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PROOF OF INSURANCE (2024 - 2025)FestivalEl Segundo Joy Around the World • Holidays "December Liability Waiver Socal Entertainment Grou "Contractor) will participate in the City of El Segundo's ("City")Joy Around the World/Festival of Holidays event (the "Event") pursuant to an agreement with the City. Contractor understands that participation in the Event is not without risk to Contractor and others. These include, without limitation, risks of physical injury, mental injury, emotional distress, trauma, death, contact with other participants, and property damage. All risks are known and appreciated by Contractor. Contractor waives any and all specific notice of the existence of risks. Contractor assumes responsibility for and will pay (if any) medical and emergency expenses in the event of injury, illness, or other incapacity regardless of whether I authorized such expenses. "Contractor" includes Contractor's employees, officers, or other agents. Contractor agrees and represents that it has inspected, or immediately upon entering Main St./ City Hall Plaza, will inspect the premises and facilities throughout the Event. Contractor's entry onto public property for all purposes associated with the Event constitutes an acknowledgment that such premises and all facilities and equipment were inspected and that Contractor finds and accepts them as being safe and reasonably suited for the purposes of Contractor's participation in the Event. By reading, signing and dating this document, Contractor hereby waives, releases, discharges, and covenants, not to sue and hold harmless the City of El Segundo, its officials, agents, sponsors, and/or employees ("Releasees") from and all damages, losses, fines, claims, suits, expenses (including attorney fees and defense costs for Council acceptable to City), judgments and/or liabilities of any form or nature resulting from Contractor's negligence, misconduct, or participation in the event, which includes, without limitation Contractor's travel to and from the Event, whether by vehicle or other means. This release of liability includes, but is not limited to any injury, death, sickness or personal injury or property damage Contractor may suffer while on or around the premises where the Event is held. This release also includes specifically, but without limitation, any and all forms of personal injury (including death) and property damage to any person, resulting from Contractor's negligence, misconduct, or participation in the event, which includes, without limitation Contractor's travel to and from the Event, whether by vehicle or other means, and Contractor expressly assume the risk of such damages or injuries and losses throughout any participation in the Event. Contractor agrees that the foregoing release and waiver is intended to be as broad as inclusive as permitted under state of California law and that, if any portion is held invalid, it is agreed that the balance will, notwithstanding, continue in full legal force and effect. The undersigned warrants that he or she has legal authority to bind Contractor and that Contractor fully understands and agrees to the above terms and conditions in consideration for the Event and further agree that no oral representations, statements, or inducement apart from the foregoing written agreement have been made. SIGNED: PRINTED: Mai ra Sol is 12/4/2024 DATE: AC"REP F12/04/2024 ATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT The Camp Team NAME: PHN9035 WADSWORTH PKWY STE 3820 IC, No, Ext FAX No); (303) 422-1276 WESTMINSTER, CO 80021-4541 1 E-MAIL INSURER A : INSURED SPORTS AND RECREATION PROVIDERS ASSOCIATION (PURCHASING GROUP)AND INSURER B : ITS PARTICIPATING MEMBERS: City Of El Segundo INSURER C ; 350 Main Street INSURERD: EL SEGUNDO, CA 90245 INsuREREc INSURER FT INSURER(S) AFFORDING COVERAGE NAIC # Great American Insurance Company 16691 COVERAGES CERTIFICATE IJIIMRCA• f]AC4SS017 no1rrcinu \nl\ae OM. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID __. ._. .. .NSRL CLAIMS. IN6SR SUB POLICY NUMBER..... MMI oY/mw..... LTR IwvDTYPE OF INSURANCE FF POLICY EXP MMiOD ........................ LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY _ ._.n,... OAMA E T(Fa NtED w._ ........ $300,000 PREM rencea CLAIMS -MADE '� OCCUR MED EXP (Any one person) 1 $10,000 A X HOST LIQUOR LIABILITY INCLUDED X C � ]C PAC 472503 V 12/05/2024 12/06/2024 •• --- --------®'-" PERSONAL & ADV INJURY $1,000,000 •- •- 12:00 AM 12:01 AM ..... GENERAL AGGREGATE $1,000,000 GEIUL AGGREGATE LIMIT "APPLIES PER PRODUCTS - COMP/OP AGG . $1,000,000 X POLICY E T LOG ........ .....�. AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea. accident. ANY AUTO ............. BODILY INJURY (Per person) '. ALL OWNED SCHEDULED BODILY INJURY (Per . _. _............. ...... AUTOS AUTOS .....NON aCoident HIRED AUTO -OWNED PROPECT"rW i)AMAGE " ............. .. AUTOS Per accident _..... UMBRELLA LIAB occuR EACH OCCURRENCE EXCESS LIAR CLAIMS -MADE ...... ......... .........�. AGGREGATE ........... DED RETENTION S ...................................................... A Professional Liability X PAC 4725036 12/05/2024 12/06/2024 EACH OCCURRENCE $1,000,000 12:00 AM 12:01 AM AGGREGATE LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Covered Activities: Christmas Tree Lighting Event/Festival The Certificate Holder is added as an additional insured but only with respect to liability arising out of the named insured during the policy period. Scheduled Activities Exclusion Applies -Please Refer to Named Insured Member Certificate of Coverage CERTIFICATE HOLDER CANCELLATION City of El Segundo 350 Main Street El Segundo, CA 90245 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Tl'& Camp- -r Lvtn. ACORD 25 (2016/03) © 1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD I CJ � Important Information, Here are your Policy Identification Cards We've provided two (2) cards for each vehicle on your policy. Need additional ID cards? The GEICO Mobile app is the quickest way to get additional ID cards. You can also send a copy of your ID cards to anyone that needs them right from the app! Evidence of Insurance Here are your Evidence of Liability Insurance Cards. Two cards have been provided for each vehicle insured. One card must be carried in the proper insured vehicle. Proof of insurance is required to register or renew the registration of your vehicle. A law enforcement officer can ask you to prove that you have liability insurance meeting the basic requirements of California law. A violation of these requirements can result in a fine of up to: $1,000 for the first time; $2,000 for additional times. Also, a judge can have your vehicle impounded. False proof of insurance may result in a fine up to $750 and 30 days in prison. Cut Aong ffie Dotted N...�ne: Cdllifoiirrfla IEVidence of III,,.'ialb lllliity IInsuiraince ""rJCy GEICO General Insurance Company PO BOX 9506 Fredericksburg, VA 22403-9506 NAIC Code 2025 HONDA PILOT 35882 Vehicle ID No.5FNYG2H48SB008336 Number Effective Date Expiration Date 4586-88-29-14 09/26/24 03/26/25 Named Insured(s) Address Maira Solis 1143 HONDA PILOT Additional Drivers MAIRA SOLIS 1143 Along ihee DoUe d D. ne _._... ._.. . _ _ .... California Evidence of Lliabliil lity linsurance C3ICOGEICO General Insurance Company PO BOX 95016 Fredericksburg, VA 22403-9506 NAIC Code 2025 HONDA PILOT 35882 Vehicle ID No. 5FNYG2H48SB008336 .,,,., . _ Policy Effective Date Expiration Date 4586-88-29-14 09/26/24 03/26/25 Named Insured(s) Address Maira Solis 1143 N This policy complies with Sections 16056 or 16500.5 of the California Vehicle Cade,. This policy complies with Sections 16056 or 96500.5 of the California Vehicle Code. L� '' 10iiial Need another form of oroof of insurance? You may need the Insurance Binder for most finance companies, dealerships or vehicle registrations. Scan this code to get another form of proof of insurance immediately! If your address changes, update it using the app or log in to geico.com. By keeping your information up-to-date, you'll continue to receive important policy documents. Cut Along the Dotted Line 2025 HONDA PILOT • Evidence of financial responsibility shall at all times be carried in the vehicle. • Insurance information has already been submitted directly to the DMV electronically, submit this document to DMV only if specifically requested by DMV. If you're in an accident: • Stay at the scene and find a safe area. • Do not admit fault or disclose your coverage limits. • Call the police, and gather driver and vehicle information. • Find any witnesses and get their contact information. To report a claim Go to geico.com/claims, use the GEICO Mobile app or call 1-800-841-3000. Need a tow or roadside assistance? Using the GEICO Mobile app is a quick and easy way to request Emergency Road Service. U4CA (08-24) 2025 HONDA PILOT • Evidence of financial responsibility shall at all times be carried in the vehicle. • Insurance information has already been submitted directly to the DMV electronically, submit this document to DMV only if specifically requested by DMV. If you're 'i'tn an accident: • Stay at the scene and find a safe area. • Do not admit fault or disclose your coverage limits. • Call the police, and gather driver and vehicle information. • Find any witnesses and get their contact information. To report a claim Go to geico.com/claims, use the GEICO Mobile app or call 1-800-841-3000. Need a tow or roadside assistance? Using the GEICO Mobile app is a quick and easy way to request Emergency Road Service. U4CA (08-24) Docusign Envelope ID: A241 BAF2-661 13-49133-8262-AD5A0913458417 CITY OF EL SEGUNDO WORKERS' COMPENSATION DECLARATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SUBJECTS AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN LABOR CODE § 3706, INTEREST, AND ATTORNEY'S FEES. I affirm under penalty of perjury under the laws of California one of the following declarations: (_) I have and will maintain a certificate of consent of self -insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Labor Code § 3700 for the performance of the work set forth the agreement with the City of El Segundo. Policy No. (_) I have and will maintain workers' compensation insurance as required by Labor Code § 3700 for the performance of the work for which the agreement with the City of El Segundo is executed. My workers' compensation insurance carrier and policy number are: Carrier Policy Number Expiration Date Name of Agent Phone # (X) I certify that, in the performance of the work set forth in the agreement with the City of El Segundo, I will not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Labor Code § 3700 1 must immediately comply with those provi ,g,ygreement will automatically become void. 11/19/2024 Signature of Applicant '"` Date ray ra Solis Print Name Agreement for: Dated:: Reviewed by: