, on a Primary & Contributory basis, as required by a written contract or agreement. Waiver of Subrogation in favor of the Additional Insureds applies to the General Liability„ Auto Liability and Workers Compensation policies, as required by a written contract or agreement. Certificate Holder is included as Additional Insured and/or Loss Payee on the Auto Liability as required by a written contract or agreement and as their interest may appear. Hired Auto Physical Damage Included, subject to $1,000 Comprehensive and Collision Deductibles. Umbrella is follow form; $2,000,000 Umbrella limit effective 9/25/24 - 10/26/24 and $3,000,000 Umbrella limit effective 10/27/24 - 9/24/25. ERTIFICATE HOLDER III SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of El Segundo its officers, officials, employees, ACCORDANCE WITH THE POLICY PROVISIONS. agents, and volunteers AUTHORIZED REPRESENTATIVE 3501 Main St El Segundo CA 90425 I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 875-00-03-55-0000 COMMERCIAL GENERAL LIABILITY CG20261219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OIL ORGANIZATION This endorsement modifies insurance provided under the following. COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Persons or Organizations as required by written contract executed prior to the date of an "Occurrence" solely and directly arising from the actions of the named insured. Information required to co m late this Schedule„ if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III — Limits Of Insurance: with respect to liability for "bodily Injury", "property If coverage provided to the additional insured is damage" or "personal and advertising injury required by a contract or agreement, the most we caused, in whole or in part, by your acts or will pay on behalf of the additionalinsured is the omissions or the acts or omissions of those acting amount of insurance: on your behalf: 1. Required by the contract or agreement; or 1. In the performance of your ongoing 2. Available under the applicable limits of operations; or 2. In connection with your premises owned by insurance; or rented to you. whichever is less. However: This endorsement shall not increase the applicable limits of insurance. 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a 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 to provide for such additional insured. CG 20 26 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 E-INSURED PN 99 04 51 A (Ed. 08120) CALIFORNIA LOSS PREVENTION NOTICE We are required by law to maintain or provide occupational safety and health loss prevention consultation services as required by Labor Code Section 6354.5 and Insurance Code Section 11703. These services are available at no additional charge to the insured. The available Loss Prevention Consultation Services include the following: • A workplace survey, including discussion with management and, where appropriate, non -management personnel with permission of the employer. r A review of injury records with appropriate personnel. o The development of a plan to improve the employer's health and safety loss prevention experience, which shall include, where appropriate, modifications to the employer's injury and illness prevention program established pursuant to Labor Code Section 6401.7. These services will identify the hazards exposing the policyholder to, or causing, significant workers' compensation losses, and will advise the insured of steps needed to mitigate the identified workers' compensation losses or exposures. Workers' compensation insurance policyholders may register comments about the insurer's loss control consultation services by writing to: State of California, Department of Industrial Relations, Division of Occupational Safety and Health, P.O. Box 420603, San Francisco, CA 94142. PN990451A (Ed. 08120) Claims Process Part of our mission as an organization is to help you prevent accidents on the job. Our Loss Control team is equipped with knowledge experts and risk mitigation resources to help ensure long term safety success for your organization. However, when injuries happen, we'll be there to guide you and your employees through the process every step of the way. ue Medical Care s im i As soon as the injury occurs, it is essential to get the appropriate care immediately. Injured Worker In an emergency, seek immediate care. Many options, including TeleCompCare®*, exist to help you get medical attention as soon as possible. In non -emergency situations, inform your employer to ensure you are using the appropriate provider.** Employer Provide first -aid, if necessary, and arrange for employee medical treatment. Alert the medical facility that the employee is coming. Your Claim Team Our team is here to support the injured employee and company from the onset of an injury. We can assist with gaining immediate medical attention. Report Your Claim 1 i i Report the injury details and refer the injured worker for further medical treatment. Reporting the claim through our online portal is the fastest, easiest option. However, you may also do so via phone or �email. Please note, you will also need to report the claim directly to OSHA. OSHA requires employers to report any worker fatality within 8 hours and any amputation, loss of an eye or hospitalization of a worker within 24 hours. Injured Worker Communicate the injury to your employer as soon as possible. It is critical to provide a detailed overview of the injury. Return all forms you receive in your welcome packet in a timely manner after the claim is reported — and consult with your claims professional on any questions. Employer Submit the claim. Gather all the employee's pertinent details, contact any witnesses, take photos and have the employee complete an accident form. Promptly submit a wage statement on lost time claims to help administer benefits. Your Claim Team A claims professional will contact you as soon as possible to discuss the incident and gather any outstanding information. AFGroup.com �OAFGroup1-844-462-2344 IC��„YI°IY� Care Following the injury, a nurse or doctor will help determine the next steps in getting the injured worker back to 100%. Injured Worker Follow treatment given by medical staff. Be sure to attend any appointments, keep your employer informed of the progress and call the claims professional after every appointment. Register for our online portal to access and manage your claim information 24-7. Employer Support the injured worker any way you can. Be sure to stay informed of the medical staff's guidance and any job duties the injured worker can begin to perform. Register for our online portal to monitor the progress of your injured worker. Your Claim Team The claims team will be a part of the entire process. We'll ensure the injured worker is getting the appropriate care and the employer is aware of the treatment status. , Return to Work/Keep at Work " i j "I An effective RTW/KAW program shortens the duration of disability and helps keep injured workers functioning effectively in the workplace. After the treating physician releases the injured worker, temporary work restrictions may be provided. Injured Worker Continue treatment with the physician and ensure a 'Work Status Form' is sent to the employer following each medical appointment. It should outline the job duties deemed physically appropriate for the injured worker. Employer Discuss temporary job modifications, alternative work and/or reduced work hours with the employee. Provide support as they transition into modified tasks. Your Claim Team The claims professional will work with the employer to review any work restrictions and assist with the employee's return to work plan. . I Recovery E w"w� �ae� Fully recovering from the work injury and returning to a sense of normalcy is the ultimate goal. Injured Worker Completing your medical care and continuing any at-home exercises will usually help get you back to peak physical condition. Employer Maintain communication with the injured employee and assist them mentally and physically as they return to the job. Your Claim Team The claims professional will continue to reach out as the claim is closed. A loss control consultant will be able to help mitigate the future risk of employee injury. *For further information regarding TeleCompCare@, please contact your agent. ** If you are not sure how care is handled in your respective state, please contact the carrier or employer for guidance. Claims Contact Information Accident Fund 866-206-5851 ClaimsExpress@AccidentFund.com Portal link: https://dcp. ccidentfund co / CompWest 888-266-7937 Portal link: Mips. /dcp cgMpp yestknsur nce cc / Third Coast 866-641-2328 ClaimsExpress@3CU.com Portal link. https //dcpm3cu corer, United Heartland 888-881-8242 ClaimsExpress@UnitedHeartland.com Portal link: https//dcp.unitedheartland.com/ AccidentFundUnitedHeatland Co"N`neto AF Group �Pderw �ult�!�us��iamuumm� rr Account Number: A010175248 Primary Named Insured: BELL EVENT SERVICES, INC. Policy Number: CW WCP 100094052 02 Policy Term: 05/25/2024 - 05/25/2025 Premium Installment Schedule as of 05/25/2024 This is not a bill. Bill Date Due Date Premium Total 05/24/2024 06/18/2024 $3,325.80 $3,325.80 05/31/2024 06/25/2024 $2,072.80 $2,072.80 06/30/2024 07/25/2024 $2,072.80 $2,072.80 07/31/2024 08/25/2024 $2,072.80 $2,072.80 08/31/2024 09/25/2024 $2,072.80 $2,072.80 09/30/2024 10/25/2024 $2,072.80 $2,072.80 10/31/2024 11/25/2024 $2,072.80 $2,072.80 11/30/2024 12/25/2024 $2,072.80 $2,072.80 12/31/2024 01/25/2025 $2,072.80 $2,072.80 01/31/2025 02/25/2025 $2,072.80 $2,072.80 $21,981.00 Invoice fees may apply. For billing inquiries, please call 888-266-7937 or log on to our customer portal at: AFGroup.com AF Group (Lansing, Mich.) and its subsidiaries are a premier provider of innovative insurance solutions. Insurance policies may be issued by any of the following companies within AF Group: Accident Fund Insurance Company of America, Accident Fund National Insurance Company, Accident Fund General Insurance Company, United Wisconsin Insurance Company, Third Coast Insurance Company or CompWest Insurance Company. PN 04 99 04 (Ed. 12-01) POLICYHOLDER NOTICE CALIFORNIA INSURANCE GUARANTEE ASSOCIATION (CIGA) SURCHARGE Companies writing property and casualty insurance business in California are required to participate in the California Insurance Guarantee Association. If a company becomes insolvent, the California Insurance Guarantee Association settles unpaid claims and assesses each insurance company for its fair share. California law requires all companies to surcharge policies to recover these assessments. If your policy is surcharged, "CA Surcharge" or "CA Surcharge (CIGA Surcharge)" with an amount will be displayed on your premium notice. This notice does not change the policy to which it is attached PN 0499 011 (Ed. 02-22) POLICYHOLDER NOTICE YOUR RIGHT TO RATING AND DIVIDEND INFORMATION I. Information Available to You A. Information Available from Us - CompWest Insurance Company (1) General questions regarding your policy should be directed to: Customer Service at CompWest Insurance Company 200 N. Grand Ave. Lansing, MI 48933-1288 1-888-266-7937 www.compwestinsurance.com (2) Dividend Calculation. If this is a participating policy (a policy on which a dividend may be paid), upon payment or non- payment of a dividend, we shall provide a written explanation to you that sets forth the basis of the dividend calculation. The explanation will be in clear, understandable language and will express the dividend as a dollar amount and as a percentage of the earned premium for the policy year on which the dividend is calculated. (3) Claims