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PROOF OF INSURANCE (2025 - 2025) CLOSEDCERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 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(les) 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). PRODUCER CONTACT....�...... .. ._ NAME 18yan 888 Liberty United Insurance Services, Inc P 8187688 - FAX "' 704 S Victory Blvd, Suite 204 EMAIL „26568e9 Burbank, CA 91502 t raa s _ a! � t !1 �t nsurance com _ License #: OF89841 ,,, ...._. INSURER ,AFFO,RDING COVE— RA .. NAIC# m(S� , GE INSURED INSURER ,B . _ Cqrtp(n UndgrWritg.Es Rt �„I yd S OfµLO,ndon , Elite Special Events, Inc INSURER C-:� _ 11278 Los Alamitos Boulevard #101 INsuReR, D _ Los Alamitos, CA 90720 INSURER E ... INSURER F . n �.. MAi C rooTtEtrArC suttteeoo• nnnnirn.77_,7 or1At. RFVIRInFJ MIIMRFR- Wig 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. _ ................ ... ........... ,,,,,, -_ ......... .. AODL 5G86Y� POLICY NUMBER MM/DDY EFF I M6-L'i .,. .._ . A ,,,,,, ........,.. ,.-...� , ... LiCY EXP-. INTR .,,SR ... LIMITS TYPE OF INSURANCE P pD/YYYY LIMITS A Y COMMERCIAL GENERALLIABILITY Y Y ZISMB1499 03 05/07/2024 05/07/2025 EACH OCCURRENCE $ 1,0,00,000 ,,, .._, w LYAMAl.`iL tIN AFC, 300,000 ,( CLAIMS -MADE OCCUR .. one person) n) &ADVINJURY .....�.$1,000 __ _ $ 000 ...................... ......,. ... LIMIT EGATE LIMIT APPLIES PER: GEN'L AGGREGATE GENERA----- GGREGATE JECT' LOC X'� PRODUCTS COMP/OP..AGG 2,0OO,000 PONIED AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT b..±.,Fa..cr�dnA1.. ....................._.. $ ...... .......... ANY AUTO I BODILY INJ URY (Per person) $ OWNED SCHEDULED I BODILY INJURY (Per accident) $ AUTOS HIRED NON -OWNED =�m AUTOS ONLY LE I J ' PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY I .Ir°�fR acul.nl)'. ... •... - ..., UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE .................. . ..._._. - AGGREGATE ._ ....._... ..... .. ...... $ ,,,,, _ ......., ... DED RETENTION $ �,. $ WORKERS COMPENSATION PER OTH „ AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE I E..L. EACH ACCIDENT .. $, OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A E..L. DISEASE EA EMPLOYEE ,,,,_......_ ..----- ............. .... $ ..-- ......,.,.,... .......�... If yes. describe under DESCRIPTION OF OPERATIONS below E.L DISEASE POLICY LIMIT $ B Accident/Medical ZISMB1499 03 05/07/2024 05/07/2025 $10,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of El Segundo, its officers, officials, employees and volunteers are listed as additional insureds as respects general liability and this insurance is primary and noncontributory with any other insurance of the additional insured GtK I IFIGA I t MULULK g1MN%1r_L_u+ t tutr 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 REPRESE U 1 VH8-2U15 AGUKU GUKYUKA I IUN. Au ngnis reserves. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Printed by SMS on 04/03/2025 at 11:11AM r0 DATE (MMIDDIYYYY) CC)V CERTIFICATE OF LIABILITY INSURANCE 04I03/2025 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). PRODUCER CONTACT Dave Warren NAME, Nielsen McAnany Insurance Services, Inc. PC'NE (805) 379 8801 FAX (805) 204-4501 No Ext ::-.. -- ..... 4165 E. Thousand Oaks Blvd E-MAIL' ADDRESS: Suite 325 INSURER(S) AFFORDING COVERAGE NAIC # Westlake Village CA 91362 INSURERA: California Auto Insurance 38342 INSURED INSURER B : ELITE SPECIAL EVENTS, INC. INSURER C : W .. 11551 Weatherby Rd INSURER D INSURER E Los Alamitos CA 90720-3846 INSURERF: COVERAGES CERTIFICATE NUMBER: CL2482810466 REVISION NUMBER: THIS IS TO CERTIFYTHAT 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 ....... POLICY EFF POL Y FRCP - LIMITS L Tk TYPE OF INSURANCESUUR INSD WVD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ AMA CLAIMS -MADE D OCCUR PREMISES fEa occurrence $ MED EXP (Any one Derson) PER SONAL&ADV INJURY $ GEN'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ POLICY D ,IE,CTPRO•' 7 LOG PRODUCTS - COMP/OP AGG $ dLi1°HERt ..... AUTOMOBILE LIABILITY COMWNFO SINGLE UMilT Ea aobq nl $ 1,000.000 ANYAUTO BODILY INJURY Per person) $ A OWNED SCHEDULED BA040000023533 08/31/2024 08/31/2025 BODILY INJURY (Per accident) $ AUTOS ONLY HIRED AUTOS w�,r NON -OWNED IPROPER'PYrMAG $ X /'�+ AUTOS ONLY ^�'"'"* AUTOS ONLY ''..�, 21 a —do, -•- UMBRELLA LIAB OCCUR —L. _ EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ ii DED L RETENTION $ $ WORKERS COMPENSATION . ........... PER OTH- STATUTE ER AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFF........ lMan EXCLUDED. EMBER N / A (Mandatory ' NH) E.L: DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E1, DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of El Segundo, its elected and appointed officals, employees, and volunteers are additional insured per attached MCA85100817-CA. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street AUTHORIZED REPRESENTATIVE ElSegundo CA 90245 J McAnany ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Business Auto Broadening Endorsement INewfy Acquired or Formed Entity (Broad Dorm Named Insured) — Adds, as an insured, any newly acquired or formed entity provided the insured owns at least 50% of that entity and it is formed during the policy period. The maximum period is 180 days. Primary and Non Contributory if Required by Contract — We will not seek contribution from any other insurance available under specific conditions. Ernpfoyees as Insureds — An employee becomes an insured while using a covered auto that the insured does not own, hire or borrow. Automatic Additional Insured — Any person or organization that the insured is required to include as an additional insured based on a contract or agreement that is executed prior to the injury or damage. Empfoyee I -fired Auto — An employee is an insured when operating an auto that is hired or rented in the employee's name while on company business. Supplementary Payments — Bail bonds coverage is increased to $3,000. Reasonable expenses and loss of earnings, up to $500 per day, incurred by the insured are covered. Fellow i:::::mpfoyee Coverage — The exclusion has been removed. Additiornall Transportation Expense — We will pay up to $50 per day, maximum is $1,000, for temporary transportation expense resulting from the total theft of a covered auto. I fired Auto I::1hysical Damage Coverage — If you have Hired Auto Liability coverage, and you carry physical damage coverage for any of your autos, we will extend coverage for Hired Auto Physical Damage to a limit of $50,000, subject to a $500 deductible. Accidental Airbag Deployment — We removed the exclusion, providing coverage for airbag deployment that is accidental. Loan/li...ease Crap — Coverage for the unpaid amount due on the lease or loan has been added if there is a total loss of an auto insured under this policy. Class I=Zepair -- Deductiibfe Waiver — We will waive the deductible if glass is repaired rather than replaced. Two or Dore Deductibles — If two or more policies or coverage forms from the company apply to the same accident, only one deductible will be applied. Amended Duties in the I::::vent of Accident, Claim, Suit or Loss — The insured must notify us of an accident as soon as possible. Waiver of Subrogation — We waive our right of recovery against others if the insured has executed a written agreement prior to the accident or loss. Uniintentfonall Error, Omission, or Failure to Disclose I fazards — The policy will not be deemed invalid if the insured unintentionally omits, errs or fails to disclose a hazard. I::mpfoyee I fired Auto - If the employee hires or rents a vehicle with permission of the insured, Hired Auto Physical Damage applies. I fired Auto Coverage 'Territory — Coverage applies anywhere in the world if an auto is leased, hired, rented or borrowed without a driver for a period of 30 days or less, and the insured's responsibility to pay for damages is determined in a suit brought in the US, its territories and possessions, Puerto Rico, Canada or in a settlement that we agree to. Bodily Injury Redefined to Include IF�esultant Mental Anguish — Bodily Injury includes mental anguish. CA, AZ, TX, OK, GA 10-16 MCA85100817-CA CERTHOLDER COPY SP P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 04-03-2025 CITY OF EL SEGUNDO SP 350 MAIN ST EL SEGUNDO CA 90245-3813 GROUP: POLICY NUMBER: 9304403-2024 CERTIFICATE ID: 22 CERTIFICATE EXPIRES: 08-26-2025 08-26-2024/08-25-2025 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exckis'ions, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2024-08-26 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF EL SEGUNDO ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 08-26-2024 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2024-08-26 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF EL SEGUNDO ENDORSEMENT #1651 - TED HOLCOMB P - EXCLUDED. ENDORSEMENT #1651 - JANET HOLCOMB S,T - EXCLUDED. EMPLOYER ELITE SPECIAL EVENTS, INC SP 11278 LOS ALAMITOS BLVD #101 LOS ALAMITOS CA 90720 [DOG,CNj (REV.7-2014) PRINTED : 04-03-2025 POLICYHOLDER COPY SP P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 04-03-2025 CITY OF EL SEGUNDO SP 350 MAIN ST EL SEGUNDO CA S0245-3813 GROUP: POLICY NUMBER: 9304403-2024 CERTIFICATE ID: 22 CERTIFICATE EXPIRES: 08-26-2025 08-26-2024/08-26-2025 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condRion of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2024-08-26 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF EL SEGUNDO ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 08-26-2024 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2024-08-28 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF EL SEGUNDO ENDORSEMENT #1651 - TED HOLCOMB P - EXCLUDED. ENDORSEMENT #1651 - JANET HOLCOMB S,T - EXCLUDED. EMPLOYER ELITE SPECIAL EVENTS, INC SP 11278 LOS ALAMITOS BLVD #101 LOS ALAMITOS CA 90720 [DOG,CNI (REV.7-2014) PRINTED : 04-03-2025 WAIVER OF SUBROGATION NOTICE Enclosed is your copy of a certificate of insurance on which the certificate holder required a waiver of subrogation: 1. Please be advised that a waiver of subrogation requires that a 3% surcharge will be applied by State Fund ONLY to the premium assessed on the payroll of your employees earned while engaged in work for that certificate holder who requested the waiver. (Note: if you have no employee payroll on that job, then there is no charge.) 2. To apply the 3% surcharge, you must also agree to maintain accurately segregated payroll records for employees engaged in work on jobls for the certificate holder who has the waiver. The payroll records are subject to verification by an auditor. Example: Payroll for job: $5,000.00 Sample Rate: 13.300 Regular Premium equals: $ 665.00 Surcharge: 3.00% Additional Waiver charge: $ 19.95 Total premium equals $ 684.95 (665.00 + 19.95)