PROOF OF INSURANCE (2026)OP ID: LM
CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY)
09/24/2025
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 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). coNTACT
PRODUCER NAME:Julie Silvis
Petra Risk Solutions PHONE��FAX � � �
www.PetraRiskSolutions.com WC. No, exl}.562-219-4128 ( „)" µde 29
AID N� 800-494 68
City ADDRESSMAIL JUIIeS 770 The Ci Drive S, Ste 1500 (a PetraRiskSolutions.com
Orange, CA 92868 PRdbUdCA
Douglas K. Douthit CUsToJM9R11P1 .EMELS 1w _ , ..., - _
.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.
®
,......." .. AC)$7LiSUf3id°
. TYPE
ILTR PE OF INSURANCE I POLICY NUMBER
POLfE`Y rrFF PO0..(Y'Exp _
I MMIDDIYY YY f MMIDDdYYYY LIMITS
GENERAL LIABILITY
EACH OCCURRENCE $
1,500,000
A X COMMERCIAL GENERAL LIABILITY RM1GL00012-251
# I EMISES E ccurna ce
01/30/2025 01/30/2026 6AMMIlez RI"NrC�I i $
1,000000
I CLAIMS -MADE X OCCUR
( one ers
MED EXP (Andy p on) $
.,,..
®I
N/
.
X Terrorism Incl
PERSONAL ADV INJURY $
1,500,000
q ty
X Liquor Llablh
GENERAL AGGREGATE$
4,000,000
G.
APPLIESL PER:
ROpDUCTS COMP/OP$ .
4 0
p,000 00
.EN POOOYAGGREGATE
PPOLIMIT
m Ben. $
1,000,0 0
AUTOMOBILE
LIABILITY
SINGLE tMIT
3, 000 00
A X.
ANY AUTO
RMlCA00004-251
� I
01/30/2025 01/30/2026
` eoDILY IN®tuRY Per person) ' $
®.,
ALL OWNED AUTOS 1
f
t
......RY(
BODILY (Per accident) $
SCHEDULED AUTOS
m.'D' A.........
PROPERIYURY
PROPE DAMAGE
$
HIRED AUTOS
C (DENT)
NON -OWNED AUTOS
I$
�$
X
f UMBRELLA LIAR X (OCCUR
EACH OCCURRENCE $
100,000,000
.,
X
EXCESS LIAB I ` CLAIMS MADE
01/30/2025
01/30/2026
AGGREGATE $ ....
0,000
OFo
,SEE NOTEPAD FOR SCHEDULE
$
Follow m
TIBLE
X
� RETENTION $ 10 00 0
$
WORKERS COMPENSATION
I WCSTATU OTH-I
= T4�RY.!...AMITI$-•...,.„.,,. FR
---------
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE "'"
.....
EL, EACH ACCIDENT $
,.
OFFICER/MEMBER EXCLUDED?�
N I A
ELDISEASE - EA EMPLOYEEI $
(Mandatory in NH)
If describe
yes,
i $
A
LiquorlLiabilliityrPERATtoNsbeioW
IRMlGL00012-251
01/30/2025'101/30/2026
Pero csE-PoucYUMlr
1,000,00
I
[
Aggregate
2,000,00
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule,
if more space is required)
Name of Event: City of El Segundo Holiday Event
Date of Event: 12/18/25
1aa:1
CITY068
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of El Segundo
350 Main Street
AUTHORIZED REPRESENTATIVE
El Segundo, CA 90245
(J 19BB-20UU AGUKU GUKVUKA I fury. AU rlgnis reserveo.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
EMELS-1 PAGE 2
NOTEPAD INSURED'SNAME Embassy Suites Los Angeles OP ID: LM Date 09/24/2025
Excess Liability/Umbrella Coverage - Effective: 01/30/25 to 01/30/26
Allied World Assurance Company A.M. Best: A XV
Policy #0309-5702
$5,000,000 Lead Umbrella
HDI Specialty Company A.M. Best: A+ XV
$5,000,000 excess of $5,000,000
Steadfast Insurance Company A.M. Best: A+ XV
$10,000,000 p/o $15,000,000 excess of $10,000,000
Westchester Surplus Lines Insurance Company A.M. Best: A+ XV
$5,000,000 p/o $15,000,000 excess of $10,000,000
Aspen Specialty Insurance Company A.M. Best: A XV
$15,000,000 p/o $75,000,000 excess of $25,000,000
Columbia Casualty Company A.M. Best: A XV
$15,000,000 p/o $75,000,000 excess of $25,000,000
Everest Inde—' t Insurance Company A.M. Best: A XV
$10,000,000 p/o 75,000,000 excess of $25,000,000
Indian Harbor Insurance Company A.M. Best: A XV
$10,000,000 p/o $75,000,000 excess of $25,000,000
Great American Assurance Company A.M. Best: A+ XV
$15,000,000 p/o $75,000,000 excess of $25,000,000
Endurance American Insurance Company Ins. Co. A.M. Best: A+ XV
$10,000,000 p/o $75,000,000 excess of $25,000,000
Policy cancellation provides 60 days cancellation, except for non-payment
of premium, which provides 10 days notice of cancellation.