Information. Pursuant to Sections 3761 and 3762 of the California Labor Code, you are entitled to receive information in our claim files that affects your premium. Copies of documents will be supplied at your expense during reasonable business hours. For claims covered under this policy, we will estimate the ultimate cost of unsettled claims for statistical purposes eighteen months after the policy becomes effective and will report those estimates to the Workers' Compensation Insurance Rating Bureau of California (WCIRB) no later than twenty months after the policy becomes effective. The cost of any settled claims will also be reported at that time. At twelve-month intervals thereafter, we will update and report to the WCIRB the estimated cost of any unsettled claims and the actual final cost of any claims settled in the interim. The amounts we report will be used by the WCIRB to compute your experience modification if you are eligible for experience rating. B. Information Available from the Workers' Compensation Insurance Rating Bureau of California (1) The WCIRB is a licensed rating organization and the California Insurance Commissioner's designated statistical agent. As such, the WCIRB is responsible for administering the California Workers' Compensation Uniform Statistical Reporting Plan-1995 (USRP) and the California Workers' Compensation Experience Rating Plan-1995 (ERP). WCIRB contact information is: WCIRB, 1901 Harrison Street, 17th Floor, Oakland, CA 94612, Attn: Customer Service; 888.229.2472 (phone); 415.778.7272 (fax); and Cu5,tat r 5,ptyjc @wOl lrt opr (email). The regulations contained in the USRP and ERP are available for public viewing through the WCIRB's website at wcirb.,.com. (2) Policyholder Information. Pursuant to California Insurance Code (CIC) Section 11752.6, upon written request, you are entitled to information relating to loss experience, claims, classification assignments, and policy contracts as well as rating plans, rating systems, manual rules, or other information impacting your premium that is maintained in the records of the WCIRB. Complaints and Requests for Action requesting policyholder information should be forwarded to: WCIRB, 1901 Harrison Street, 17th Floor, Oakland, CA 94612, Attn: Custodian of Records. The Custodian of Records can be reached at 415.777.0777 (phone) and 415.778.7272 (fax). (3) Experience Rating Form. Each experience rated risk may receive a single copy of its current Experience Rating Form/ Worksheet free of charge by completing a Policyholder Experience Rating Worksheet Request Form on the WCIRB's website at w curl n + r8 r fi_)Mgt,. The Experience Rating Form/Worksheet will include a Loss -Free Rating, which is the experience modification that would have been calculated if $0 (zero) actual losses were incurred during the experience period. This hypothetical rating calculation is provided for informational purposes only. II. Dispute Process You may dispute our actions or the actions of the WCIRB pursuant to CIC Sections 11737 and 11753.1. A. Our Dispute Resolution Process If you are aggrieved by our decision adopting a change in a classification assignment that results in increased premium, or by the application of our rating system to your workers' compensation insurance, you may dispute these matters with us. If you are dissatisfied with the outcome of the initial dispute with us, you may send us a written Complaint and Request for Action as outlined below. PN 04 99 011 Page 1 of 3 (Ed. 02-22) PN 04 99 011 (Ed. 02-22) You may send us a written Complaint and Request for Action requesting that we reconsider a change in a classification assignment that results in an increased premium and/or requesting that we review the manner in which our rating system has been applied in connection with the insurance afforded or offered you. Written Complaints and Requests for Action should be forwarded to: CompWest Insurance Company Attn: Olivia Dimithe Consumer Complaints 100 Pringle Ave., Suite 515 Walnut Creek, CA 94596 1-888-266-7937 Fax: 517-346-2069 After you send your Complaint and Request for Action, we have 30 days to send you a written notice indicating whether your written request will be reviewed. If we agree to review your request, we must conduct the review and issue a decision granting or rejecting your request within 60 days after sending you the written notice granting review. If we decline to review your request, if you are dissatisfied with the decision upon review, or if we fail to grant or reject your request or issue a decision upon review, you may appeal to the Insurance Commissioner as described in paragraph II.C., below. B. Disputing the Actions of the WCIRB. If you have been aggrieved by any decision, action, or omission to act of the WCIRB, you may request, in writing, that the WCIRB reconsider its decision, action, or omission to act. You may also request, in writing, that the WCIRB review the manner in which its rating system has been applied in connection with the insurance afforded or offered you. For requests related to classification disputes, the reporting of experience, or coverage issues, your initial request for review must be received by the WCIRB within 12 months after the expiration date of the policy to which the request for review pertains, except if the request involves the application of the Revision of Losses rule. For requests related to your experience modification, your initial request for review must be received by the WCIRB within 6 months after the issuance, or 12 months after the expiration date, of the experience modification to which the request for review pertains, whichever is later, except if the request for review involves the application of the Revision of Losses rule. If the request involves the Revision of Losses rule, the tir, a to state your appeal may be longer. (See Section VI, Rule 7 of the ERP). You may commence the review process by sending the WCIRB a written Inquiry. Written Inquiries should be sent to: WCIRB, 1901 Harrison Street, 17th Floor, Oakland, CA 94612, Attn: Customer Service. Customer Service can be reached at 888.229.2472 (phone), 415.778.7272 (fax) and gstomersery r it ,.,g,fa,im (email). If you are dissatisfied with the WCIRB's decision upon an Inquiry, or if the WCIRB fails to respond within 90 days after receipt of the Inquiry, you may pursue the subject of the Inquiry by sending the WCIRB a written Complaint and Request for Action. After you send your Complaint and Request for Action, the WCIRB has 30 days to send you written notice indicating whether your written request will be reviewed. If the WCIRB agrees to review your request, it must conduct the review and issue a decision granting or rejecting your request within 60 days after sending you the written notice granting review. If the WCIRB declines to review your request, if you are dissatisfied with the decision upon review, or if the WCIRB fails to grant or reject your request or issue a decision upon review, you may appeal to the Insurance Commissioner as described in paragraph II.C., below. Written Complaints and Requests for Action should be forwarded to: WCIRB, 1901 Harrison Street, 17th Floor, Oakland, CA 94612, Attn: Complaints and Reconsideration. The WCIRB's contact information is 888.229.2472 (phone), 415.371.5204 (fax) and custom r e i e@wc.irb corn, (email). C. California Department of Insurance — Appeals to the Insurance Commissioner. After you follow the appropriate dispute resolution process described above, if (1) we or the WCIRB decline to review your request, (2) you are dissatisfied with the decision upon review, or (3) we or the WCIRB fail to grant or reject your request or issue a decision upon review, you may appeal to the Insurance Commissioner pursuant to CIC Sections 11737, 11752.6, 11753.1 and Title 10, California Code of Regulations, Section 2509.40 et seq. You must file your appeal within 30 days after we or the WCIRB send you the notice rejecting review of your Complaint and Request for Action or the decision upon your Complaint and Request for Action. If no written decision regarding your Complaint and Request for Action is sent, your appeal must be filed within 120 days after you sent your Complaint and Request for Action to us or to the WCIRB. The filing address for all appeals to the Insurance Commissioner is: Administrative Hearing Bureau California Department of Insurance 1901 Harrison Street, 3rd Floor Mailroom Oakland, CA 94612 415.538.4243 You have the right to a hearing before the Insurance Commissioner, and our action, or the action of the WCIRB, may be affirmed, modified or reversed. PN 04 99 011 Page 2 of 3 (Ed. 02-22) PN 04 99 011 (Ed. 02-22) III. Resources Available to You in Obtaining Information and Pursuing Disputes A. Policyholder Ombudsman. Pursuant to California Insurance Code Section 11752.6, a policyholder ombudsman is available at the WCIRB to assist you in obtaining and evaluating the rating, policy, and claims information referenced in I.A. and I.B., above. The ombudsman may advise you on any dispute with us, the WCIRB, or on an appeal to the Insurance Commissioner pursuant to Section 11737 of the Insurance Code. The address of the policyholder ombudsman is WCIRB, 1901 Harrison Street, 17th Floor, Oakland, CA 94612, Attn: Policyholder Ombudsman. The policyholder ombudsman can be reached at 415.778.7159 (phone), 415.371.5288 (fax) and onlbud rn_an w it .c n (email). B. California Department of Insurance - Information and Assistance. Information and assistance on policy questions can be obtained from the Department of Insurance Consumer HOTLINE, 800.927.HELP (4357) or i0s _gpy. For questions and correspondence regarding appeals to the Administrative Hearing Bureau, see the contact information in paragraph II.C. This notice does not change the policy to which it is attached. PN 04 99 011 Page 3 of 3 (Ed. 02-22) PN 04 99 02 B (Ed. 05-02) POLICYHOLDER NOTICE CALIFORNIA WORKERS' COMPENSATION INSURANCE RATING LAWS Pursuant to Section 11752.8 of the California Insurance Code, we are providing you with an explanation of the California workers' compensation rating laws. 1.We establish our own rates for workers' compensation. Our rates, rating plans, and related information are filed with the insurance commissioner and are open for public inspection. 2.The insurance commissioner can disapprove our rates, rating plans, or classifications only if he or she has determined after public hearing that our rates might jeopardize our ability to pay claims or might create a monopoly in the market. A monopoly is defined by law as a market where one insurer writes 20% or more of that part of the California workers' compensation insurance that is not written by the State Compensation Insurance Fund. If the insurance commissioner disapproves our rates, rating plans, or classifications, he or she may order an increase in the rates applicable to outstanding policies. 3.Rating organizations may develop pure premium rates that are subject to the insurance commissioner's approval. A pure premium rate reflects the anticipated cost and expenses of claims per $100 of payroll for a given classification. Pure premium rates are advisory only, as we are not required to use the pure premium rates developed by any rating organization in establishing our own rates. 4.We must adhere to a single, uniform experience rating plan. If you are eligible for experience rating under the plan, we will be required to adjust your premium to reflect your claim history. A better claim history generally results in a lower experience rating modification; more claims, or more expensive claims, generally result in a higher experience rating modification. The uniform experience rating plan, which is developed by the insurance rating organization designated by the insurance commissioner, is subject to approval by the insurance commissioner. 