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PROOF OF INSURANCE (2013) CLOSEDDATE (MM/DD /YYYY) CERTIFICATE OF LIABILITY INSURANCE 04/24/2013 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 poltcy(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). –CURT ACT PRODUCER NAME: P HCC Specialty PHONE � EX1,d 401 Edgewater Place, Suite 400 ADDRESS. Y$RO)DUCSI - -- Wakefield, MA 01880 PUPT MERIt?0; 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 INSURER(S) AFFORDING COVERAGE NAIC # INSURED TYPEOFINSURANCE L�MI LTR INSR WVD POLICY NUMBER MM /DD/YYY MM /DD /YY MITS INSU RERA: New Insurance Company 23841 Neon Nation SEL082848050 07/08/2013 ,Hampshire EACH OCCURRENCE $ 1a000 a000 2809 Atadero Court X COMMERCIAL GENERAL LIABILITY INSURERS: Carlsbad, CA 92009 INSURERC: [ OCCUR INSURERD: INSURERE: INSURER F : a COV'FRA(,FS rFRTIFIir:ATF NI IMRFR• RFVIGInN NI IMRFR- 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. 094 DDL "SCYBYI — PC)CICS� PCILYOWEXP TYPEOFINSURANCE L�MI LTR INSR WVD POLICY NUMBER MM /DD/YYY MM /DD /YY MITS GENERAL LIABILITY SEL082848050 07/08/2013 08/05/2013 EACH OCCURRENCE $ 1a000 a000 X COMMERCIAL GENERAL LIABILITY MU ES - 300,0000 [ OCCUR CLAIMS-MADE a X Host Liquor Host PERSONAL m ............. .. ......_ _ ..,._.. . 000 000 &ADVINJURY $ 1a ................ +w.....m _. _., A I GENERAL AGGREGATE N APPLIES G - —.. PER: PRODUCTS - COMP /OP,AGG....$ 1 000, 000 � � X POLC�ICYEGATEJ PRO- T OC _......- -- . ............................... ......... ..... . AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO ................. __............ -- �...............- _........ BODILY INJURY (Per person) $ ALL OWNED AUTOS ._ ......... ........................__.._.. _ .. ............................... BODILY INJURY (Per accident) $ DAUTOS AUTOS ................_....__ .. ......_ . --, ............ ............................... PROPERTY DAMAGE $ -- HIRED ( Per accident) NON -OWNED AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB LA M CIS -MADE AGGRE GATE $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY $ O BER EXCLUDED? OFFICER/MEMBER EXCLUDED E CEA ./ ICERIM in E L DISEASE EMPLOYE $ If yes, describe under ....... --------..-.. m ................. ............................_ -. DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The Certificate Holder is added as Additional Insured with respects to our Insured's operations only. This insurance is primary and non- contnbutory as required by written contract. This coverage is with respect to El Segundo Summer Concert Series event to be held 8/412013 - 8/4/2013 at Library Park El Segundo CA IR City of El Segundo, its officers, officials, employees,, agents, and volunteers 350 Main Street El Segundo, CA 90245 4g� 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 RE'PRE'SENTATIVE I ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD COMMERCIAL LINES POLICY COMMON POLICY DECLARATIONS ❑ Granite State Insurance Company ❑ Illinois National Insurance Co. ❑X New Hampshire Insurance Company (Each of the above being a capital stock company) 175 Water Street 18`" Floor New York, New York 10038 212 458 5000 RENEWAL OF NUMBER POLICY NO. 82848050 NAMED INSURED Neon Nation MAILING ADDRESS 2809 Atadero Court, Carlsbad, CA 92009 POLICY PERIOD: From Jul 08, 2013 to Aug 05, 2013 PRODUCER: HCC Specialty 84213 at 12:01 A.M. Standard Time at your mailing address shown above. BUSINESS DESCRIPTION El Segundo Summer Concert Series to be held 08/04/2013 at Library Park, El Segundo, CA 90245 IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS FOR WHICH A PREMIUM IS INDICATED. THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT. PREMIUM Commercial Property Coverage Part N/A Commercial General Liability Coverage Part $100.00 Commercial Crime Coverage Part N/A Commercial Inland Marine Coverage Part $0.00 Boiler and Machinery Coverage Part N/A Commercial Auto Coverage Part $0.00 Liquor Liability Coverage Part $0.00 TRIA $1.00 Damage to Premises Rented to You $0.00 TOTAL $101.00 Premium shown is payable: $101.00 at inception. **Plus Form(s) and Endorsement(s) made part of this policy at time of issue *: 1st Anniversary. 