PROOF OF INSURANCE (2010) CLOSEDCERTIFICATE OF LIABILITY INSURANCE r 200^'1
GNOW?l20Op
PRODUCER TH CERTIFICATION I ISSUED AS A MATTER OF INFORMATION
RJF Agencies, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
6000 Nathan Lane North, Suite 400 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Minneapolis, MN 55442 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE I NAIC v
INSURER A: LBXlnCtOn Insurance Com mw Imes?
Performers Of Ina U.S. & Club Members INSURER B:
PO Boot 24 INSURER c
New Riohmond. VA 54017 INSuAER Ct
Phone: 715-246-8908 Fox. 715.248 -4257
COVERAGES
ANY REQUIRIcMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH SPECTTO MICH THIS CERTTIFICAITEE INDICATED. NOTWITHSTANDING S pg
MAY P6RTAJN. 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.
WLTPr f TYPE DP W00011LNCE POLICY NUMBER P M I C w-E P � MW 7TOR �
oeNlwLLiABIUTY 008844163 04!2512009 I 0412512010 EACHOCCURR£Nce f 3,000,000
A X COMMERCIALGENERALLIADuTy
CWM MADt X I FJ Oda�tM106) t 100.0°
OCCYR MED EX$' fay eyN p�ron) t 5,000
X .'. 10103
DUCMPTION OF OPMT90NI f LOCATIONf ! NeNICLEa f EJCCLL910NS ADDED BY ENDORSEMENT r SP6CNAr- PRWprONB
Performer Is an insurOd as a member of Performers of the U.S. (FORM CG2002 111W.
Eric R. Greenberg dbs Liberty City
Additional Inured: Clty.*1EI Segundo. its officers, officials, employees, agents and certiried volunteers.
Fax: 818 344.6108
City Of Ell Segundo SHOULD ANY Of THE ADO" 01$"Ggo ►oUCIEt as CANCELLED BEPORaE THE EXPIRATION
401 Sheldon $}feet DATE THEREOF, THE IaBU&C INSURER WILL410MEMMMML
EI Segundo, CA 90246 oAYs wRrrT>=N
NOTCE TO TNB CBRTIFlCATE HOLDER NAMED TO THR LIFT, C�
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Performer Is an insurOd as a member of Performers of the U.S. (FORM CG2002 111W.
Eric R. Greenberg dbs Liberty City
Additional Inured: Clty.*1EI Segundo. its officers, officials, employees, agents and certiried volunteers.
Fax: 818 344.6108
City Of Ell Segundo SHOULD ANY Of THE ADO" 01$"Ggo ►oUCIEt as CANCELLED BEPORaE THE EXPIRATION
401 Sheldon $}feet DATE THEREOF, THE IaBU&C INSURER WILL410MEMMMML
EI Segundo, CA 90246 oAYs wRrrT>=N
NOTCE TO TNB CBRTIFlCATE HOLDER NAMED TO THR LIFT, C�
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05/27/2009 14:10 7152464257 SPECIALTY INSURANCE PAGE 02102
POLICY NUMBER: 008641163
COMMERCIAL GENERAL LIABILITY
CG20 26 C 7 04
THIS ENDORSEMENT CHANCES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED
PERSON OR ORGANIZATION
TWO e0d0x3crue0t modifies insurance provided under the Wowing
COMMF.RCTAT, GENERAL LIABILITY COVERAGE PART
Name 6f Additional Insured Pemon(s) or orpnizatloniaj:
Premises Location:
City of El Segundo City Clerk
Attu; Recreation & Parks Director
350 Main Street, Roam 5
El Segundo, CA 90245.3 913
Additional Insured: The City of El Segundo, its officers, officials, employees, agents & certified volunteers
This insurance will be deemed "primary" such that any other insurance that may be carried by City of Ej
Sege dO will be excess thereto. This insurance will be oru an "occur=ce ", not a "claims made" basis or
equivalent.
Infbmuttion requlmd 10 ca►npiete thIS Schedule, if not shown above Will be shown in the Deciaralaons.
5ecdon II — Who is Art Iuanted is amended to include
as an additional iosuted the peraon(s) or ozgarliza.tion(s)
shown in the Schedule, but oeY with respect to liability
for "bodily injmy","propctty dmvr or openonal and
zdveranugel5a h e�cd, in Whole or in par� by, yvwr acts or omissions or the seta or omissions of thogc ld*
A. In the pesforn=ce of your ongoing opemtions: or
B. Iii connection with your prcmiaes owned by or rented to you
CG 20 26 07 04 ®ISO Propettiss, Inc,, 7004
Page 1 of 1
[I*DS[-Iy4*
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Vina Ramos
Accounting
City of El Segundo
April 14, 2009
Dear Vina,
Due to the sporadic nature involved in obtaining performers for various events, our company
hires all of its performers as independent contractors on a per job as needed basis.
Therefore we are exempted from providing workman's compensation for the performers.
Sincerely,
Eric Greenberg
18560 Vanowen St. #14 • Reseda, CA 91335 • office: 818 - 344 -8929 • fax: 818 -344 -6108
www.Iibertyc1tyent. corn