5.A standard classification system, developed by the insurance rating organization designated by the insurance commissioner, is subject to approval by the insurance commissioner. The standard classification system is a method of recognizing and separating policyholders into industry or occupational groups according to their similarities and/or differences. We can adopt and apply the standard classification system or develop and apply our own classification system, provided we can report the payroll, expenses, and other costs of claims in a way that is consistent with the uniform statistical plan or the standard classification system. 6.Our rates and classifications may not violate the Unruh Civil Rights Act or be unfairly discriminatory. 7.We will provide an appeal process for you to appeal the way we rate your insurance policy. The process requires us to respond to your written appeal within 30 days. If you are not satisfied with the result of your appeal, you may appeal our decision to the insurance commissioner. 1of2 PN 04 99 02 B (Ed. 05-02) California Workers' Compensation Insurance Notice of Nonrenewal Section 11664 of the California Insurance Code requires us, in most instances, to provide you with a notice of nonrenewal. Except as specified in paragraphs 1 through 6 below, if we elect to nonrenew your policy, we are required to deliver or mail to you a written notice stating the reason or reasons for the nonrenewal of the policy. The notice is required to be sent to you no earlier than 120 days before the end of the policy period and no later than 30 days before the end of the policy period. If we fail to provide you the required notice, we are required to continue the coverage under the policy with no change in the premium rate until 60 days after we provide you with the required notice. We are not required to provide you with a notice of nonrenewal in any of the following situations: 1.Your policy was transferred or renewed without a change in its terms or conditions or the rate on which the premium is based to another insurer or other insurers who are members of the same insurance group as us. 2.The policy was extended for 90 days or less and the required notice was given prior to the extension. 3.You obtained replacement coverage or agreed, in writing, within 60 days of the termination of the policy, to obtain that coverage. 4.The policy is for a period of no more than 60 days and you were notified at the time of issuance that it may not be renewed. 5.You requested a change in the terms or conditions or risks covered by the policy within 60 days prior to the end of the policy period. 6.We made a written offer to you to renew the policy at a premium rate increase of less than 25 percent. (A) If the premium rate in your governing classification is to be increased 25 percent or greater and we intend to renew the policy, we shall provide a written notice of a renewal offer not less than 30 days prior to the policy renewal date. The governing classification shall be determined by the rules and regulations established in accordance with California Insurance Code Section 11750.3(c). (B) For purposes of this Notice, "premium rate" means the cost of insurance per unit of exposure prior to the application of individual risk variations based on loss or expense considerations such as scheduled rating and experience rating. This notice does not change the policy to which it is attached. 2 of 2 Premium Audit I nstructions What is a premium audit? Premium audits are standard practice and are a condition of the policy. When a workers' compensation policy is purchased, the premium on that policy is estimated based on your business operations and exposures. Throughout the life of the policy, those exposures and payroll might change, resulting in a higher or lower premium. During a premium audit, which is conducted at the expiration of the policy period, actual exposures and classifications are compared to what was estimated to determine the final premium. We understand that the word `audit' can sound daunting, but rest assured, our team will be there to guide you. And, in some cases, audits actually save our customers money, which is another reason it's such an important part of the work comp process! How are premium audits completed? All workers' compensation policies require a premium audit - there are various ways they can be completed. • Physical audit - A meeting is scheduled with one of our auditors to review audit records, operations and documentation at your business location. • Virtual audit - Using a virtual setting (e.g., MS Teams, Zoom, etc.), we'll review the audit records with you. • Online audit - Simply log into our secure portal using your provided ID and password to input audit information. Note that not all policies qualify for online audits. • Phone audit - The completed audit form and supporting documentation are reviewed with a member of our audit team over the phone. • Mail audit - An audit form is completed and returned with the required supporting documentation via mail, email or fax. Prepare for the Audit Here are some common records and documents needed to complete the audit: Payroll records State and Federal tax reports: 941's,1120, Schedule C, state unemployment forms job duties for employees, principals and subcontracted labor Total cost paid to subcontracted/1099/cash labor Certificates of workers' compensation insurance for subcontractors Profit and loss statements or general ledger Note, this list is not all-inclusive; we will alert you of the specific records needed for your audit. What is an audit noncompliance charge (ANC)? To comply with state bureaus and the National Council on Compensation (NCCI), AF Group applies an audit noncompliance charge if a policyholder does not comply with the request for a premium audit. Please refer to your policy for details regarding the ANC charge. The ANC charge varies by state. Audit Disputes Audit disputes can occur and settling them can be time- consuming. To prevent this: Make sure the auditor has access to a complete set of records. Ensure you or your accountant can provide a detailed description of your operation and a job description of each of your employees and subcontractors. Have someone (an owner, if possible) review the audit with the auditor during the exit interview. Our team will work with you to handle any disputes in a timely manner should they occur. If a dispute does arise, please visit the applicable brand website: Accident flmd: UWaVJmmw.urre4! iCia:a�,l, r 'I?l far��nrea.;� : m�"x t:'xruc :a CompWest: bl is :JM�ain(.e.cnrro pt_)J Third Coast Underwriters: L%tt;1) rvff,]+.wry`o:.��1te United Heartland: �It �1. In w',;!r14�L ,r1"x nr 0and cr,,�p�j�pa,rimrmwwm a� rin,! p:gg2a. Z If you have any questions, please contact us at premiumaudit@accidentfund.com or 1-866-206-5851. AUDIT (Ed. 07-23) Privacy Disclosure Notice To our customers CompWest Insurance Company ("the Company" or "we") does not disclose any non- public personal information about our individual policyholders, applicants, claimants, customers or former customers to any non-affiliated third party other than those permitted by law and only for the purpose of transacting the business of insurance. What kinds of information do we collect and from whom? The Company collects majority of its information directly from you and/or your agent. This information can include, but is not limited to, name, address, e-mail address, phone number, social security number, income, account balances, transaction history, credit history, insurance claim history, and medical information. The personal information collected is used to help serve your insurance needs, conduct company business, adjust claims, provide customer service and fulfill legal regulatory requirements. What do we do with the information collected about you? We use the information collected to evaluate your request for insurance coverage, provide policy and premium quotes, service your claims, and determine your rates. We do not disclose information about you to anyone unless such disclosure is expressly authorized by you, required by law, or is necessary to enable our employees or authorized agents to perform functions for the Company. The information is not available to the public. What safeguards do we use? The Company has a security program consisting of physical, electronic, and procedural safeguards designed to ensure the security and confidentiality of information collected and disclosed. For a copy of our Privacy Policy: Visit our website: www.compwestinsurance.com Call toll -free: 1-888-266-7937 Write: CompWest Insurance Company Office of the General Counsel Attn: Privacy Officer PO Box 40790 Lansing, MI 48901-7990 C-NTI-PD A (Ed. 7-23) DISCLOSUR2 Ed. 09/2020 POLICYHOLDER DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGE Coverage for acts of terrorism is included in your policy. You are hereby notified that under the Terrorism Risk Insurance Act, as amended in 2019, the definition of act of terrorism has changed. As defined in Section 102(1) of the Act: The term "act of terrorism" means any act or acts that are certified by the Secretary of the Treasury — in consultation with the Secretary of Homeland Security, and the Attorney General of the United States — to be an act of terrorism; to be a violent act or an act that is dangerous to human life, property, or infrastructure; to have resulted in damage within the United States, or outside the United States in the case of certain air carriers or vessels, or the premises of a United States mission; and to have been committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. Under your coverage, any losses resulting from certified acts of terrorism may be partially reimbursed by the United States Government under a formula established by the Terrorism Risk Insurance Act, as amended. However, your policy may contain other exclusions which- might affect your coverage, such as exclusion for nuclear events. Under the formula, the United States Government generally reimburses 80% beginning on January 1, 2020, of covered terrorism losses exceeding the statutorily established deductible paid by the insurance company providing the coverage. The Terrorism Risk Insurance Act, as amended, contains a $100 billion cap that limits U.S. Government reimbursement as well as insurers' liability for losses resulting from certified acts of terrorism when the amount of such losses exceeds $100 billion in anyone calendar year. If the aggregate insured losses for all insurers exceed $100 billion, your coverage may be reduced. The portion of your annual premium that is attributable to coverage for acts of terrorism is listed under Item 4 Premium of the Policy Information Page, and does not include any charges for the portion of losses covered by the United States Government under the Act. DISCLOSUR2 (Ed. 09/2020) CompWest Insurance Company PO BOX 40790 LANSING, MI 48901-7990 INFORMATION PAGE Renewal of Policy CWWCP100094052 ITEM 1. Named Insured and BELL EVENT SERVICES, INC. 3636 W 139TH ST HAWTHORNE, CA 90250-8774 bellevent@gmail.com worKers t.ompensaiion ana tmployers Liam my Insurance Policy Policy Number Policy Period From To CW WCP 1000940521 05/25/2024 05/25/2025 12:01 A.M. Standard Time at the described loca EDGEWOOD PARTNERS INSURANCE CENTER - PASADENA P.O. BOX 7072 PASADENA, CA 91109 626-795-9000 CW37100 Other Workplaces Not Shown Above: See schedule attached Extended Named Insured: Absence of an entry means no exception Interstate ID: Intrastate ID: Insured Is: Corporation FEIN#: 900959186 Bureau/Risk ID: 009613818 NCCI #: 12985 Unemployment ID Number: ITEM 2. POLICY PERIOD is from 12:01 A.M., 05/25/2024 to 12:01 A.M., 05/25/2025 Standard Time at the insured's mailing address. ITEM 3. COVERAGE A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: CA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 1,000,000 each accident Bodily Injury by Disease $ 1,000,000 policy limit Bodily Injury by Disease $ 1,000,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here. D. This policy includes these endorsements and schedules: See endorsement schedule ITEM 4. PREMIUM The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates, and Rating Plans. All information required below is subject to verification and change by audit. CLASSIFICATIONS SEE SCHEDULE OF CLASSIFICATIONS ON FOLLOWING PAGE(S) MinimumPremiumD�eplps tmm,Premiurru Total m_Estimated wwAnnual , Premium Premium, A&Mment. Period: $ 1,000 $3,325.80 $ 21,981 Annual - Reporting INSURED COPY WC000001A Ed 0588 Printed On 05/25/2024 Page 1 of 5 I CombWest worKers uompensailon ana tmployers Liammy Insurance Policy Insurance Company Policy Number Policy Period PO BOX 40790 From To LANSING, MI 48901-7990 CW WCP 100094052 05/25/2024 05/25/2025 12:D1 A.M.