2nd Anniversary *Omits applicable Forms and Endorsements if shown in specific Coverage Part/Coverage Form Declarations. Countersigned: B . y� Authorized Itepresentatdve THESE DECLARATIONS TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE PART DECLARATIONS, COVERAGE PART COV- ERAGE FORM(S) AND FORMS AND ENDORSEMENTS, IF ANY, ISSUED TO FORM A PART THEREOF, COMPLETE THE ABOVE NUMBERED POLICY. T Includes copyrighted materials of Insurance Services Office, Inc., with its permission. Copyright, Insurance Services Office, Inc. 1983, 1984 94858 ADDENDUM TO THE DECLARATIONS By signing below, the President and the Secretary of the Insurer agree on behalf of the Insurer to all the terms of this Policy. Peter J. Eastwood PRESIDENT Denis M. Butkovic SECRETARY Granite State Insurance Company The Insurance Company of the State of Pennsylvania Illinois National Insurance Co. New Hampshire Insurance Company American Home Assurance Company National Union Fire Insurance Company of Pittsburgh, Pa. Commerce and Industry Insurance Company This Policy shall not be valid unless signed at the time of issuance by an authorized representative of the Insurer, either below or on the Declarations page of the Policy.. Ethan D. Allen AUTHORIZED REPRESENTATIVE COUNTERSIGNATURE DATE 78711 07 12 COUNTERSIGNED AT Renewal of Number* Policy No. 82848050 COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS 1 COVERAGE IS PROVIDED IN THE COMPANY DESIGNATED BY NUMBER, A STOCK INSURANCE COMPANY (HEREIN CALLED THE COMPANY) Named Insured and Mailing Address (No., Street, Town or City, county, State, zip Code) _ Neon Nation 2809 Atadero Court, Carlsbad, CA 92009 Policy Period *: From Jul 08, 2013 to Aug 05, 2013 at 12:01 A.M. Standard Time at your mailing address shown above. 1 NEW HAMPSHIRE INSURANCE COMPANY 2GRANITE STATE INSURANCE COMPANY 31LLINOIS NATIONAL INSURANCE COMPANY EXECUTIVE OFFICES 175 WATER STREET, 18' FL.. NEW YORK, N.Y. 10038 Producer: HCC Specialty 84213 IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCF AS STATFD IN THIS POI ICY LIMITS OF INSURANCE General Aggregate Limit (Other Than Products - Completed Operations) $2,000,000.00 Products- Completed Operations Aggregate Limit $1,000,000.00 Personal and Advertising Injury Limit $1,000,000.00 Each Occurrence Limit $1,000,000.00 Damage To Premises Rented to You Limit $300,000.00 Medical Expense Limit 5 000.00 Any One Person DESCRIPTION OF BUSINESS AND LOCATION OF PREMISES Individual ❑ Joint Venture [:1 Partnership E] Limited Liability Company ❑ Corporation ❑ Organization (Other than one indicated above) Business Description *: El Segundo Summer Concert Series to be held 08/04/2013 at Library Park, El Segundo, CA 90245 Location of All Premises You Own, Rent or Occupy: Library Park / 600 block of Main Street El Segundo, CA 90245 PREMIUM - SUBJECT TO AUDIT ** Rate Advance Premium Classification Code No. Premium Basis Pr /Co All Other Pr /Co All Other Music Festival $50.00 N/A $50.00 Additional Insured(s) $50.00 $50.00 TRIA $1.00 $1.00 Tax/Other (if applicable) Total Advance Premium $101.00 * *Audit Period (if applicable): ( ) Annually ( ) Semi - Annually ( ) Quarterly ( ) Monthly Premium shown is payable*: $101.00 at inception; $ 1st Anniversa ; $ 2nd Anniversary FORMS AND ENDORSEMENTS Forms and