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PROOF OF INSURANCE (2012) CLOSEDCERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 10/09/2012 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). PRODUCER CONTACT I PAR' . ............. HCC Specialty PHONE N( 401 Edgewater Place, Suite 400 AIDDRESS� .... ....... PA060CEA' ............................ Wakefield, MA 01880 QUSTPM9R JPC .......... INSURED DaytonBorders 531 Main St. #527 El Segundo, CA 90245 COVERAGES CERTIFICATE NUMBER: INSURER(S) AFFORDING COVERAGE ......... . ....... ,I,N,S,U,RER,A,:-,""N" HarripShire Insurance Company ....................... . . . . . . . INSURER B IN,SUR,ER­C­�1 ..................... ... INSURER D i - __ .......................... .......... INSURERE: INSURER F: REVISION NUMBER: NAIC # . ...... ................. TH6 IIS TO CEPTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO 'THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, 7rRM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECI TO WHICH THIS CERTIFICATE MAYBE ISSUE[) OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE -TERMS, EXCLUSIIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. i'NSk' LTR ­ TYPE OF INSURANCE �AtJUL INSR Won WVD - ---------- . ......... POLICY NUMBER POLICYEFF (MM/DDIYYYY) I POLICY kP (MWDDIYYY)Q ........... LIMITS A GENERAL LIABILITY SEL031182200 10/09/2012 11/01/2012 EACH OCCURRENCE $ 1.000.000 - 1111- ­­ ­­­­ I 1 .1-1 COMMERCIAL GENERAL LIABILITY DAMAGE TO MU4TED FRFMl$E§ (E.4,0 $ 300,000 I x �' OCCUR CLAIMS-MADE ,,XP,(Apypno,per,5pn), $ ....... . ........ 51000 111c),st Liquor,—" PERS NAL&ADV INJURY $ 1,000/000 A . . .. .... GENERAL AGGREGATE $ 2,000,000 ........... . GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000,000 POLICY r Eri,��)i OR: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS 1 1 I 1 BODILY INJURY (Per accident) $ SCHEDULED AUTOS ­­­­ ­11- ­ ........... . . . . . . ..... PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS ........... $ . .............. $ . . . ...... .... ........... UMBRELLA LIAB JOCCUR E�CURRENCE $ EXCESS LIAB CLAIMS MADE' AGGREGATE ............ $ DEDUCTIBLE ..... . . . .................. . . RETENTION $ $ WORK E PIS COMPENSATION 1��A AND EMPLOYERS' LIABILITY Yd Y 07t 1 MITS ANY PROP R IETO R/PARTNE R/EXECUTIVE E.L. EACH ACCIDENT $ 1 )FFICFNMFMBf.'-.R EXCLUDED? . El IMandilory in NH) ID!tSEASE- EA EMPLOYEE $ It s, dbs4�,Anibo undo r ..... . . . . ......... DESCRIPTION OF OPERATIONS belo,w 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-contributory as required by written contract. This coverage is with respect to El Segundo Halloween Frolic event to be held 10/31/2012 - 10/3112012 at Streets of El Seguno El Segundo CA CERTIFICATE HOLDER CANCELLATION City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 350 Main Street BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED El Segundo, CA 90245 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATNE ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved, The ACORD name and logo are registered marks of ACORD Page 1 of 1 Ramos, Vina From: Dayton Borders [daytonborders @hotmail.com] Sent: Thursday, September 13, 2012 3:47 PM To: Ramos, Vina Subject: 2nd page of contract from Dayton Attachments: 090512_Dayton_Borders. pdf Hi Vina Here is the contract including the 2nd page. I have read and understand it. Please add to my already signed contract and scope of events documents I faxed earlier today. All the best, Dayton 310 - 871 -7057 9/13/2012