-Standard Time at the described location Transaction INFORMATION PAGE Renewal of Policy CWWCP100094052 ITEM 1. Named Insured and Address Agent BELL EVENT SERVICES, INC. EDGEWOOD PARTNERS INSURANCE CENTER - 3636 W 139TH ST PASADENA HAWTHORNE, CA 90250-8774 P.O. BOX 7072 bellevent@gmail.com PASADENA, CA 91109 626-795-9000 CW37100 SCHEDULE OF CLASSIFICATIONS:05/25/2024-05/25/2025 CLASSIFICATIONS CODE NO PREM BASIS ESTIMATED REMUNERATION RATE PER $100 ESTIMATED ANNUAL PREMIUM STATE., CRLi rni CLERICAL OFFICE EMPLOYEES - N.O.C. 8810 56,769 0.5400 $307 STORES - WHOLESALE - N.O.C. 8018 0 12.8200 $0 STORES -- RETAIL - N.O.0 8017-1 15,450 6.0300 $932 TELEVISION'„ VIDEO„ AUDIO OR RADIO EQUIPMENT 9516 130,836 5.5800 $7,301 INSTALLATION„ SERVICE OR REPAIR - SHOP OR OUTSIDE THEATERS - NOT MOTION PICTURE --ALL 9154 195,285 4.4300 $8,651 EMPLOYEES OTHER THAN PERFORMERS AND DIRECTORS OF PERFORMERS - INCLUDING MANAGERS, STAGE TECHNICIANS, BOX OFFICE EMPLOYEES OR USHERS Total Manual Premium $17,191 Specific Waiver of Subrogation 0930 2 100 1 $200 Total Subject Premium $17,391 Total Modified Premium . $17,391 Schedule Rating befit; 9889 17,391 1.3000 $5,217 Commission Adjustment SAAJC 22,608 0.9420 ($1,311) Total Standard Premium $21,297 Premium Discount 0063 21,297 0.9517 ($1,029) Expense Constant 0900 1 300 $300 Terrorism Premium 9740 398,340 0.0200 $80 Catastrophe Premium 9741 398,340 0.0200 $80 Estimated Annual Premium $20,728 Other Premium and Surcharges CA Guaranty Association Surcharge Cl IGA 20,728 0 $0 CA Administration Revolving Fund Surcharge CA SRG 20,728 0.0246 $510 CA Occupational Safety and Health Fund Surcharge CA OSH 2O,728 0.0073 $151 CA Uninsured Employers Benefit Trust Fund Surcharge CA UEB 20,728 1 0.0015 $31 CA Subsequent Injuries Benefit Trust Fund Surcharge CA SIB 1 20,728 0.0159 $329 CA Labor Enforcement and Compliance Fund CA LEC 20,728 0.0071 $147 Assessment CA Fraud Surcharge CA AST 20,728 0.0041 $85 INSURED COPY WC000001A Ed 0588 Printed On 05/25/2024 Page 2 of 5 COMOWest worKers L;ompensauon ana tmpioyem Liaminy Insurance Policy Insurance Company Policy Number Policy Period PO BOX 40790 From To CW WCP 100094052 05/25/2024 05/25/2025 LANSING, MI 48901-7990 12:01 A.M. Standard Time at the described location Transaction INFORMATION PAGE Renewal of Policy CWWCP100094052 ITEM 1. Named Insured and Address Agent BELL EVENT SERVICES, INC. EDGEWOOD PARTNERS INSURANCE CENTER - 3636 W 139TH ST PASADENA HAWTHORNE, CA 90250-8774 P.O. BOX 7072 bellevent@gmail.com PASADENA, CA 91109 626-795-9000 CW37100 Total Amount Due T $21,981 Total Estimated Annual Premium $21,981 INSURED COPY WC000001A Ed 0588 Printed On 05/25/2024 Page 3 of 5 COMOWest Insurance Company PO BOX 40790 LANSING, MI 48901-7990 worKers uompensailon ana tmpioyem Liaouiry Insurance Policy Policy Number Policy Period From To CW WCP 100094052 05/25/2024 05/25/2025 12:01 A.M. Standard Time at the described location INFORMATION PAGE Renewal of Policy CWWCP100094052 ITEM 1. Named Insured and Address Agent BELL EVENT SERVICES, INC. EDGEWOOD PARTNERS INSURANCE CENTER - 3636 W 139TH ST PASADENA HAWTHORNE, CA 90250-8774 P.O. BOX 7072 bellevent@gmail.com PASADENA, CA 91109 626-795-9000 CW37100 SCHEDULE OF COVERED WORKPLACES Address BELL EVENT SERVICES, INC. - 900959186 3636 W 139th St Suite 4 Hawthorne, CA 90250-8774 INSURED COPY WC000001A Ed 0588 Printed On 05/25/2024 Page 4 of 5 COMOWest Insurance Company PO BOX 40790 LANSING, MI 48901-7990 INFORMATION PAGE Renewal of Policy CWWCP100094052 ITEM 1. Named Insured and BELL EVENT SERVICES, INC. 3636 W 139TH ST HAWTHORNE, CA 90250-8774 bellevent@gmail.com State Form Nbr worKers compensation ana tmpioyers Liammy Insurance Policy Policy Number Policy Period From To CW WCP 100094052 05/25/2024 05/25/2025 12:01 A.M. Standard Time at the described location on EDGEWOOD PARTNE PASADENA P.O. BOX 7072 PASADENA, CA 91109 626-795-9000 ENDORSEMENT SCHEDULE Ed. Date Description CA WC 00 00,01 A 0588 CA WC 00 00 00 C CA 0115 CA WC 00 04 06 A 0795 CA WC 00 04 19 0101 CA WC 00 04 21 F 0822 CA CA CA CA CA CA CA CA CA CA CA WC 00 04 22 C 0121 WC 04 03 01 D 0218 WC 04 03 03 C 0718 WC 04 03 10 0195 WC 04 03 60 B 0115 WC 04 04 21 0108 WC 04 06 01 B 0122 WC 99 0107 B 0515 WC 99 03 13 C 0709 WC 99 04 10 0721 WC 99 06 60 0517 Agent INSURANCE CENTER - CW37100 Information Page - AF CW Workers Compensation and Employers Liability Insurance Policy Premium Discount Endorsement Premium Due Date Endorsement Catastrophe (Other Than Certified Acts of Terrorism) Premium Endorsement Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement Policy Amendatory Endorsement - California (Includes Statutorily Mandated Language) Endorsement Agreement Limiting and Restricting This Insurance (Officers and Directors Coverage/Exclusion- California) Duty to Defend - California Employers' Liability Coverage Amendatory Endorsement - California Optional Premium Increase Endorsement - California California Cancellation Endorsement Special Cancellation Prov Waiver of Our Right To Recover From Others Endorsement California Non -Sufficient Funds and Reinstatement Fee Charges Endorsement California Execution Clause Endorsement WC000001A Ed 0588 Printed On 05/25/2024 INSURED COPY Page 5of5 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 00 00 C CA COMPWEST INSURANCE COMPANY (Ed. 1-15) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY In return for the payment of the premium and subject to all terms of this policy, we agree with you as follows: GENERAL SECTION A. The Policy This policy includes at its effective date the Infor- mation Page and all endorsements and schedules listed there. It is a contract of insurance between you (the employer named in Item 1 of the Infor- mation Page) and us (the insurer named on the In- formation Page). The only agreements relating to this insurance are stated in this policy. The terms of this policy may not be changed or waived except by endorsement issued by us to be part of this policy. B. Who is Insured You are insured if you are an employer named in Item 1 of the Information Page. If that employer is a partnership, and if you are one of its partners, you are insured, but only in your capacity as an em- ployer of the partnership's employees. C. Workers Compensation Law Workers Compensation Law means the workers or workmen's compensation law and occupational dis- ease law of each state or territory named in Item 3.A. of the Information Page. It includes any amendments to that law which are in effect during the policy period. It does not include any federal workers or workmen's compensation law, any fed- eral occupational disease law or the provisions of any law that provide nonoccupational disability benefits. D. State State means any state of the United States of America, and the District of Columbia. E. Locations This policy covers all of your workplaces listed in Items 1 or 4 of the Information Page; and it covers all other workplaces in Item 3.A. states unless you have other insurance or are self -insured for such workplaces. PART ONE WORKERS COMPENSATION INSURANCE A. How This Insurance Applies This workers compensation insurance applies to bodily injury by accident or bodily injury by disease. Bodily injury includes resulting death. 1. Bodily injury by accident must occur during the policy period. 2. Bodily injury by disease must be caused or ag- gravated by the conditions of your employment. The employee's last day of last exposure to the conditions causing or aggravating such bodily in- jury by disease must occur during the policy period. B. We Will Pay We will pay promptly when due the benefits required of you by the workers compensation law. C. We Will Defend We have the right and duty to defend at our expense any claim, proceeding or suit against you for benefits payable by this insurance. We have the right to in- vestigate and settle these claims, proceedings or suits. We have no duty to defend a claim, proceeding or suit that is not covered by this insurance. D. We Will Also Pay We will also pay these costs, in addition to other amounts payable under this insurance, as part of any claim, proceeding or suit we defend: 1. reasonable expenses incurred at our request, but not loss of earnings; 2. premiums for bonds to release attachments and for appeal bonds in bond amounts up to the amount payable under this insurance; 3. litigation costs taxed against you; 4. interest on a judgment as required by law until we offer the amount due under this insurance; and 5. expenses we incur. E. Other Insurance We will not pay more than our share of benefits and costs covered by this insurance and other Page 1 of 6 © Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved. WC 00 00 00 C CA WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY (Ed. 1-15) COMPWEST INSURANCE COMPANY insurance or self-insurance. Subject to any limits of liability that may apply, all shares will be equal until the loss is paid. If any insurance or self-insurance is exhausted, the shares of all remaining insurance will be equal until the loss is paid. F. Payments You Must Make You are responsible for any payments in excess of the benefits regularly provided by the workers com- pensation law including those required be- cause: 1. of your serious and willful misconduct; 2. you knowingly employ an employee in violation of law; 3. you fail to comply with a health or safety law or regulation; or 4. you discharge, coerce or otherwise discriminate against any employee in violation of the workers compensation law. If we make any payments in excess of the benefits regularly provided by the workers compensation law on your behalf, you will reimburse us promptly. G. Recovery From Others We have your rights, and the rights of persons enti- tled to the benefits of this insurance, to recover our payments from anyone liable for the injury. You will do everything necessary to protect those rights for us and to help us enforce them. H. Statutory Provisions These statements apply where they are required by law. 1. As between an injured worker and us, we have notice of the injury when you have notice. 2. Your default or the bankruptcy or insolvency of you or your estate will not relieve us of our du- ties under this insurance after an injury occurs. 