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PROOF OF INSURANCE (2011) CLOSEDOP ID: NR A FRO' CERTIFICATE OF LIABILITY INSURANCE DATE 03125DNYYY) 03125!11 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. IMPORTAN'T': If the certificate holder is an ADDITIONAL INSURED, the poli'cy(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 419- 255 -1020 CONTACT NAME; lant onAve- Toledo 419 - 255 -7557 PHONE Toledo, OH 43604 E, IL Jeannie Y. H lant y ADDRESS .... - - -- -- �.....,. P5't"JcE' X � � Oa7rrrt I ; M&JKI -1 1111 1111 CLAIMS, MADE 0CCUCr ING COVERAGE NAIC INSURE I. G O �........ INSURED INSURERA Philadelphia Inde mnl Insr Co 18058 nde '.r....... Mad Science of Los Angeles g �. .. ,_,phia ... .....__ ............... .. ... INSURER B 8107 Orion Ave —... Van Nuys, CA 91406 INSURER C — ........ AUTOMOBILE LIABILITY IA INSURER D __. INSURER E: INSURER F : COVERAGES CERTIFICATE NU'MBE'R: 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. 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. d'�1;�R r„ AtSDL �� 1111... � TYPE OF INSURANCE POLICY L Y NUMBER _ � 0_L`1,C'Y' EFF 5dcf 'EXP .... - - -.._ ......... ..... MMODIYYYY I (Mmmoreyyyl LIMITS GENERAL ACC OC'CURRIE:IVUL $ 1,000,000 A X COMMERCIAL GENERAL I IABIUTY X PHPK576577 nU1J1j U5 07/01/10 07101!11 I TGrI Il i' II � �� I��en � 1 � 300,000 X � � .... *15,000 CLAIMS, MADE 0CCUCr rl.�n���reo���ol Abuse /M _ X olestatlon PHPK576577 07!01110 07/01/11 PERSONAL AL &ADV INJURY $ 1,000,000 "1111 __.._. - ....�. _... RA AcCREGATE $ 2,000 000 cElvEm umlrL F>01III CIS COMPrOPACC $ 2,000,000 POLICY I "Cr LOC -- - _, 1111.. .. -- - & M $ 500,000 AUTOMOBILE LIABILITY IA C OIMBINI! I) IN L.IF: LfAl I" $ 1,000,000 F�INYLwLnrCV PHPK576577 07!01110 cdrpu�t} 07!01111 - -•e -- -- - DODILY IN IUI° Y (Pe,r pee son) ALL I_ C) VVCd E!I: b AtJ..X..C) Sd 1111.. - --" "' BODILY INJURY (Per accident) $ X PROPER C!i:6LC1(I.)AIwARISI- $ era)AUT C)£; (Peraccielent) X IV'ON- C7V,414IJ D AIJ.l..OS $ ..........�.. ..........--.._. .1111.......... UMBRELLA LIAS OC,CUR'. I,�r�CLIIOCCU,"R. -NCI- EXCESS LIAB NIP)F �rG C2[G..A. I ....... ,....1.11..... ....1 IDI DUCCIEiI..E $ ....... _1111. .......:) ---- --._,,,,...... .................. Rt IrN -ZION $ g WORKERS COMPENSA'T'ION WC; Is I r,,7 °U.. 01 H.. AND EMPLOYERS' LIABILITY � � N i c,yluav I h! 1 ;,,., ER . 1111 ANY PROFRIETORIPARTNERIEXECUIIVF Il YC C IO. IAIII $ OPFICFRIMEMBER EXCLUDED? NIA 1111 1111... (MandatoryinNH) --- C I DISI' -A E EAE.IMI1LOYII:. $ If yes, describe tinder ........ ........,...��.. ....._._._........ �........ 1111... DESCRIPTION OF OPFRATIONS below J f I L DLSEA E -. I1011 ICY L..IIM111'I $ DESCRIPTION OF OPERATIONS! LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The City, its officers, offlclals, employees, included as an Additional Insured AMA agents perform and volunteers are CG2010. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo Parks & Rec ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Ms. Ramos -•.. 350 Man Stna AUTHORIZED REPRESENTATIVE El Segundo, CA 90245 ©1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: PHPK576577 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS -SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE A. Section II —Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) 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) designated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. 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 its 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. DATE (MMIDDIYYYY) ACORD,. CERTIFICATE OF LIABILITY INSURANCE 02/22/2011 PRODUCER 818.889.2155 FAX 805.379.4198 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ISU Insurance Services License #OB50569 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Stanton & Associates ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 3625 Thousand Oaks Blvd #319 Westlake Village, CA 91362 INSURERS AFFORDING COVERAGE NAIC # INSURED M & 3 Kids Science ' INSURERA Employers Compensation Ins Co Dba: Mad Science of Los Angeles INSURER B: 8107 Orion Avenue INSURER C- Van Nuys, CA 91406 INSURER D � Fa :818.909.6771 w INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. )N "'�{T %A?D•. ..._�.._ .�_...._. .,.�.�,,, _._.,.�_. 0 SFFECT9V P'b'LN� YAC�I+I.mm... .— ......•. -..._ .._.,.._...._ ..._....._._�_......_.. ... LTR INSR TYPEOFINSURANCE POLICY NUMBER GATE ,.,,DDiYY,Y DATC MMdDDPY YY LIMITS GENERAL LIABILITY � EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY C PRFM1iSES Ea orcurrenra S CLAIMS MADE 0 OCCUR MED EXP (Any one person) S PERSONAL S ADV INJURY S NERAL AGGREGATE _ $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG S POLICY M LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S ''.. ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per parson) HIRED AUTOS BODILY INJURY $ NOWOWNED AUTOS (Per accident) _..w........- _.__ -� PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY -EA ACCIDENT $ ANY AUTO OTHER THAN w ACC S mm WS AUTO ONLY: AGG EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ S S DEDUCTIBLE RETENTION S 5 WORKERS COMPENSATION EIG1056715 -03 11/01/2010 11%01/2011 X TORY LIMIrs ER AND EMPLOYERS' LIABILITY -• ------- -- ---- YIN ANY PROPRBIETOR1�PARTNER EXECUN`IVE E L EACH ACCIDENT S 1,000,000 A OFFMERIMEMBER EXCLUDEOY �Mundalo(y In NH) E L. DISEASE - EA EMPLOYEE S 1 000 000' N yes, das bounder SF�ECIAL PROVISIONS below E. L. DISEASE - POLICY LIMIT S 1 000 000 OTHER DESCRIPTION OF OPERATIONS! LOCATIONS! VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS GERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City Of El Segundo Parks /& e, DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Ms. Vi na Ramos NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Administrative Analyst LK� IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 350 Main St REPRESENTATIVES El Segundo, CA 90245 AUTHORIZED REPfjgy T AE I /+ / 1, 1988-2009 AC( The ACORD name and logo are registered marks of ACORD