Endorsements applying to this Coverage Part and made part of this policy at time of issuet: See attached Forms and Endorsements Schedule Countersigned:* By * Entry optional if shown in Common Policy Declarations. t Forms and Endorsements applicable to this Coverage Part omitted if shown elsewhere in the policy. Authorized Representative THESE DECLARATIONS AND THE COMMON POLICY DECLARATIONS, IF APPLICABLE, TOGETHER WITH THE COMMON POLICY CONDITIONS, COV- ERAGE FORM(S) AND FORMS AND ENDORSEMENTS, IF ANY, ISSUED TO FORM A PART THEREOF, COMPLETE THE ABOVE NUMBERED POLICY. Includes copyrighted material of Insurance Services Office, Inc, with its permission. Copyright, Insurance Services Office, Inc. 1994 CLAIM REPORTING PROCEDURES During Business Hours of Monday — Friday 9am to 5pm Eastern Time: All claims regardless of severity or location should be reported directly to HCC Specialty [ "HCCS "]. HCCS will forward all claims and appropriate documentation on to YORK Claims Services [ "YORK "] for adjusting of the losses. Please note that each and every claim should be reported through the email address listed below. 1. Email: claims @totaleventinsurance.com 2. Telephone: 781 - 994 -6000 Important! • Notices that do not require action ( "incident reports ") should be clearly marked "REPORT ONLY ". HCCS will review all claims notices upon receipt and send to YORK for assignment to the YORK handling branch office. A claim acknowledgement will then be transmitted to the designated individual advising of the YORK claim number and the adjuster assigned to the claim. During Weekends, After Business Hours; Claims should be reported directly to York Claim Services [ "YORK "] for assignment to the YORK handling branch office by one of the following methods: 1. Email: yorkclaimsintakeCaD-york- claims.com 2. Telephone: 1- 866 - 391 -9675 A claim acknowledgement will then be transmitted to the designated individual advising of the YORK claim number and the adjuster assigned to the claim. Important! • To expedite the handling of your newly reported loss, please be sure to include your YORK Client Code with each new loss report! • The YORK Client Code for the HCC Special Event Liability program is 1799. • Notices that do not require action ( "incident reports ") should be clearly marked "REPORT ONLY ". FORMS and ENDORSEMENTS SCHEDULE FORMS PART OF POLICY NO.: 82848050 ISSUED TO: Neon Nation BY: New Hampshire Insurance Company Description Form Number Declaration Page 94858 Addendum To Declarations 78711 09 -11 CGL Coverage Part Declarations JDL 190 (2) -X -A (1 -95) Claims Reporting Instructions n/a Forms And Endorsements List n/a Common Policy Conditions IL 00 17 11 98 CGL Coverage Form CG 00 01 04 13 CGL Enhancement Endorsement 86563 12 04 Abuse or Molestation Exclusion CG 21 46 07 98 Asbestos and Silica Exclusion 82540 (8/07) Assault & Battery Exclusion 101145409 Attendance Limitation Exclusion 100461 3 09 Field of Entertainment Exclusion 603685 Fireworks Exclusion 96725 1207 Limited Event Coverage 100472 (3/09) Limited Event Cov ADDENDUM Short Term JDL 190(2) X -A (1 -95) Nuclear Energy Exclusion IL 00 21 05 04 Prof Liab Excl 97020208 Securities and Financial Interest 73003499 Silicosis Exclusion 64003 901 Sports Leisure Entertainment Exclusions 100456309 Stunt Exclusion 72981 499 Total Lead Exclusion 58332 793 Violation Statutes Exclusion 87295 105 War Exclusion CG 00 63 12 Al - Managers Lessors CG 20 11 04 13 Al - Subdivision CG 20 12 07 98 Al - Designated Persons CG 20 26 04 13 Amendment of Liquor Liability CG 21 50 04 13 TRIA Disclosure 96556 (2/08) Chartis Privacy Notice 78052 Rev 12 09 Chartis 2009 -37 NY AG Notice n/a Time Stamp Endorsement 102215 (7/10) OFAC Endorsement 89644