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PROOF OF INSURANCE (2026)m, DATE SPECIALTY CERTIFICATE OF LIABILITY INSURANCE (MM/ 312025 N N S U R A ow c¢ A c it N c 'if 09/0/2025 IfwfhORTANT; 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 end.rsement(s). Specialty Insurance Agency Performers of the U.S. 3432 Denmark Ave #231 Eagan, MN 55123 PERFORMERSOF THE U.S. AND ITS PAR Terry Conci dba Franklin Haynes Marionettes 1234 Muirfield Road Riverside, CA 92506 -TT94tlA Contact Name: Heather Weiss Zenzen Phone: 715-246-8908 FAX: 715-246-8908 Email: certs@specialtyinsuranceagency.com INSURERS AFFORDING COVERAGE NAIC R INSURER A: Evanston Insurance Company 35378 INSURER B: INSURER C: INSURER D: 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION INSD WVD DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS �COMMEACIALGENERAL EACH OCCURRENCE $ 1,000,000 KX LIABILITY DAMAGE TO RENTED $ 300,000 CLAIMS MADE DCCUR PREMISES (Ea occurrence) MED EXP (Any one person) $ 5,000 A GEN'L AGGREGATE LIMIT X X 2CN0183-7334 09/08/2025 09/08/202612:01am PERSONAL & ADV INJURY 0 $1,00,000 APPLIES PER: X PROJECT POLICY GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP $ 2,000,000 LOC AGG EACH OCCURRENCE $ '............... PERFORMER ASSISTANT(S) A AGGREGATE $ A BUSINESS PERSONAL AGGREGATE $ PROPERTY - INLAND MARINE SEXUAL ABUSE AND EACH OCCURRENCE $ 100.000 A MOLEsranoN 2CN0183-7334 09/08/2025 09/08I202612:01am AGGREGATE $ 300,000 OCCUR A DATA BREACH AND CYBER AGGREGATE $ LIABILITY COVERAGE A EQUIPMENT LEASED OR AGGREGATE $ RENTED DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS PERFORMER IS A NAMED INSURED AS A MEMBER OF PERFORMERS OF THE U.S.: Terry Conci dba Franklin Haynes Marionettes Additional Insured: The City of El Segundo, its officers, officials, employees, agents and certified volunteers are named as additional insured, but only insofar as the operations under this contract are concerned. Sexual abuse or molestation coverage is not excluded by endorsement. Email: RDelgado@elsegundo.org Attn: Pamella Roach Event Dates: 10/25/2025 - 10/25/2025 Insured for: Puppeteer CERTIFICATE HLUER. City of El Segundo 350 Main Street, Room 5 El Segundo, CA 90245-3813 5.x'f91Y'.V'G.W Ldw� 11MAI.N BEFORE THE EXPIRATION DATE THEREOF, THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE 11 � POLICY NUMBER: 2CN0183-7334 COMMERCIAL GENERAL LIABILITY CG 20 12 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: City of El Segundo 350 Main Street, Room 5 El Segundo, CA 90245-3813 The City of El Segundo, its officers, officials, employees, agents and certified volunteers are named as additional insured, but only insofar as the operations under this contract are concerned. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured any state or governmental agency or subdivision or political subdivision shown in the Schedule, subject to the following provisions: 1. This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. However: a. The insurance afforded to such additional insured only applies to the extent permitted by law; and b. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. 2. This insurance does not apply to: a. "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or b. "Bodily injury" or "property damage" included within the "products -completed operations hazard". B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 12 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 COMMERCIAL GENERAL LIABILITY POLICY NUMBER: III 2CN0183-7334 EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE _. _. _...._ Name Of Person Or Organization: Any person(s) or organization(s) with whom the Named Insured agrees, in a written contract executed prior to the 'occurrence", to waive rights of recovery Additional Premium: $ The following is added to Condition 8. Transfer Of Rights Of Recovery Against Others To Us under Section IV — Commercial General Liability Conditions: We waive any right of recovery we may have against any person or organization shown in the Schedule of this endorsement. This waiver applies only to the person or organization shown in the Schedule of this endorsement. All other terms and conditions remain unchanged. MEGL 0241-01 05 16 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. POLICY NUMBER: 2CN0183-7334 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTNER INSURANCE CONDITION. This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 CITY OF EL SEGUNDO WORKERS' COMPENSATION DECLARATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SUBJECTS AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN LABOR CODE § 3706, INTEREST, AND ATTORNEY'S FEES. I affirm under penalty of perjury under the laws of California one of the following declarations: L_) I have and will maintain a certificate of consent of self -insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Labor Code § 3700 for the performance of the work set forth the agreement with the City of El Segundo. Policy No. C_) I have and will maintain workers' compensation insurance as required by Labor Code § 3700 for the performance of the work for which the agreement with the City of El Segundo is executed. My workers' compensation insurance carrier and policy number are: Carrier Name of Agent Policy Number Expiration Date Phone # C) I certify that, 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 subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Labor Code § 3700 1 must immediately comply with those prsions or the agireement will automatically become void. Signature of Applicant ~~ ` Date 9/24/25 Print Name Franklon Haynes - Agreement for: Dated: Reviewed by: