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PROOF OF INSURANCE (2012) CLOSEDCERTIFICATE OF LIABILITY INSURANCE DATE 18 /2 /Y01 06/18/22 2 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 Alc N" wsib2004nn ahoo.com ...... Nis ... Western Sent Insurance Brokers NAME 4212 E Los Angeles Ave #9 A ass 805 - 577 - �52� _ 888 875 -2902 AD Simi Valley CA 93063 INSURER(S RDI j AFFONG COVERAGE NAIC # ''_.�.... INSURED INSUR O C E ERA: One Beacon Insurance c / .B.I. Michael Bell INSURER B: dba: Bell Event Services INSURER C: NsUR 3206 Galli St ......ww ..__.._. ER D: Hawthorne CA 90250 INSURER E: __ -- �... . . ..............................� INSURER F: 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. 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. ViNSR " "...... � F NSR TYPE OF INSURANCE VWVD POLICY NUMBER MM/ DY Y MWDD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 COMMERCIAL ERA ......1..00 CLAIMS -MADE OCCUR J MEEDny one person) $ 000 A x GL00248 -02 10/25/11 10/25/12 PERSONAL RADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMITAPPLIESPER: PRODUCTS - COMP /OPAGG ''$ 2,000,000'' POLICY PR;OJ Em, LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEDULEDAUTOS ( racadent) BODILY INJURY Pe,,..... $ PROPERTY DAMAGE HIRED AUTOS (Per accident) $ NON-OWNED AUTOS i $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIA B CLAIMS -MADE ........,W ATE AGGREGATE I_. .. DEDUCTIBLE $ . RETENTION $ WORKERS COMPENSATION AND W1 STAIU OTH- EMPLOYERS' LIABILITY Y / N TORY I IMITS, E R ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ! N/A Mandato m NH P GI�f LO I P $ If yes, describe under mm.... 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) Additional Insured: City of El Segundo, its officers, officials, employees, agents and volunteers As per CG 20 26 07 04 >>>SUPERSEDES /REPLACES PREVIOUS CERTIFICATE<<< CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of El Segundo EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH 350 Main St Rm 5 THE POLICY PROVISIONS. El Segundo CA 90245 -3813 AUTHORIZED REPRESENTATIVE Certified Signature------------------------ -- - --- -Jerry Glenn ©1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: GL00248-02 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance prodded under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Section 11 — 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 your acts • omissions or the acts or omissions of those acting on your behalf, A. In the perfon-nance of your ongoing operations; or B. In connection with your premises owned by or rented to you, CG 20 26 07 04 (0 ISO Properties, Inc., 2004 Page 9 of 1 0 PROGRFS5IVE RO BOA 94739 CLEVELAND, ON 44101 001822 Named insured MICHAEL J BELL VANESSA E BELL BELL EVENT SERVICES 531 MAIN ST #229 EL SEGUNDO, CA 90245 9r a � ar Policy number: 043152742 Underwritten by: Progressive Express Ins Company A.ugLS; 23, 2011 Poly Period, Aug 2;, 2011 • Aug 2 i, 2012 Page 1 01 2 progressive.com Online Service Make payments, check billing activity, print pollry co[Lr:".ents, orcheck the stat0s 0f a Commercial Auto claim, Insurance Coverage Summary 800 - 895 -2886 =or customer service ar.d service, This is your Renewal 24 hours a day, 7 days av:eek, Declarations Page Yourccverage bear• or.August2l, 2011. at 12:01 a.m, Th1:5 PI;'d expires or August 21, 2012 at 12,•01 a, This coverage sum^ ary rep;aces your prior ore. Your insurance poli:y and any policy endorsements contain a fill exp'aration of your coverage The P, ) "y ?I mits shown for an auto ma, not be combine�J a;?;w17 the limits for the sar°e cov =rage or arcther auto, unless the po cy corn ra:t a lows the s;ackirig or limas. The p0iicy contact is fonn 6912(03; 05), The contract is modified ty forms 5_70'i (02/055), 4852 CA 0 x;'04), 4881CA 112104, Z228 (07105) and 2'435 (12106;. The ramed insured organization type is a sole proprietorship. Outline of coverage 9e Limits Liability To Others c ',' ,nary and arcpe.rty 133TEge ! ia^ility y7501,000 combired single limit v: n dlUrde �n•L .G �Moto� st . ..,..,. .." " ". °. Re�"ette Unrnsun -d Motorist Property Damage ..Retected Subtotal policy premium ................ ... Califcrr a `!chide A« __essment Fee .°. .. . ..... ..... .. ... ° ...,. °.., " " "•• " Tt..i'1i . ....................... .......... Ced crib�r Y Prenium o a month policy premium ancf fees . , ° . , Di,tount if pa . ... id it 'L.; ... ...... Total 12 month policy premium if paid in fulE ..... ° ,. " Important information about fees $5,804.00 7.20 $3,811,20 S5,2Z5.20 An installment fee of $1.40 has been included in each payment, You may avoid paying additional installment fees by paying your remaining balance in full by the due date. You may reduce the amount you pay in installment fees by paying your premium in larger amounts and fewer installments. Please call 804 -895 -2886 for details. The follol.AAng additional fees may apply: fee for returned checks or refused payments $20.00 Rated drivers 1. G;JYGOJ91_L= 2. Iv1iCNP,EL i3ELL ...... .. . .......... _.........,................, ,,... , ... 3. IIANESSA. BILL ............... 4, J_h:'rdl=E.RTRA3ER ... ............. . . ............ . ..... . Farr 6499 C,: (i 2: QE LJ Ca ltinued Ue1 I Event Services 531 Main St. # 229 El Segundo, CA 90245 Entail- ell vent sooai.rr coo Phone - 310),349-0743 FaX-- (310) 349 -2009 ............ m ic! . f Faxt VHOFlft From: 'n. ell ,ue-r& pages: 1 1:2- re5 T� t I,\ a- P] 9