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PROOF OF INSURANCE (2024 - 2025)egundo Joy Around the world Festival of Holidays December 5, 2024 Liability Waiver City"b joy 4round � 11 undox ( ("Contractor") will participate in the City of EI deg h the City, Contractor the World/Festival of Holidays event (the "Event") p ursua ant k o agreement Contractor andtothers, These inclvdex understands that participation in the Event is not without risk to Codeath, contact with without limitation, risks of physical injury, mental injury, emotional dtstrss, trau orwtrawtorM Contractor other participants, and property damage. All risks are known'and apprecs ted by onsi,bility for and will pay waives any and all specific notice of the existence of risks. Contractor assume$ resp a ardle s of (if any). medical and emergency expenses in the event of'i�njury, ll�lness, or other eeS, o f rs or,other a �nts� � l� eel, whether I authorized such expenses. "Contractor" includes Contractor's enp y Clta19 Contractor agrees and represents that it has inspected, or immediately upon entering Main sc/ y Plaza, will inspect the premises and facilities throughout the Event. Contractor's entry Onto public property ` rer�rnlses and all faclllties for all purposes associated with the Event constitutes an acknowledgment that such and reesonatwl and equipment were inspected and that Contractor finds and accepts them as being suited for the purposes of Contractor's participation in the Event. By reading, signing and dating this document, Contractor hereby waives, releases, discharges, and agents, sponsors, and/or covenants, not to sue and hold harmless the City of El Segundo, ,its officials, employees ("Releasees")from and all damages,,losses, fines, claims, suits, llite spof any form Orenses nn tuner resulting and defense costs for Council acceptable*to Cin )rtnjudgments ton in the/eventwhich includes, without limitation AC40RO DATE (MM/DDIYYYY) 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 A/CNN Ext A Noll: (303) 422-1276 WESTMINSTER, CO 80021-4541 tMIL----_.............._.................._. INSURERA 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 INSURER t INSURER F : COVERAGES CERTIFICATE NUMBER: GAS155937 INSURER(S) AFFORDING COVERAGE NAIC # Great American Insurance Company 16691 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L.._.. ._....,__..- 1 _ NS TYPE OF INSURANCE ADDLSUOR POLICYNUMBER POLICY EFF POLICYEXP LTR INSR ;wVD MMIDDIYYYY) MMM01YYYY. .......... LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea OCF lr @nCCI $300,000 CLAIMS MADE � OCCUR .....w.� MED EXP (Any one person) $10,000 12/05/2024 12/06/2024......................................"'� A X HOSl LIQUOR LIABILITY INCLUDED X PAC 4725036 12:00AM 12:01 AM PERSONAL& ADV INJURY $1,000,000 GENERAL AGGREGATE $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $1,000,000 PRO X POLICY .tlEG:.T LOC COMBINE® SINGLE LIMIT AUTOMOBILE LIABILITY Ea acaidenq ....... ANY AUTO BODILY INJURY (Per person) ALL OWNED SCHEDULED ...... BODILY INJURY (Per ............. .__ ....... AUTOS AUTOS accident HIRED AUTO NON -OWNED PROPER rY DAMAGE AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE ........................ EXCESS LIAB CLAIMS -MADE ......................_...._......... �._....... AGGREGATE ..._....... DED RETENTION $ 12/05/2024 12/06/2024 EACH OCCURRENCE $1,000,000 A Professional Liability X PAC 4725036 12:00 AM 12:01 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 Tl.e' Cu*'�p -r w"' ACORD 25 (2016/03) © 1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Offou ror insuring with us! Here are your wwriancluonza f50M7;-- ;%kKt VOMM000, CALIFORNIA AUTOMOBILE EVIDENCE OF LIABILITY INSURANCE This insurance complies with CVC § 16056 or § 16500-.5 POLICY NUMBER kmW Prefermd Insurance Company P0 Box 3199 %vinston Sawn NC 27902-3199 31498 2e3424m Sew 019,0 KEEP THIS CARD IN YOUR MOTOR VEHICLE Direct Auto Insurance Ton free at: 800-A03-1077 YEAR MAKE ... -- — ------- ----iODEL VEHICLE CE IF GER 2018 DODG GRMD CA 1032f 01012QTI1 A Cut On Dotted Line — Store In Your Vehicle v P. im"Ct 9—QvEwM= CALIFORNIA AUTOMOBILE EVIDENCE OF LIABILITY INSURANCE Thm insurance complies with CVC § 16056 or § 16500.5 Prefanvd Insurance Company NAIC POLICY NUMBER Salem NC27102-3199 31488 202424T608 - EFFECTIVE DATE EXPRATM DATE a24,2024 3e24,2025 KEEP THIS CARD IN YOUR MOTOR VEHICLE 1irect Au Insurance Toli free at: ON-403-1077 MODEL VEHICLE IDENTIFICATION NUMBER CY TOWN & C ICWP641. CITY OF EL SEGUNDO WORKERS' COMPENSATION DECLARATION IG: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE ►WFUL'' AND SUBJECTS AN EMPLOYER TO CRIMINAL PENALTIES III L FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), TION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED LABOR CODE § 3706 INTEREST, AND ATTORNEY'S FEES. Ity of perjury under the laws of California one of the following declarations: II rfiamtain,a.,deltificate of consent of's if in'stare for workers' compensation, issued by the Director on's as provi e+ f+ `Labor Code § V00 for the performance of the work set forth the agreement Segundo -' rental �ete compensation insurance as required by Labor Code § 3700 for the performance � ii h%,the �e tn'enf with the City of El Segundo is executed. My workers' compensation insurance � ntxrn��r are ,, Policy NurriberExpiration Date Phone # ot s" o ens tton laws oty0f El f California,undo, I will an oh f e� sab thevrr t with a Ca ;lpi �n f e� / , w be wori er ° oo ro ns ton provisions of Labor` �o / Q I r u�s "� „o p( Est n t o� nt�rn .wlNl utoetic lly he me gold. , , Date t,f 6 ,