Loading...
PROOF OF INSURANCE (2024 - 2025)^fM,El Segundo • w — •w HolidaysFestival of December1 Liability Waiver WE-VOC Entertainment, IV4�-ontractor") 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: .�.�-ate � PRINTED: Lisa Stanley for WE-VOC Entertainment, Inc. DATE: 12-5-24 DATE (MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 12/04/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER CONTACT The Camp Team NAME` 9035 WADSWORTH PKWY STE 3820 PHONE NIC No Ext : ANC, No): (303) 422 1276 E-MAIL WESTMINSTER, CO 80021-4541 _ INSURERA : ......................................... INSURED SPORTS AND RECREATION PROVIDERS ASSOCIATION (PURCHASING GROUP) AND INSURERB ; ITS PARTICIPATING MEMBERS: City Of El Segundo INSURER C r 350 Main Street INSURERD: EL SEGUNDO, CA 90245 INSURERE: INSURER F : INSURER(S) AFFORDING COVERAGE NAIC # Great American Insurance Company 16691 Cr1V9=0AC.FC CERTIFICATE NIIMRFR• r:AC155Q37 RFVISInN NI)MRER- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ................ . . ._............ INS TYPE OF INSURANCE ADDL SUBR.. _ POLICY NUMBER POLICY EFF POLICY EXP LTR INSR WVD MMIDDNYYY MM/DDIYYYY '.. LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 X COMMERCIAL. GENERAL LIABILITY DAMAGE TO RENTED 2,20r B'm avRx:u "M" $300,000 CLAIMS -MADE OCCUR MED EXP (Any one person) $10 000 12/05/2024 12/06/2024 ' A X T HGS LIQUOR LIABILITY INCLUDED X PAC 4725036 12:00 AM 12:01 AM PERSONAL & ADV INJURY $1,000 000 .............. w GENERAL AGGREGATE $1,000,000 GEN L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $1,000,000 X POLICY PRO- EC:T' LOC COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY '. Ea ar;cld�nl ANY AUTO BODILY INJURY (Per person) ALL OWNED SCHEDULED BODILY INJURY (Per AUTOS AUTOS aecidenlj° HIRED AUTO NON -OWNED PROPERLY DAMAGE AUTOS(PPr accident. UMBRELLA LIAB'. OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS -MADE AGGREGATE UED J '. RETENTION S 12/0 12/06/ EACH OCCURRENCE $1,000,000 A Professional Liability X PAC 4725036 12:00 AM AM 12:01 AM AM AGGREGATE LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/ 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 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 350 Main Street BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN El Segundo, CA 90245 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE -r"'C,zmp Teavw ACORD 25 (2016/03) © 1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Cut Along the Dotted Line California m m rnia Evidence of Liability Insurance r .. - � . ^ m. ifo y nsurance C CO, GEICO General Insurance Company o PO BOX 9506 Fredericksburg, VA 22403-9506 NAIC Code 2001 LEXS RX 300/1-TD p 35882 Vehicle ID No. 441,. A.:w_.mm..� ....._...... _ ..M._. Policy Number Effective Date Expiration Date 6-79 30-34 1 1 /16/24 05/16/25 Named Insureds) _ Address . .... 5033 Denny Ave Lisa Ann Stanley N Hollywood CA 91601-4026 a FOLD HERE FOLD HERE FOLD HERE FOLD HERE FOLD HERE FOLD HERE ° 20,01 LEXS RX 300/LTD l Additional Drivers ��.....� .__�..�.._. � 4 This olic lies with Sections 16056 or 16500.5 0Vehicle .. "—""�p ..y.. complies of leCode. a r Cut Along the Dotted Line y Insurance n California Evidence of Liability ..__ �Nrem -- " surance GEIM,GEICO General Insurance Company PO BOX 9506 Fredericksburg, VA '22403-9506 " 35 12iCOde Vehle DSRNo.. JTJGF1 OU710118521 mm m Number Effective.Date Expiration Date 4416-79-30=34 k 11 /16/24 05/16/25 ... ............ Named Insured(s) Address Neal Edward Himelhoch 5033 Ann Stanley N Hollywood CA 91601-4026 FOLD HERE FOLD HERE FOLD HERE FOLD HERE FOLD HERE JF.OLD HERE 2001 LEXS RX 300/LTD. w Additional Drive..... rs This policy complies with Sections 16056 or 16500.5 of the..._�_ _.. California Vehicle Code. { 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. C_) 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 Name of Agent Policy Number Expiration Date Phone # (x)o 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 thos provisions erne will automatically become void. Signature of Applicant Date 11 /13/24 Print Name Agreement for: Dated: Reviewed by: