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PROOF OF INSURANCE (2024 - 2025) CLOSEDDATE (MM/DDNYYY) .-- ° 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 endorsement(s). PRODUCER CONTACT The Camp Team NAME: 9035 WADSWORTH PKWY STE 3820 A/CN., Ext): (Atc, N) (303) 422-1276 WESTMINSTER, CO 80021-4541 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # ............. .._..W._......._............... ..................... ._ ........ _.... _...... , INSURERA: Great American Insurance Company 16691 INSURED SPORTS AND RECREATION PROVIDERS ASSOCIATION (PURCHASING GROUP) AND INSURER B ITS PARTICIPATING MEMBERS: ..........................................................-•-••--•-•--••--- City Of El Segundo INSURERC: 350 Main Street INSURERD: EL SEGUNDO, CA 90245 INSURER E _WWW...WW.•.•....._ '... INSURER F : COVERAGES CERTIFICATE NUMBER: GAS155937 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. INSR LTR TYPE OF INSURANCE ADDL'SUSR NSR '.wVD '',. POLICY NUMBER POLICY EFF MMIODNYYY POLICY EXP MM/DDIYVYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 COMMERCIAL GENERAL LIABILITY .............. DAMAGE TO RENTED $300,000 T 12/05/2024 12/06/2024 p A X LIABILITY INCLUDEDOCCUR HOST LIQUORCLAIMS-MADE x PAC 4725036 12:00 AM 12:01 AM RSONAL & ADV INJURY _-- $1,000 000 GENERAL AGGREGATE $1,000,000 GENL _•. ...... ........... AGGREGATE LIMIT APPLIES PER: ......... PRODUCTS - COMP/OP AGG . $1,000000 X I POLICY ,PNF' '... LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT � BfCi{I2nl. ''. ANY AUTO BODILY INJURY (Per person) ............... ALL OWNED SCHEDULED .... ....... BODILY I......NJURY (Per� AUTOS AUTOS aGClderll HIRED AUTO NON -OWNED .. �......m..;�._.......,�...� PROPER1Y DAMAGE .,.,.,.... _......... AUTOS Per ircide.n9 UMBRELLA LIAB '... OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS -MADE AGGREGATE DED I I RETENTION S A Professional Liability x 12/06/2024 EACH OCCURRENCE $1,000,000 PAC 4725036=1122/05/2024 AM 12:01 AM AGGREGATE LIMIT $1,000,000 :00 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 Tl1& C 411r Te.a*1111 ACORD 25 (2016/03) © 1988-2016 ACORD CORPORATION- All rights reserved. The ACORD name and logo are registered marks of ACORD El Segundo Joys Around the World i Festiva of Holidays December 5, 2024 Liability Waiver Marcela Murillo ("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. � 0t SIGNED: PRINTED: 0A `�D DATE: 1d-� GEICO GEICO GENERAL INSURANCE COMPANY () PO Box 509090 NAIC 1 800-841-3000 San Diego, CA 92150-9090 35882 California Evidence of I iability Insurance Policy Nijn-riber Effective [",,),at- e Exp"�'rati�b�n Date 44004601.03 07/09/202/09/2025 1� LIL DIANA M MURILLO UOA View Ali Active Drivers V� N Year Make Model 2007 1 IYUNI'.)AI SADID 'TA f:::::'E � � • • � • • � I� � � � 't� tl 11 I alfrnn under penalty of perjury under the laws of California one of the following declarations �_l 1 have and will maMaui a Ceflifcate of set*isjre for workers' Compensalron, issued by the Director of �nduslrial Relations as pravided for by Labor C , 37' 0,, "cr the performance of the work set forth the agree,Tlent wiln the City of El Segundo v Policy No raj I Have and wntl Maintain workers' compensation n ,r jrjjn -,�r as required by Labor Code § 370,0 tof the performance of the work for which the agreement with the City of El Segundo is executed. My workers r ��rrrpvnsatron insurance ca►rier find pol,cy number are Camel Narrtc of Agent Policy Number Expiration Date Phone 0 I certify lizat 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 subiecl to the workers' Compensation laws of California, and ayre�e Thal, it I Shou!d become subject to the workers" compensation provisions of Labor Code § 3700 1 must Fp v , g !.. catty become void. .. � N r Date SiynaEur e of A � Rant ,� I �� � d � ' rtJ automatically .. �.�.. imrntdidlci C.r;ril i with 18 � u ir,r �� �M�;� or the � br � mL'nt w� Plait NarflC .t ti t t_,- e t c"V& 1L ��e _ Ulll Agreement for 10�I Reviewed by