3. We are directly and primarily liable to any per- son entitled to the benefits payable by this insur- ance. Those persons may enforce our duties; so may an agency authorized by law. Enforcement may be against us or against you and us. 4. Jurisdiction over you is jurisdiction over us for purposes of the workers compensation law. We are bound by decisions against you under that law, subject to the provisions of this policy that are not in conflict with that law. 5. This insurance conforms to the parts of the workers compensation law that apply to: a. benefits payable by this insurance; b. special taxes, payments into security or other special funds, and assessments paya- ble by us under that law. 6. Terms of this insurance that conflict with the workers compensation law are changed by this statement to conform to that law. Nothing in these paragraphs relieves you of your du- ties under this policy. PART TWO EMPLOYERS LIABILITY INSURANCE A. How This Insurance Applies This employers liability insurance applies to bodily injury by accident or bodily injury by disease. Bodily injury includes resulting death. 1. The bodily injury must arise out of and in the course of the injured employee's employment by you. 2. The employment must be necessary or inci- dental to your work in a state or territory listed in Item 3.A. of the Information Page. 3. Bodily injury by accident must occur during the policy period. 4. Bodily injury by disease must be caused or ag- gravated by the conditions of your employment. The employee's last day of last exposure to the conditions causing or aggravating such bodily in- jury by disease must occur during the policy period. 5. If you are sued, the original suit and any related legal actions for damages for bodily injury by ac- cident or by disease must be brought in the United States of America, its territories or pos- sessions, or Canada. B. We Will Pay We will pay all sums that you legally must pay as damages because of bodily injury to your employ- ees, provided the bodily injury is covered by this Em- ployers Liability Insurance. The damages we will pay, where recovery is permit- ted by law, include damages: 1. For which you are liable to a third party by rea- son of a claim or suit against you by that third party to recover the damages claimed against Page 2 of 6 © Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 00 00 C CA COMPWEST INSURANCE COMPANY such third party as a result of injury to your employee; 2. For care and loss of services; and 3. For consequential bodily injury to a spouse, child, parent, brother or sister of the injured em- ployee; provided that these damages are the di- rect consequence of bodily injury that arises out of and in the course of the injured employee's employment by you; and 4. Because of bodily injury to your employee that arises out of and in the course of employment, claimed against you in a capacity other than as employer. C. Exclusions This insurance does not cover: 1. Liability assumed under a contract. This exclu- sion does not apply to a warranty that your work will be done in a workmanlike manner; 2. Punitive or exemplary damages because of bod- ily injury to an employee employed in violation of law; 3. Bodily injury to an employee while employed in violation of law with your actual knowledge or the actual knowledge of any of your executive officers; 4. Any obligation imposed by a workers compensa- tion, occupational disease, unemployment com- pensation, or disability benefits law, or any simi- lar law; 5. Bodily injury intentionally caused or aggravated by you; 6. Bodily injury occurring outside the United States of America, its territories or possessions, and Canada. This exclusion does not apply to bodily injury to a citizen or resident of the United States of America or Canada who is temporarily outside these countries; 7. Damages arising out of coercion, criticism, de- motion, evaluation, reassignment, discipline, def- amation, harassment, humiliation, discrimination against or termination of any employee, or any personnel practices, policies, acts or omis- sions; 8. Bodily injury to any person in work subject to the Longshore and Harbor Workers' Compensation Act (33 U.S.C. Sections 901 et seq.), the Nonap- propriated Fund Instrumentalities Act (5 U.S.C. Sections 8171 et seq.), the Outer Continental Shelf Lands Act (43 U.S.C. Sections 1331 et seq.), the Defense Base Act (42 U.S.C. Sections 1651-1654), the Federal Mine Safety and Health Act (30 U.S.C. Sections 801 et seq. and 901- 944), any other federal workers or workmen's compensation law or other federal occupational disease law, or any amendments to these laws; (Ed. 1-15) 9. Bodily injury to any person in work subject to the Federal Employers' Liability Act (45 U.S.C. Sec- tions 51 et seq.), any other federal laws obligat- ing an employer to pay damages to an employee due to bodily injury arising out of or in the course of employment, or any amendments to those laws; 10.Bodily injury to a master or member of the crew of any vessel, and does not cover punitive dam- ages related to your duty or obligation to provide transportation, wages, maintenance, and cure under any applicable maritime law; 11.Fines or penalties imposed for violation of federal or state law; and 12.Damages payable under the Migrant and Sea- sonal Agricultural Worker Protection Act (29 U.S.C. Sections 1801 et seq.) and under any other federal law awarding damages for violation of those laws or regulations issued thereunder, and any amendments to those laws. D. We Will Defend We have the right and duty to defend, at our ex- pense, any claim, proceeding or suit against you for damages payable by this insurance. We have the right to investigate and settle these claims, proceed- ings and suits. We have no duty to defend a claim, proceeding or suit that is not covered by this insurance: We have no duty to defend or continue defending after we have paid our applicable limit of liability under this insurance. E. We Will Also Pay We will also pay these costs, in addition to other amounts payable under this insurance, as part of any claim, proceeding, or suit we defend: 1. Reasonable expenses incurred at our request, but not loss of earnings; 2. Premiums for bonds to release attachments and for appeal bonds in bond amounts up to the limit of our liability under this insurance; 3. Litigation costs taxed against you; 4. Interest on a judgment as required by law until we offer the amount due under this insurance; and 5. Expenses we incur. Page 3 of 6 © Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved. WC 00 00 00 C CA WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY (Ed. 1-15) F. Other Insurance We will not pay more than our share of damages and costs covered by this insurance and other insur- ance or self-insurance. Subject to any limits of liabil- ity that apply, all shares will be equal until the loss is paid. If any insurance or self-insurance is exhausted, the shares of all remaining insurance and self-insur- ance will be equal until the loss is paid. G. Limits of Liability Our liability to pay for damages is limited. Our limits of liability are shown in Item 3.6. of the Information Page. They apply as explained below. 1. Bodily Injury by Accident. The limit shown for "bodily injury by accident —each accident" is the most we will pay for all damages covered by this insurance because of bodily injury to one or more employees in any one accident. A disease is not bodily injury by accident unless it results directly from bodily injury by accident. 2. Bodily Injury by Disease. The limit shown for "bodily injury by disease —policy limit" is the most we will pay for all damages covered by this insurance and arising out of bodily injury by dis- ease, regardless of the number of employees who sustain bodily injury by disease. The limit shown for "bodily injury by disease —each em- ployee" is the most we will pay for all damages because of bodily injury by disease to any one employee. Bodily injury by disease does not include dis- ease that results directly from a bodily injury by accident. 3. We will not pay any claims for damages after we have paid the applicable limit of our liability un- der this insurance. H. Recovery From Others We have your rights to recover our payment from anyone liable for an injury covered by this insurance You will do everything necessary to protect those rights for us and to help us enforce them. Actions Against Us There will be no right of action against us under this insurance unless: 1. You have complied with all the terms of this pol- icy; and COMPWEST INSURANCE COMPANY 2. The amount you owe has been determined with our consent or by actual trial and final judgment. This insurance does not give anyone the right to add us as a defendant in an action against you to deter- mine your liability. The bankruptcy or insolvency of you or your estate will not relieve us of our obliga- tions under this Part. PART THREE OTHER STATES INSURANCE A. How This Insurance Applies 1. This other states insurance applies only if one or more states are shown in Item 3.C. of the Infor- mation Page. 2. If you begin work in any one of those states after the effective date of this policy and are not in- sured or are not self -insured for such work, all provisions of the policy will apply as though that state were listed in Item 3.A. of the Information Page. 3. We will reimburse you for the benefits required by the workers compensation law of that state if we are not permitted to pay the benefits directly to persons entitled to them. 4. If you have work on the effective date of this pol- icy in any state not listed in Item 3.A. of the In- formation Page, coverage will not be afforded for that state unless we are notified within thirty days. B. Notice Tell us at once if you begin work in any state listed in Item 3.C. of the Information Page. PART FOUR YOUR DUTIES IF INJURY OCCURS Tell us at once if injury occurs that may be covered by this policy. Your other duties are listed here. 1. Provide for immediate medical and other ser- vices required by the workers compensation law. 2. Give us or our agent the names and addresses of the injured persons and of witnesses, and other information we may need. 3. Promptly give us all notices, demands and legal Page 4 of 6 © Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 00 00 C CA COMPWEST INSURANCE COMPANY papers related to the injury, claim, proceeding or suit. 4. Cooperate with us and assist us, as we may re- quest, in the investigation, settlement or defense of any claim, proceeding or suit. 5. Do nothing after an injury occurs that would in- terfere with our right to recover from others. 6. Do not voluntarily make payments, assume obli- gations or incur expenses, except at your own cost. PART FIVE —PREMIUM A. Our Manuals All premium for this policy will be determined by our manuals of rules, rates, rating plans and classifica- tions. We may change our manuals and apply the changes to this policy if authorized by law or a gov- ernmental agency regulating this insurance. B. Classifications Item 4 of the Information Page shows the rate and premium basis for certain business or work classifi- cations. These classifications were assigned based on an estimate of the exposures you would have during the policy period. If your actual exposures are not properly described by those classifications, we will assign proper classifications, rates and premium basis by endorsement to this policy. C. Remuneration Premium for each work classification is determined by multiplying a rate times a premium basis. Remu- neration is the most common premium basis. This premium basis includes payroll and all other remu- neration paid or payable during the policy period for the services of: 1. all your officers and employees engaged in work covered by this policy; and 2. all other persons engaged in work that could make us liable under Part One (Workers Com- pensation Insurance) of this policy. If you do not have payroll records for these persons, the con- tract price for their services and materials may be used as the premium basis. This paragraph 2 will not apply if you give us proof that the em- ployers of these persons lawfully secured their workers compensation obligations. D. Premium Payments (Ed. 1-15) You will pay all premium when due. You will pay the premium even if part or all of a workers compensa- tion law is not valid. E. Final Premium The premium shown on the Information Page, schedules, and endorsements is an estimate. The fi- nal premium will be determined after this policy ends by using the actual, not the estimated, premium ba- sis and the proper classifications and rates that law- fully apply to the business and work covered by this policy. If the final premium is more than the premium you paid to us, you must pay us the balance. If it is less, we will refund the balance to you. The final pre- mium will not be less than the highest minimum pre- mium for the classifications covered by this policy. If this policy is canceled, final premium will be deter- mined in the following way unless our manuals pro- vide otherwise: 1. If we cancel, final premium will be calculated pro rata based on the time this policy was in force. Final premium will not be less than the pro rata share of the minimum premium. 2. If you cancel, final premium will be more than pro rata; it will be based on the time this policy was in force, and increased by our short -rate cancelation table and procedure. Final premium will not be less than the minimum premium. F. Records You will keep records of information needed to com- pute premium. You will provide us with copies of those records when we ask for them. G. Audit You will let us examine and audit all your records that relate to this policy. These records include ledg- ers, journals, registers, vouchers, contracts, tax re- ports, payroll and disbursement records, and pro- grams for storing and retrieving data. We may con- duct the audits during regular business hours during the policy period and within three years after the pol- icy period ends. Information developed by audit will be used to determine final premium. Insurance rate service organizations have the same rights we have under this provision. Page 5 of 6 © Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved. WC 00 00 00 C CA WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY (Ed. 1-15) COMPWEST INSURANCE COMPANY PART SIX —CONDITIONS A. Inspection We have the right, but are not obliged to inspect your workplaces at any time. Our inspections are not safety inspections. They relate only to the insurabil- ity of the workplaces and the premiums to be charged. We may give you reports on the conditions we find. We may also recommend changes. While they may help reduce losses, we do not undertake to perform the duty of any person to provide for the health or safety of your employees or the public. We do not warrant that your workplaces are safe or healthful or that they comply with laws, regulations, codes or standards. Insurance rate service organiza- tions have the same rights we have under this pro- vision. B. Long Term Policy If the policy period is longer than one year and six- teen days, all provisions of this policy will apply as though a new policy were issued on each annual an- niversary that this policy is in force. C. Transfer of Your Rights and Duties Your rights or duties under this policy may not be transferred without our written consent. If you die and we receive notice within thirty days af- ter your death, we will cover your legal representa- tive as insured. D. Cancelation 1. You may cancel this policy. You must mail or de- liver advance written notice to us stating when the cancelation is to take effect. 2. We may cancel this policy. We must mail or de- liver to you not less than ten days advance writ- ten notice stating when the cancelation is to take effect. Mailing that notice to you at your mailing address shown in Item 1 of the Information Page will be sufficient to prove notice. 3. The policy period will end on the day and hour stated in the cancelation notice. 4. Any of these provisions that conflict with a law that controls the cancelation of the insurance in this policy is changed by this statement to com- ply with the law. E. Sole Representative The insured first named in Item 1 of the Information Page will act on behalf of all insureds to change this policy, receive return premium, and give or receive notice of cancelation. Page 6 of 6 © Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved. COMPWEST INSURANCE COMPANY WC 00 04 06 A WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY (Ed. 7-95) PREMIUM DISCOUNT ENDORSEMENT The premium for this policy and the policies, if any, listed in Item 3 of the Schedule may be eligible for a discount. This endorsement shows your estimated discount in Items 1 or 2 of the Schedule. The final calculation of premium discount will be determined by our manuals and your premium basis as determined by audit. Premium subject to retrospective rating is not subject to premium discount. Schedule 1. State Estimated Eligible Premium First Next Next Over $10,000 $190,000 $1,550,000 $1,750,000 California 0% 9.1% 11.3% 12.3% 2. Average percentage discount: 3. Other policies: 4. If there are no entries in Items 1, 2 and 3 of the Schedule, see the Premium -Discount Endorsement attached to your policy number: This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 05/25/2024 Policy No. CW WCP 100094052 02 Endorsement No. Insured BELL EVENT SERVICES, INC. Premium: $0 Insurance Company COMPWEST INSURANCE Countersigned by COMPANY WC 00 04 06 A (Ed. 7-95) © 1995 National Council on Compensation Insurance, Inc. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 04 19 PREMIUM DUE DATE ENDORSEMENT This endorsement is used to amend: Section D. of Part Five of the policy is replaced by this provision. PART FIVE PREMIUM (Ed. 1-01) D. Premium is amended to read: You will pay all premium when due. You will pay the premium even if part or all of a workers compensation law is not valid. The due date for audit and retrospective premiums is the date of the billing. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The inforMation below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 05/25/2024 Policy No. CW WCP 100094052 02 Endorsement No. Insured BELL EVENT SERVICES, INC. Premium: $0 Insurance Company COMPWEST INSURANCE Countersigned by COMPANY WC 00 0419 (Ed. 1-01) © 2000 National Council on Compensation Insurance, Inc. COMPWEST INSURANCE COMPANY WC 00 04 21 F WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY (Ed. 08-22) Catastrophe (Other Than Certified Acts of Terrorism) Premium Endorsement This endorsement is notification that we are charging premium to cover the losses that may occur in the event of a Catastrophe (Other Than Certified Acts of Terrorism) as that term is defined below. Your policy provides coverage for workers compensation losses caused by a Catastrophe (Other Than Certified Acts of Terrorism). Coverage for such losses is subject to all terms, definitions, exclusions, and conditions in your policy, and any applicable federal and/or state laws, rules, or regulations. This premium charge does not provide funding for Certified Acts of Terrorism contemplated under the Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement attached to this policy. For purposes of this endorsement, Catastrophe (Other Than Certified Acts of Terrorism) is defined as: A single event or peril resulting in a group of claims with aggregate workers compensation losses in excess of $50 million. This $50 million threshold applies per occurrence, across all states for which claims arise from a single event or peril. The premium charge for the coverage your policy provides for workers compensation losses caused by a Catastrophe (Other Than Certified Acts of Terrorism) is shown in Item 4 of the Information Page or in the Schedule below. Schedule State Rate Premium California 0.02 $80 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 05/25/2024 Policy No. CW WCP 100094052 02 Endorsement No. Insured BELL EVENT SERVICES, INC. Premium: $0 Insurance Company COMPWEST INSURANCE Countersigned by COMPANY WC000421F (Ed. 08-22) Page 1 of 1 © Copyright 2020 National Council on Compensation Insurance, Inc. All Rights Reserved. COMPWEST INSURANCE COMPANY WC 00 04 22 C WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY (Ed. 01-21) Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement This endorsement addresses the requirements of the Terrorism Risk Insurance Act of 2002 as amended and extended by the Terrorism Risk Insurance Program Reauthorization Act of 2019. It serves to notify you of certain limitations under the Act, and that your insurance carrier is charging premium for losses that may occur in the event of an Act of Terrorism. Your policy provides coverage for workers compensation losses caused by Acts of Terrorism, including workers compensation benefit obligations dictated by state law. Coverage for such losses is still subject to all terms, definitions, exclusions, and conditions in your policy, and any applicable federal and/or state laws, rules, or regulations. Definitions The definitions provided in this endorsement are based on and have the same meaning as the definitions in the Act. If words or phrases not defined in this endorsement are defined in the Act, the definitions in the Act will apply "Act" means the Terrorism Risk Insurance Act of 2002, which took effect on November 26, 2002, and any amendments thereto, including any amendments resulting from the Terrorism Risk Insurance Program Reauthorization Act of 2019. "Act of Terrorism" means any act that is certified by the Secretary of the Treasury, in consultation with the Secretary of Homeland Security, and the Attorney General of the United States, as meeting all of the following requirements: a. The act is an act of terrorism. b. The act is violent or dangerous to human life, property, or infrastructure. c. The act resulted in damage within the United States, or outside of the United States in the case of the premises of United States missions or certain air carriers or vessels. d. The act has been committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. "Insured Loss" means any loss resulting from an act of terrorism (and, except for Pennsylvania, including an act of war, in the case of workers compensation) that is covered by primary or excess property and casualty insurance issued by an insurer if the loss occurs in the United States or at the premises of United States missions or to certain air carriers or vessels. "Insurer Deductible" means, for the period beginning on January 1, 2021, and ending on December 31, 2027, an amount equal to 20% of our direct earned premiums during the immediately preceding calendar year. Page Iof2 © Copyright 2020 National Council on Compensation Insurance, Inc. All Rights Reserved. COMPWEST INSURANCE COMPANY WC 00 04 22 C WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY (Ed. 01-21) Limitation of Liability The Act limits our liability to you under this policy. If aggregate Insured Losses exceed $100,000,000,000 in a calendar year and if we have met our Insurer Deductible, we are not liable for the payment of any portion of the amount of Insured Losses that exceeds $100,000,000,000; and for aggregate Insured Losses up to $100,000,000,000, we will pay only a pro rata share of such Insured Losses as determined by the Secretary of the Treasury. Policyholder Disclosure Notice 2. 3. Insured Losses would be partially reimbursed by the United States Government. If the aggregate industry Insured Losses occurring in any calendar year exceed $200,000,000, the United States Government would pay 80% of our Insured Losses that exceed our Insurer Deductible. Notwithstanding item 1 above, the United States Government will not make any payment under the Act for any portion of Insured Losses that exceed $100,000,000,000. The premium charge for the coverage your policy provides for Insured Losses is included in the amount shown in Item 4 of the Information Page or in the Schedule below. Schedule State Rate Premium California 0.02 $80 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 05/25/2024 Policy No. CW WCP 100094052 02 Insured BELL EVENT SERVICES, INC. Insurance Company COMPWEST INSURANCE Countersigned by COMPANY WC 00 04 22 C (Ed. 01-21) Endorsement No. Premium: $0 Page 2 of 2 © Copyright 2020 National Council on Compensation Insurance, Inc. All Rights Reserved. COMPWEST INSURANCE COMPANY WC040301D WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY (Ed. 02-18) POLICY AMENDATORY ENDORSEMENT - CALIFORNIA It is agreed that, anything in the policy to the contrary notwithstanding, such insurance as is afforded by this policy by reason of the designation of California in Item 3 of the Information Page is subject to the following provisions: 1. Minors Illegally Employed - Not Insured. This policy does not cover liability for additional compensation imposed on you under Section 4557, Division IV, Labor Code of the State of California, by reason of injury to an employee under sixteen years of age and illegally employed at the time of injury. 2. Punitive or Exemplary Damages - Uninsurable. This policy does not cover punitive or exemplary damages where insurance of liability therefor is prohibited by law or contrary to public policy. 3. Increase in Indemnity Payment - Reimbursement. You are obligated to reimburse us for the amount of increase in indemnity payments made pursuant to Subdivision (d) of Section 4650 of the California Labor Code, if the late indemnity payment which gives rise to the increase in the amount of payment is due less than seven (7) days after we receive the completed claim form from you. You are obligated to reimburse us for any increase in indemnity payments not covered under this policy and will reimburse us for any increase in indemnity payment not covered under the policy when the aggregate total amount of the reimbursement payments paid in a policy year exceeds one hundred dollars ($100). If we notify you in writing, within 30 days of the payment, that you are obligated to reimburse us, we will bill you for the amount of increase in indemnity payment and collect it no later than the final audit. You will have 60 days, following notice of the obligation to reimburse, to appeal the decision of the insurer to the Department of Insurance. 4. Application of Policy. Part One, "Workers Compensation Insurance", A, "How This Insurance Applies", is amended to read as follows: This workers compensation insurance applies to bodily injury by accident or disease, including death resulting therefrom. Bodily injury by accident must occur during the policy period. Bodily injury by disease must be caused or aggravated by the conditions of your employment. Your employee's exposure to those conditions causing or aggravating such bodily injury by disease must occur during the policy period. 5. Rate Changes. The premium and rates with respect to the insurance provided by this policy by reason of the designation of California in Item 3 of the Information Page are subject to change if ordered by the Insurance Commissioner of the State of California pursuant to Section 11737 of the California Insurance Code. 6. Long Term Policy. If this policy is written for a period longer than one year, all the provisions of this policy shall apply separately to each consecutive twelve-month period or, if the first or last consecutive period is less than twelve months, to such period of less than twelve months, in the same manner as if a separate policy had been written for each consecutive period. 7. Statutory Provision. Your employee has a first lien upon any amount which becomes owing to you by us on account of this policy, and in the case of your legal incapacity or inability to receive the money and pay it to the claimant, we will pay it directly to the claimant. Part Five, "Premium", E, "Final Premium", is amended to read as follows. - The premium shown on the Information Page, schedules, and endorsements is an estimate. The final premium will be determined after this policy ends by using the actual, not the estimated, premium basis and the proper classifications and rates that lawfully apply to the business and work covered by this policy. If the final premium is more than the premium you paid to us, you must pay us the balance. If it is less, we will refund the balance to you. The final premium will not be less than the highest minimum premium for the classifications covered by this policy. WC040301D (Ed. 02-18) Page 1 of 2 COMPWEST INSURANCE COMPANY WC 04 03 01 D WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY (Ed. 02-18) If this policy is canceled, final premium will be determined in the following way unless our manuals provide otherwise: a. If we cancel, final premium will be calculated pro rats based on the time this policy was in force. Final premium will not be less than the pro rata share of the minimum premium. b. If you cancel, final premium may be more than pro rata; it will be based on the time this policy was in force, and may be increased by our short -rate cancelation table and procedure. Final premium will not be less than the pro rata share of the minimum premium. It is further agreed that this policy, including all endorsements forming a part thereof, constitutes the entire contract of insurance. No condition, provision, agreement, or understanding not set forth in this policy or such endorsements shall affect such contract or any rights, duties, or privileges arising therefrom. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 05125/2024 Policy No. CW WCP 3.00094052 02 Endorsement No. Insured BELL EVENT SERVICES, INC. Insurance Company COMPWEST INSURANCE COMPANY WC 04 03 01 D (Ed. 02-18) Countersigned by Page 2 of 2 COMPWEST INSURANCE COMPANY WC 04 03 03 C WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY (Ed. 07-18) ENDORSEMENT AGREEMENT LIMITING AND RESTRICTING THIS INSURANCE OFFICERS AND DIRECTORS COVERAGE 1 EXCLUSION - CALIFORNIA If the employer named in Item 1 of the Information Page is a quasi -public or private corporation, this policy applies to all officers and members of boards of directors while rendering actual service for the corporation for pay, as employees, except those excluded below who 1. individually own at least 10 percent of the corporation's issued and outstanding stock, or 2. individually own at least 1 percent of the corporation's issued and outstanding stock if that officer's or member's parent, grandparent, sibling, spouse, or child owns at least 10 percent of the corporation's issued and outstanding stock and that officer or member is covered by a health insurance policy or a health care service plan, or 3. are officers or members of the board of directors of a cooperative corporation organized pursuant to the Cooperative Corporation Law (Corporations Code, Sections 12200 - 12704) who state that he or she is covered by both a health care service plan or health insurance policy, and a disability insurance policy that is comparable in scope and coverage, as determined by the Insurance Commissioner, to a workers' compensation policy. If the employer named in Item 1 of the Information Page is a private corporation, or a private cooperative corporation organized pursuant to the Cooperative Corporation Law, this policy applies to an officer or director who is the sole shareholder of the corporation, as an employee, except if excluded below. The insurance under this policy is limited as follows: It is AGREED that, anything in this policy to the contrary notwithstanding, this policy DOES NOT INSURE: Officers, Directors and Trustees Excluded Title MICHAEL BELL CHIEF EXECUTIVE OFFICER COMPWEST INSURANCE COMPANY WC040303C WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY (Ed. 07-18) Nothing in this endorsement shall be held to vary, alter, waive or extend any of the terms, conditions, agreements, or limitations of this policy other than as above stated. Nothing elsewhere in this policy shall be held to vary, alter, waive or limit the terms, conditions, agreements or limitations in this endorsement. It is further agreed that "remuneration" when used as a premium basis for such insurance as is afforded by this policy shall not include the remuneration of any person excluded from coverage in accordance with the foregoing. FAILURE TO SECURE THE PAYMENT OF FULL COMPENSATION BENEFITS FOR ALL EMPLOYEES AS REQUIRED BY LABOR CODE SECTION 3700 IS A VIOLATION OF LAW AND MAY SUBJECT THE EMPLOYER TO THE IMPOSITION OF A WORK STOP ORDER, LARGE FINES AND OTHER SUBSTANTIAL PENALTIES (Labor Code Section 3710.1, et seq.). This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 05/25/2024 Policy No. CW WCP 100094052 02 Endorsement No. Insured BELL EVENT SERVICES, INC. Insurance Company COMPWEST INSURANCE COMPANY Countersigned by COMPWEST INSURANCE COMPANY WC 04 03 10 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY (Ed. 01-95) DUTY TO DEFEND - CALIFORNIA The insurance afforded by Part One, Section C, "We Will Defend", is hereby deleted and replaced with the following: WE WILL DEFEND We have the right and duty to defend at our expense any claim or proceeding against you before the California Workers' Compensation Appeals Board or its equivalent in any other state (and any appeal of a decision therefrom) for the benefits payable by this workers' compensation insurance. We have the right to investigate and settle these claims or proceedings. We have no duty to defend a claim, proceeding, or suit that is not covered by this insurance. Nothing contained in this Section shall amend, modify, restrict, or otherwise alter any obligations or conditions under Part Two — Employer's Liability Insurance of the policy. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 05/25/2024 Policy No. CW WCP 100094052 02 Endorsement No. Insured BELL EVENT SERVICES, INC. Insurance Company COMPWEST INSURANCE COMPANY Countersigned by WC 04 0310 (Ed. 01-95) COMPWEST INSURANCE COMPANY WC 04 03 60 B WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY (Ed. 01-15) EMPLOYERS' LIABILITY COVERGE AMENDATORY ENDORSEMENT — CALIFORNIA The insurance afforded by Part Two (Employers' Liability Insurance) by reason of designation of California in Item 3 of the Information Page is subject to the following provisions: A. "How This Insurance Applies," is amended to read as follows: This employers' liability insurance applies to bodily injury by accident or bodily injury by disease. Bodily injury means a physical injury, including resulting death. 1. The bodily injury must arise out of and in the course of the injured employee's employment by you. 2. The employment must be necessary or incidental to your work in California. 3. Bodily injury by accident must occur during the policy period. 4. Bodily injury by disease must be caused or aggravated by the conditions of your employment. The employee's last day of last exposure to the conditions causing or aggravating such bodily injury by disease must occur during the policy period. 