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PROOF OF INSURANCE (2013) CLOSEDINLAN -1 OP ID: IL CERTIFICATE OF LIABILITY INSURANCE °" ;�� """s 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(Sj AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. COVERAGES CERTIFICATE NUMBER, REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. N01WITHSTANDINGT 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, EXCLUS IONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, fff TYPEOF INSURANCE wart wvn I POLICY NUMBBR MMdiIDdY LMMMDIYYYYYI LIMITS GENERAL LIABILITY ACH OCCURRENCE s 2,000,00 A X MEPCIAL OE�IFRbt , LIA I,,11Y X X LI581000MO 08131/12 08/31/13 Y rya M � t 10O,GIO larsx� OCCUR MEG IAnYate"MM IF 5, ......... _.. ��- ,........ PERSONALS ADV INJJRY 9 2,000,00 GENE AGGREGATE Is 2,000,00 GEN'L AGGREGATELIMIT APPLIES PER PRODUCTS- COMPIOP AGG Ii 17 POLICY PRI' LOC AUTOMgBILELIABILITY C" BINEDSXV L ka 5,0�� A ANY AUTO X X EtA1S7040k10 08131/12 08/31113 • �RY(Perper nl S X AUTOSNEO OOULEO FDODILY vINJURY(Peraca® CI X NEE ®AUTOS X NON•OWNED RUTOS clvitaln $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAS M CLAS -MADE AGGRE GATE _ -.- $ DELI RETENTION .... $ WORKERS WC STATU- 0TH - ITORY1 AND EMPLOY ERSLIBIUTV YIN WITS ER ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERROEMBEREXCLUDECO D NIA E L EACH ACC Pti $ (Mandatory In NH) Vyes, descnbe under E L D! - EA EMPLOYEE! $ — DESCR�TIONOF OPERATIONS wlow EL Di - POLILYUMIT $ DESCRIPTION OF OPERATIONS ! LOCATIONS t "4"E CLEF �A ' I. A RamaAs Setzedulo, If more space is requlrsd) THE CITY OF EL SEIGUNDO, ITS CIVE1 CER OFFIC EMPLOYEES AND VOLUNTEERS ARE ADDED A ADDITIONAL. INSURED I�dUT ONLY TO THE EXTENT THAT THE CERTIFICATE HELD ATE HOLDER LIABLE FOR THE CONDUCT OF THE NAMED INSURED.' WAIVER OF SUBROGATION Sro "' ACORD 25 (2010105) The ACORD a me and Togo are registered marks of ACORD POLICY NUMBER: GLI56100410 COMMERCIAL GENERAL LIABILITY CG 2010 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Ki Or SCHEDULE THE (CITY OF EL SEcrUNI)O. ITS OFFICERS, OFFICLUS, EAlPLOI-'EES AND VOL'ITNTEERS 50 Alain Stmt Room 3 El Segundo, CA 902 {5 this Schedule, if not shown A. Section II — Who Is An Msured is amended to include as an additional Insured the person(s) or organizations) shown in the Schedule, but only with respect to liability for 'bodily injury ", "property damage °' or `personal and advertising injury," caused, in whole or in part, by. 1. Your acts or omissions, or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) desig- nated above. K%Tbn %TiTlr reli in the B. With respect to the insurance afforded to these additional insureds, the fog additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: I. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed: or 2. That portion of "your work " out of which the injury or damage arises has been put to ifs intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 2010 07 04 0 BO Properties, Inc-, 2004 Page 1 of 1 INLAN -1 OP I0: IL CERTIFICATE OF LIABILITY INSURANCE °A'10""' 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 CERTIFICA7E OF INSURANCE DOES NOT CONS77ME 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 Ia ll y(io) must he endorsed. If SUBROGATION-IS WAIVED, &ubjact 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 Neu of such end' ent(si PRODUCER 818-246-2800 1113 Trans nation Isms Brokers $26 West rroad , Suite 400 916-24"690 ,Tlendala, CA91 Jack Sandstrom A., Republic Indem Co of America INSURED Infand Empire Stages Ltd. 9567 Eighth: Street. Rancho Cucamonga, CA 91730 -4504 NAIL s COVER ES CERTIFICATE NUMBER: RE'VISIO'N NUMBER: 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 CONDMION 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, LIMBS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. Im TYPE OF INSURANCE POLICY NUMBER (MMM0fYYYY1 FIMMMIXPIWIY- LIMrr8 GENERAL LIABILITY EACH OCCURRENCE i ; 4M IFR iAl, GEN RAL LIABILITY V . MS g CLA,kuti.,4AACC- El OCCUR MED EXP gAny&njpetson� $ PERSONAL S ADV INJURY ; GENERAL AGGREGATE S GEN°L AGGREGATE LIMIT fwPPLIE PRODUCTS, CO COP AG G $ _..I POLICY E F�1;0- L('11C ; ALMOMOBILE LIABILITY "IAA VI LE L%1I "T d ANY AUTO BOD4LY r4JURY (P®rpe w) ; ALL OWNED SCHEDULED SLY INJURY (Pee accident) S AUTOS AUTOS , HED AUTOS AUTOS 4 LIdBRELLA LIAR OCCUR EAOII O�.cLIRRFtIC,F $ EXCESS LIAR CLANS -MADE AGGREGATE ..�� DED I JR jENTLON S WOOERS COMPENSATION x WC STATIY 0TH - AND EMPLOYERS' LIABILITY A ANY PROPRFETORIPARTNER/EXECUTIVEY!N 10101/12 10101/13 EL EACH ACC ; 1,000, ON OFFICER&EMEEREXCLUDED? ry-1 MIA (Mandatory In NH) E.L DI . EA EMPLOYEE ', It 1,000, I I yes, describe under DA RPTIONOF OPERATIONS bellow EL DISEASE - POLICY L SIT $ 1,0w, DESCRIPTION OF OPERATIONS! LOCATIONS IVEHICLES (Attaefi AC CIIW 101. Add b&W Rwo&&A Schedids, it more space Is requlmd) Officef Exclusion Applies - Curtfs BaW, Nicole Basey 0 1969-2010 ACORD CORPORATION. AN righfis reserved ACORD 25 (2010)05) The ACORD name and logo are registered matf(s of ACORD YT�AYlT7Ty2TfY� l'VAw.r V I viI%�iuxw vrru Lry CH i 1"114 turL L` 1rr1 LlJ i L' MLJ3 LI -ILDJ Lt A I r kJ -L1t, Y Waiver of Our Right to Recover From Others Endorsement - California WC040306 We have the right to recover our payments liouu anyone liable 'for an injury covered by this policy. We will not enforce our right against the person or organization .named in the Schedule. °l'fuis agreement applies only to the extent that you performs work under a written contract that requires you to obtain this agreement from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be otherwise due on such remuneration. Person or Organization CITY OF EL SEGUNDO PARK & RECREATIONAL ATTN: CITY CLERK 350 MAIN ST ROOK! 5 EL SEGUNDO, CA 90245 * of the California workers' compensation premium Schedule Job Description ALL OPERATIONS * In lieu of percentage charge to be applied to segregated payroll, we will apply a flat charge of $ 25 per job for those jobs listed above. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. Republic Indemnity Company of America Company No. 19739 Insured: INLAND EMPIRE STAGES LTD Policy-Number: -156690-11 Endorsement Number: 11 Endorsement Effective: October 01, 2012 Printed on: October 10, 2012 Form No. WC306 10/93 AM 172? 4 -254)