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PROOF OF INSURANCE (2014) CLOSEDaAn'a Y�akODM"FY°Mry.. ( CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS RIS -UEO AS A MATTER OF —INFORMAPON ONLV AND CONFERS NO FUGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY Ak1END, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIUD REPRESENITATiVE OR PRODUCER, AND THE CERTIFICATE HOLDEN HAFORTANTt if tho coniflcate hotdot loan ADDITIONAL INSURED, the PORCY)los) must be endorsed» N SUDROOAIRON IS WAIVED, sub)oot to tlwD torms and 0ondl ono of Ilia poWlcy, eertaln poltolas may r"Wre an endorsement A statarnent on this eertHicats does not c W tlgt s to the cortlfdoate holder In lieu at such andorsame s), Pacoum L.RICHARDSONAGENCY R dW�WTT TANIA RICHARDSON, AGENT stftfo— 17715 CRENSHAW BLVD w tP q((P6 f nn rr„ TORRANCE, CA 90504 VISION ADELANTE._____. a._ _. _. ut�l(4sI _kErm Irglrlq tea.._ -.TlitdlT_»m. A PARTY POSIES 1311 SARTORI AVE TORRANCE, CA 90501 -2720 tERTIFICA NOTV4M1TNBTANDINfI ANY REQUIREMENT, TEAMT OR CONDITION OF ANY9C014TRACTrOn OTHER MUIJVL 10N THE RESPECT TO WHICH THIS CER'TdFICATE' MA'Y RF ISS'UEO OR MAY PERTAIN, THE INSUr"CE AFFORDED BY TIME FOLIWES DESCRIBED HEREIN IS SU'BqWT TO ALL THE TERMS, . , CONOITIONS OF SUCH POUCIES,. LIMITS SHO!A!M MAY HAVE BEEN REQUCEDSY PAID CLAIMS. E% CLUSMONSAND.,....»_.......,....,».... ._._.....,..�.._..__..W...».... IHrrT'&7MaANdE � ..� _ _..»_... ...,._.»...»..,.,.,.,�....� w„„,„,,,_ .m_,.,„,......._ A 09 rr� L UA1%UL. ............. ... FOU8CY �N9" UNITS.......,- »......... TrFa sail ._.,.; ,,. „.� ""�, C&T'ar'EfYAq¢sWBI'Ur'Y Y B2- BT- P1li1 -9 10101r20t7 tOg1n011 � "� 9 P ctmusmcs [izl CcCkNt L FAAAEMTATE WAI AFPtpEspe : I lMkCwDG 'Iffi C4? C7V++w,*4 S WOOLS UA$^nV ANYAUTO ... .......�...� ..,.. »,, a ALL OWNED .• UTDS iTBFk"omt�ffiD�Ymrxargy AUTOS UOS o INRDAuTos -0 — II UUs.. A u m x r r. fi,�o��uNfRtNC.C'.. NIA 91, a reAlNSltocAnDNSS as ( ANSMACano III, MalonNapmamAslw ,eww„asNr�ulgnavmM�TrArlMr�ul The CAY of El Segundo, Ns officers. officials, employees, agents, and volunleers are named addfildnal Insured as respells general fiEblity end this Insurance b pdmEN and noncontributory wfih any other Insurance of The additional Ensured. Shoui d any policy be cancelled before the expiration dale, State Ferro Insurance will mail 30 (thirty) days wrillen notice 10 The canlficale holders which require such action per wdBen contract or agreement, except 10 days notice of cancellallm for nonpaynmi of premlum. City Of El Segundo I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 350 Main St THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN „r ACCORDANCE WITH THE POLICY PROVISIONS. EI Segundo, CA 90245 ! a _ da 1 OSS0t1, ACi?RB CdtlfrORATdOII, AH idghls tm6atvad 010106) ACORD 26 (2 The ACORD name and hxSo Era registered marks Dt ACORD 1001488 132849,8 01 -23 -2013 FE-6809 SECTION II ADDITIONAL INSURED ENDORSEMENT Pape 1 of 1 POlicy No.: 92-137-P I54-9 Named Insured: VISION ADELAN "fE �.....r DBA PANTY POSIES 13,11 'SARTORI AV TORRANCE CA 90501-2720 TGdENT FALffiF NDO ITS address): . _ Tl1 CITY OF L EGIy� _....�� ., "...A.. 01ICEfiS OFILIALS EMPLOYEES ARN OTY CLERIC 115 350 Mg,qIN� ST EL wSEN"Nf10 CA 90245 -3895 WHO IS AN INSURED, under SECTION II DESIGNATION OF INSURED, is amended to include as an insured the Additional Insured shown above, but only to the extent that liability is Imposed on that Additional Insured solely because of your work performed for that Additional Insured shown above. Any insurance provided to the Additional Insured shall only apply with respect to a claim made or suit brought for damages for which you are provided coverage. The Primary Insurance coverage below applies only when there Is an "X" In the box. ® Primary Insurance. The insurance provided to the Additional Insured shown above shall be primary Insurance. Any insurance carried by the Additional Insured shall be noncontributory with respect to coverage provided to you. All other provisions of the policy apply. FE-66M Reproduction of Insurance Services Office, Inc. Form