5. If you sued, the original suit and any related legal actions for damages for bodily injury by accident or by disease must be brought in the United States of America, its territories or possessions, or Canada. C. The "Exclusions" section is modified as follows (all other exclusions in the "Exclusions" section remain as is): 1. Exclusion 1 is amended to read as follows: 1. liability assumed under a contract. 2. Exclusion 2 is deleted. 3. Exclusion 7 is amended to read as follows: 7. damages arising out of coercion, criticism, demotion, evaluation, reassignment, discipline, defamation, harassment, humiliation, discrimination against or termination of any employee, termination of employment, or any personnel practices, policies, acts or omissions. 4. The following exclusions are added: 1. bodily injury to any member of the flying crew of any aircraft. 2. bodily injury to an employee when you are deprived of statutory or common law defenses or are subject to penalty because of your failure to secure your obligations under the workers' compensation law(s) applicable to you or otherwise fail to comply with that law. 3. liability arising from California Labor Code Section 2810.3 which relates to labor contracting. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 05/2512024 Policy No. CW WCP 100094052 02 Endorsement No, Insured BELL EVENT SERVICES, INC. Insurance Company COMPWEST INSURANCE COMPANY Countersigned by WC 04 03 60 B (Ed. 01-15) COMPWEST INSURANCE COMPANY WC 04 04 21 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY (Ed. 01-08) OPTIONAL PREMIUM INCREASE ENDORSEMENT — CALIFORNIA You must provide us, or our authorized representative, access to records necessary to perform a payroll verification audit. If you fail to provide access within 90 days after expiration of the policy, you are liable to pay a total premium equal to 3 times our current estimate of the annual premium for your policy. In addition, if you fail to provide access after our third request within a 90 day or longer period, you are also liable for our costs in attempting to perform the audit unless you provide a compelling business reason for your failure. We will contact you to schedule appointments during normal business hours. We will notify you of your failure to provide access by mailing a certified, return -receipt document stating the increased premium and the total amount of our costs incurred in our attempt(s) to perform an audit. In addition to any other obligations under this contract, 30 days after you receive the notification, you will be obligated to pay the total premium and costs referenced above. If, thereafter, you provide access to your records within three years after the policy expires, or within another mutually agreed upon time, and we succeed in performing the audit to our satisfaction, we will revise your total premium and the costs due to reflect the results of the audit. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 05/25/2024 Policy No. CW WCP 100094052 02 Endorsement No. Insured BELL EVENT SERVICES, INC. Insurance Company COMPWEST INSURANCE COMPANY Countersigned by WC 04 04 21 (Ed. 01-08) COMPWEST INSURANCE COMPANY WC 04 06 01 B WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY (Ed. 01-22) CALIFORNIA CANCELATION ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. The cancelation condition in Part Six (Conditions) of the policy is replaced by these conditions: Cancelation: 1. You may cancel this policy. You must mail or deliver advance written notice to us stating when the cancelation is to take effect. 3 4 5 We may cancel this policy for one or more of the following reasons: a. Non-payment of premium; b. Failure to report payroll; c. Failure to permit us to audit payroll as required by the terms of this policy or of a previous policy issued by us; d. Failure to pay any additional premium resulting from an audit of payroll required by the terms of this policy or any previous policy issued by us; e. Material misrepresentation made by you or your agent; f. Failure to cooperate with us in the investigation of a claim; g. Material failure to comply with federal or state safety orders or written recommendations of our designated loss control representatives; h. The occurrence of a material change in the ownership of your business; i. The occurrence of any change in your business or operations that materially increases the hazard for frequency or severity of loss; j. The occurrence of any change in your business or operation that requires additional or different classification for premium calculation; k. The occurrence of any change in your business or operation which contemplates an activity excluded by our reinsurance treaties. If we cancel your policy for any of the reasons listed in (a) through (f), we will give you 10 days advance written notice, stating when the cancelation is to take effect. Mailing that notice to you at your mailing address shown in Item 1 of the Information Page will be sufficient to prove notice. If we cancel your policy for any of the reasons listed in Items (g) through (k), we will give you 30 days advance written notice; however, we agree that in the event of cancelation and reissuance of a policy effective upon a material change in ownership or operations, notice will not be provided. If we mail the notice to you, the stated periods of notice and your right to remedy the condition will be extended by 5 days if the place of mailing and your mailing address is within California, 10 days if the place of mailing or your mailing address is outside of California and 20 days if the place of mailing or your mailing address is outside of the United States. The policy period will end on the day and hour stated in the cancelation notice. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 05/25/2024 Policy No. CW WCP 100094052 02 Insured BELL EVENT SERVICES, INC. Insurance Company COMPWEST INSURANCE Countersigned by COMPANY WC 04 06 01 B (Ed. 01-22) Endorsement No. Premium: $0 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 0107 B (Ed. 5-15) SPECIAL CANCELLATION PROVISION It is agreed that, anything in the policy to the contrary notwithstanding, such insurance as is afforded by this policy is subject to the following provisions: If you cancel the policy or if the policy is cancelled for non-payment of any premium, cancellation premium may be computed using the short rate cancellation table. The following table shall be used in computing the Short Rate Premium: 1of2 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 05/25/2024 File No. Endorsement No. Carrier Policy No. CW WCP 100094052 02 Carrier No. Insured BELL EVENT SERVICES, INC. Premium: $0 Insurance Company COMPWEST INSURANCE COMPANY WC 99 0107 B (Ed. 5115) Countersigned by WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 0107 B SPECIAL CANCELLATION PROVISION Short Rate Cancellation Table (Ed. 5-15) _. _._ Extended Number Of Days _ ....... Percent of Full Policy Premium ....... Ww _ _ ........ Extended Number Of Days Percent of Full Policy Premium Extended Number Of Days �W Percent of Full Policy Premium 1 5% 95-98 37% 219-223 69% 2 6% 99-102 38% 224-228 70% 3-4 7% 103-105 39% 229-232 71% 5-6 8% 106-109 40% 233-237 72% 7-8 9% 110-113 41% 238-241 73% 9-10 10% 114-116 42% 242-246 74% 11-12 11% 117-120 43% 247-250 75% 13-14 12% 121-124 44% 251-255 76% 15-16 13% 125-127 45% 256-260 77% 17-18 14% 128-131 46% 261-264 78% 19-20 15% 132-135 47% 265-269 79% 21-22 16% 136-138 48% 270-273 80% 23-25 17% 139-142 49% 274-278 81% 26-29 18% 143-146 50% 279-282 82% 30-32 19% 147-149 51% 283-287 83% 33-36 20% 150-153 52% 288-291 84% 37-40 21% 154-156 53% 292-296 85% 41-43 22% 157-160 54% 297-301 86% 44-47 23% 161-164 55% 302-305 87% 48-51 24% 165-167 56% 306-310 88% 52-54 25% 168-171 57% 311-314 89% 55-58 26% 172-175 58% 315-319 90% 59-62 27% 176-178 59% 320-323 91% 63-65 38% 179-182 60% 324-328 92% 66-69 29% 183-187 61% 329-332 93% 70-73 30% 188-191 62% 333-337 94% 74-76 31% 192-196 63% 338-342 95% 77-80 32% 197-200 64% 343-346 96% 81-83 33% 201-205 65% 347-351 97% 84-87 34% 206-299 66% 352-355 98% 88-91 35% 210-214 67% 356-360 99% 92-94 36% 215-218 68% 361-365 100% 2of2 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 05/25/2024 File No. Endorsement No, Carrier Policy No.CW WCP 100094052 02 Carrier No. Insured BELL EVENT SERVICES, INC. Premium: $0 Insurance Company COMPWEST INSURANCE COMPANY WC 99 0107 B (Ed. 5115) Countersigned by COMPWEST INSURANCE COMPANY WC 99 03 13 C WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY (Ed. 7-09) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT — CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be $ 200, Schedule Person or Organizationl Description CITY OF EL SEGUNDO RECREATION AND PARKS DEPT 401 SHEDON STREET EL SEGUNDO, CA 90245 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 05/25/2024 Policy No. CW WCP 100094052 02 Endorsement No. Insured BELL EVENT SERVICES, INC. Premium: $0 Insurance Company COMPWEST INSURANCE Countersigned by COMPANY WC990313C (Ed. 7-09) COMPWEST INSURANCE COMPANY WC 99 03 13 C WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY (Ed. 7-09) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT — CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be $ 200. Schedule Person or Organizationl Description ANY WRITTEN CONTRACT REQUIRING ENDORSEMENT FROM OUR INSURED 531 MAIN ST #228 EL SEGUNDO, CA 90245 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 05/25/2024 Policy No. CW WCP 100094052 02 Endorsement No. Insured BELL EVENT SERVICES, INC. Premium: $0 Insurance Company COMPWEST INSURANCE Countersigned by COMPANY WC990313C (Ed. 7-09) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 0410 NON -SUFFICIENT FUNDS AND REINSTATEMENT FEE CHARGES ENDORSEMENT - CALIFORNIA (Ed. 7-21) If a payment is made to us on a direct bill policy by check, draft, debit card, credit card, electronic funds transfer (EFT), or electronic check that is returned, declined, or cannot be processed due to insufficient funds, we will impose a charge of a $20 insufficient funds fee per failed payment transaction. However, we will not charge an insufficient funds fee if the failure in payment resulted from fraud or misuse on the policyholder's account from which the payment was made and such fraud or misuse was not attributed to the policyholder. There will be a $20 reinstatement fee charged for direct bill policies when the payment is posted after the cancellation date and the reinstatement is non -system generated. The fee will not be charged when the payment is posted prior to the cancellation date and reinstatement is done electronically by the policy system. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 05/2512024 Policy No. CW WCP 100094052 02 Endorsement No. Insured BELL EVENT SERVICES, INC. Premium: $0 Insurance Company COMPWEST INSURANCE Countersigned by .................._ COMPANY WC 99 0410 (Ed. 7-21) © Copyright 2018 National Council on Compensation Insurance, Inc. All Rights Reserved. COMPWEST INSURANCE COMPANY WC 99 06 60 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY (Ed. 05-17) Execution Clause Endorsement In Witness Whererof, the Company has caused this policy to be executed and attested to by its President and Secretary. Where required by law, the information Page has been countersigned by our duly authorized representative. President —&Lt,=d er g, Secretary This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 05/25/2024 Policy No. CW WCP 100094052 02 Endorsement No. Insured BELL EVENT SERVICES, INC. Premium: $0 Insurance Company COMPWEST INSURANCE Countersigned by COMPANY WC 99 06 60 (Ed. 05-17)