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PROOF OF INSURANCE (2025 - 2026)CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 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). CON Sam PRODUCER S 8187618888Ya rW ........._...,— LibertUnited Insurance Services, Inc NAM A T F ai .... NAME. ONE 704 S Victory Blvd, Suite 204 AH t) ��� ��� sss2s5ssss Burbank, CA 91502 LOOREsS Sam 9ibeutyuniiedlnsl�rance com _.... --- License #: OF89841 _... ,,,,,,,,,,, INSURER(!) AFFORDING COVERAGE _..,mmmmmm ITITNAIC # INSURER A: Certain Underwriters at Llovd's of Lon:::::] don __________ INSURED INSURER B Elite Special Events, Inc IrIsuRERc 11278 Los Alamitos Boulevard #101 INSURER D .__.................. . _.. _.. Los Alamitos, CA 90720 INSURER E INSURER F : rrrrr•M.�C kilIRMMCO- nnnnen77 37onno RFVl-glnM NIIMRr-R, 47A THIS IS TO CE11 RTIFY 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. _._.. — _ .ADD S — I�TR MAC ICDY FF POLICY EXP LIMITS TYPE OF INSURANCE POLICY NUMBER M dDOfYYYY' A XCOMMERCIAL GENERAL Y Y ZISMB1499 04 05/07/2025 05/07/2026 EACH OCCURRENCE_ mmY $ 1�000y000 -$ -REMISE�S�aoNEcc rence) 300 000 mmmmmm-- MED EXP (Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ mmm9,000,OOO_ GEN'LAGGREGATELIMITAPPLIESPER: ,GGREGATE GENERALA .t $ 2,000,000.. ..._ �qI PRO- POLICY It_ JEC'6 ❑ LOC -COMP/OPAGG PRODUCTS.......- ''$ . .......m2-,000,000 .. $ OTHER. ED SINGLE k..BMI $ AUTOMOBILE LIABILITY ffisumI ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON -OWNED �- PROPERT"COAMAGL $ AUTOS ONLY AUTOS ONLY T�rarcrickcnt) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS -MADE =DED AGGREGATE ........... $ RETENTION $ $ WORKERS COMPENSATION PER OTH STATACCIDEN FR LITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE T $... ........... OFFICER/MEMBER EXCBIUER/E = (Mandatory in NH) NIA E - EA EMPLOYE E.L. DISEASE 5............__ $ ....................... If yes, describe under DESCRIPTION OF OPERATIONS below EL. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / 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 I,.AMICLLPi 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 El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE r (snn, ........... V 79t$S-ZU15 AGUKU UUKI-UKA 1 IUIN. All rlgnis reserveu. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Printed by SMS on 06/12/2025 at 01:17PM Effective date of this Endorsement: 06/12/2025 This Endorsement is attached to and forms a part of Policy Number: ZISMB1499 04 Zodiac Insurance, A World Company Referred to in this endorsement as either the "Insurer" or the "Underwriters" ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: ENTERTAINMENT EQUIPMENT OPERATOR GENERAL LIABILITY CLAIMS MADE AND REPORTED INSURANCE In consideration of the premium charged for this policy, it is understood and agreed that: 1!. Section III. PERSONS INSURED is amended to include as an Insured the person or organization shown in the Schedule at paragraph 2. below, but only with respect to liability arising out of the Named Insured's operations or premises owned by or rented to the Named Insured. 2. SCHEDULE Name of Person or Organization: City of El Segundo, its officers, officials, employees and volunteers 350 Main Street El Segundo, CA 90245 FOR PROOF ONLY, EVENT DATE NOT CONFIRMED Any person or organization for whom the Named Insured has agreed by written "insured contract" to designate as an additional insured subject to all provisions and limitations of this policy. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement). All other terms and conditions of the Policy remain unchanged. AC40RD CERTIFICATE OF LIABILITY INSURANCE DATE /03/2DIYYYY) 04103/2025 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 p1a'licy(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 Dave Warren NAME: Nielsen McAnany Insurance Services, Inc. PNtH'N6 805 , ( ) 379-8801 AC (805) 204-4501 N� 4165 E. Thousand Oaks Blvd E-MAIL ADDREss: Suite 325 WSURERIS) AFFORDING COVERAGE NAIC # Westlake Village CA 91362 INSU,RERA: California Auto Insurance 38342' INSURED INSURER B : ......._._ ELITE SPECIAL EVENTS, INC. INSURER C: 11551 Weatherby Rd INSURER D : INSURER. E Los Alamitos CA 90720-3846 INSOPER F t. COVERAGES CERTIFICATE NUMBER; CL2482810456 REVISION NUMBER: THIS IS TO CERTIFYTHATTHE 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 ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _.. ......LIMITS POLICY EFF P LCYEX'P LTR TYPE OF POLICY NUMEER N;rMI00FYYYY MMVOOPYYYY. ,�„�,�, .. COMMERCIAL GENERAL LIABILITY EftCNd OCOU'RRFNCE CLAIMS -MADE OCCUR PREMISES I"•etacca+a�s 5 •�— MED EXP NAnw one eeIM) PERSONAL AA•DVINJURY S