INSURER: ISO FORM CG 20 10 1185: (MODIFIED) POLICY NUMBER: COMMERCIAL GENERAL LIABILITY ENDORSEMENT NUMBER: EXHIBIT I -A THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED — OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVE:RAUE PART'. SCHEDULE The City, its officers, officials, employees, agents, and volunteers (If no entry appears above, the information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section 11) is amended to include as an Insured the person or organization shown in the Schedule, but only with respect to liability arising out of `your work" far that insured by or for you. Modifications to ISO form CG 20 10 11 85: The insured scheduled above includes the Insured's officers, officials, employees; volunteers. 2. This insurance shall be primary as respects the insured shown in the schedule abc or if excess, shall stand in an unbroken chain of coverage excess of the Nar: Insured's scheduled underlying primary coverage. In either evettt, any other insure maintained by the Insured scheduled above shall be In excess of this Insurance shall not be called upon to contribute with it. 3. The insurance afforded by this policy shall not be canceled except after thirty d prior written notice by certified mail return receipt requested has been given to Entity. 4. Coverage shall not extend to any indemnity coverage for the active ttegli,genca of additional insured in any case where an agrucmetut to indemnify the additional insu CG 20 10 1185 Insurnuce Services Officq Inc. Form (Modified) =-M. L_J CERTIFICATE OF INSURANCE SUCH INSURANCE AS RESPECTS THE INTEREST OF THE CERTIFICATE HOLDER NAMED BELOW WILL NOT BE CANCELED OR OTHERWISE TERMINATED WITHOUT GIVING 10 DAYS PRIOR WRITTEN NOTICE TO THE CERTIFICATE HOLDER, BUT IN NO EVENT SHALL THIS CERTIFICATE BE VALID MORE THAN 30 DAYS FROM THE DATE WRITTEN. THIS CERTIFICATE OF INSURANCE DOES NOT CHANGE THE COVERAGE PROVIDED BY ANY POLICY DESCRIBED BELOW. This certifies that 0 STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY of Bloomington, Illinois ❑ STATE FARM FIRE AND CASUALTY COMPANY Of Bloomington, Illinois ❑ STATE FARM COUNTY MUTUAL INSURANCE COMPANY OF TEXAS of Dallas, Texas, or ❑ STATE FARM INDEMNITY COMPANY of Bloomington, Illinois has CoveTq! Lin force for The followi __.._jMNqmedInsured1 as shown below: PARTY POSICS POLICY NUMBER 1 143 0 CA 90501 DESCRIPTION OF 195 _!� pequqt_ VEHICLE (InClUding VIN) FORD CLUBWAGON iFnFl! H3SHA69833 LIABILITY COVERAGE -OFLIABILITY11-11 10 YES ❑ NO ❑ YES 0 NO rl�ITS b. Collision $Soo a. Bodily Injury $ Deducill Person Person._ loo o00 NO Each Accident 300, 000 IRE JA&L H 0 CAR L ITY OVERAGE C W . bP�; tyD.,.g. _ _ ❑ YES — Each Accident 100,000 C. Bodily Property Damage ❑ YES NO Single Limit ❑ NO Each def*' AL I=GE COVERAGES Z YES ❑ NO ❑ YES ❑ NO IL OMPLkhensive _500 _!� pequqt_ $ Deducti YES ❑ NO ❑ YES ❑ NO b. Collision $Soo Deductible $ Deducill EMPLOYERS NONr-OWNED CAR LVOL"y YES NO ❑ 0 YES ❑ NO IRE JA&L H 0 CAR L ITY OVERAGE C W ❑ YES ONO ❑ YES ONO ' FFLFET - COVE—RAG E FOR A L� LZOWNEDANOLICENSED '40� MOTOR VEHICLES ❑ YES NO ❑ YES ❑ NO ❑ YES ❑ NO 0 YES ❑ NO ❑ YES ❑ NO $ Dedudit *❑YES ' —0 NO $ Deducft ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO 0643 CITY OF EL 5EGtJvqo"' L. RICHARDSON AGENCY EL SEGUNDO, CA TANIA RICHARDSON, AGENT 5 17715 CRENSHAW BLVD. TORRANCE, CA 90504 350 MAIN STREET A ��_ 310 225-5600 01 A I I: PA FA USE ONLY: Request P0010"sM C . 611roate of Insurance for Hab6lHyr covbr,— 122429.2 Rev.Mio.2oo4 HIR"U6110 CQd#keIQ Holder to be added as an Additional Insured. ❑ YES ❑ NO Doduclib ❑ YES ❑ NO L DOftdb ❑ YES ❑ NO E YES 6140 OYES .—ONO 10/04/13 Party Posies Floral Floral & Event Planning October 2, 2013 Vina Ramos 350 Man Street El Segundo, Ca. 90245 Dear Vina, This letter is to inform you that Party Posies/Vision Adelante will be hiring independent contractors for the Christmas installation on December 3, 2013. Please fill free to contact me should you have any question. Thank you, Rosana Torres 1311 Sartori Ave., CA 90501 Phone: (310) 378 -1018 Fax: (310) 320 -3450