GENrRALAGGREGATF S GEN'L AGGREGATE LIMITAPPLIES PER, PRODUCTS-CONPA G S POLICY � EC LOC •-•tdn $ OTHER, CChNASNCNED SNNGi E LIMN $ 1,000„000 AUTOMOBILE LIABILITY E:a:8.15l M _ ANYAUTO BODILY INJURY (Per person) S BODILY INJURY (Per acc dent) $ A OWNED SCHEDULED BA040000023533 08/31/2024 08/31/2025 AUTOS ONLY AUTOS HIRED NON -OWNED 1xx tisogn� JArrMN a� $ AUTOS ONLY AUTOS ONLY $ UMBRELLALIAB OCCUR EACI N OCCURRENCE . $ AGGREGA"N'E'.. EXCESS UAB CLAIMS-MAOE '. OEt'? F•e TEN I'ION S S 'WORKE.R,SCOMPENSATION LR A STATR,)TE. R... E .... WAND EMPLOYERS' LIABILITY Y / N ' ANY PROPM TCRPARTNER"ECUTIV'E. ESL. EACH ACCIDENT EX, DISEASE-EAEMPLOY EE S '., OFFtC.ERN'M8 MBER E'.XCLUDE01 ❑ ('Mandatory in NH) N / /` E.L.DISEASE- POLICY UMMf%T 5 ''.,. IN yes deasvYbo under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 13'1,A441flonal Remarks Schedule, maybe 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. City of El Segundo 350 Main Street 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 ElSegundo CA 90245 1 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 Newly Acquired or Formed Entity (Broad Form 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. Employees 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. EmployeeHiredAuto—An employee is an insured when operating onauto that is hired or rented in the emplovme'mnan�emh�com pany bu�nmae. Supplementary'Payments — Bail bonds coverage isincreased to$3.OUO.Reasonable expenses and loss ofearnings, upto$5OOper day, incurred bythe insured are covered. Fellow Employee Coverage —The exclusion has been removed. Additional Transportation Expense — We will pay up to $50 per day, maximum is $1.000.fmr tm^~ transportation ��mx9emseramuUUnAhrp othetmta|theftof a covered auto Hired Auto Physical D�rnmgaCoverage —|fyou have Hired Auto Liability coverage, and you carry physical damage coverage for any ofyour autos, mxewill extend coverage for Hired Auto Physical Damage toalimit of $50,000.subject tom$500 deductible. Accidental Airbag Deployment —omremoved the e,xc}uaion.providing coverage for airbag deployment that isaccidental. Loan/Lease Gap — Coverage for the unpaid amount due on the lease or loan has been added if there imatotal loss of anauto insured under this policy. Glass Repair — Deductible Waiver —Wewill waive the deductible ifglass ierepaired rather than replaced. ' Two or More 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 Event of Accident, Claim, Suit or Loss — The insured must notify us of an accident aasoon aopossible. Waiver of Subrogation — We waive our right of recovery against others if the insured has executed owritten agreement prior bzthe accident orloss. Unintentional Error, Omission, or Failure to Disclose Hazards — The policy will not be deemed invalid if the insured unintentionally omits, errs or fails to disclose a hazard. Employee Hired Auto - If the employee hires or rents a vehicle with permission of the insured, Hired Auto Physical Damage applies. HimadAuto—Covmnage Territory — Coverage applies anywhere inthe world ifamauto imleased, hired, rented orborrowed without a driver for aperiod of3Odays urless, and the |neunyd's responsibility to pay for damages is determined in a suit brought in the US, its territories and possessions, Puerto Rico, Canada orinmsettlement that vveagree to. Bodily Injury Redefinedto|no|udmResu|tmntK4entafAnguioh—Bmdi|y| 'uryinc|udeonmenba| anguish. Q CERTHOLDER COPY SIR P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 04-03-2025 CITY OF EL SEGUNDO SIR 350 MAIN ST EL SEGUNDO CA 90245-3813 GROUP: POLICY NUMBER: 9304403-2024 CERTIFICATE ID: 22 CERTIFICATE EXPIRES: 08-26-2025 08-26-2024/08-26-2025 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 notamend, 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, 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 #2055 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 SIR 11278 LOS ALAMITOS BLVD #101 LOS ALAMITOS CA 90720 [DOG,CNj (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 •e advised that a waiver of subrogation requiires that a 3,% surchargq will be applied by State Fund ONLY to the premium assessed on the payroll s • • • -•engaged • + • • who requested the waiver. (�Note: if you have no employee payroll on that jo then there is nocharge) 2. • apply the 3%surcharge, you • agree to maintain r cerfificate holder who segregated payroll records for employees engaged in work on job/s for th(z verificationby an Example: Payroll for job: Sample Rate: Regular Premium equals: Surcharge: Additional Waiver charge: Total premium equals $5,000.00 13.300 $ 665.00 3.00% $ 19.95 $ 684.95 (665.00 + 19.95)