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PROOF OF INSURANCE (2016) CLOSEDDATE (MMIDDIYYYY) A RV CERTIFICATE OF LIABILITY INSURANCE 4/6/2015 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 koUN d N4G I' NAtIIV�' Britton Gallagher PHONE x.100. I,.N4*.2).mOal- X101.. One Cleveland Center, Floor 30 _AFAX E -MAIL 1375 East 9th Street ADDR 1s. Cleveland OH 44114 INSURERS) AFFORDING COVERAGE NAIC P ..... ..... .... .... _ INSURER A:Eve rest National .Insurance ..Company „ °101.20 .. INSURED INSURER S :NlaXum_Indemnity.Company 30743 yro Spectacular's inc, INSURER C: San Diego Fireworks P. O. 130X 2329 INSURER O . Rialto CA 92377 NNSURER E INSURER F z COVERAGES CERTIFICATE NUMBER: 946988032 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. INS.R'...... ..... ,. ..... ADDL .50nW R TYPE OF INSURANCE, IN, R WVD POLICY NUMBER POLICYEFF I POLICYEXP .... .... ..... ... Lpr�#1i091+`.'YYN+�MI1I IYYYY.. LIMITS GENERAL LIABILITY ',. EACH OCCURRENCE S.. `I7AI4gA4 F °p"c) r�I.NT�o -- COMMERCIAL GENERAL LIABILITY '.,.. I" RL'AIgSa aMcudrrgoruul , '' ..._ ..... CLAIMS -MADE :OCCUR -.M DEXPlA,nyannporson) ,S ITR SI7Iul& S AM,)v NUI,)I4Y $ i,4.7ENr -,RAI AG43I`fEGATE GENL AGGR EI GATE LIMIT APPLIES PER: � f1RO0UC rs CIOM}iOla AGG S POL�CY A AUTOMOBILE LIABILITY 518CA00031 -151 6W13012TYR5 111312016 tiT0 W4�a I . A ,,,,,,,, ,,,, ti . ;1 # 0P,TY" :X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED : AUTOS AUTOS : ;BODILY INJURY (Per accident) $ p NON -OWNED ,X HIRED AUTOS X 'AUTOS I PROPERTY DAMAGE (Per accident) $_ a UMBRELLA LIAB X OCCUR EXC6017996 1/13/2015 1/1312016 EACH OCCURRENCE $4,000,000 -- EXCESS LIAB CLAI4I �f Gdal7� ..... .... i AGGREGATE $4,000,000 G I, CS RE r'EN ION S WORKERS COMPENSATION WCSTA7U lidIIGI AND EMPLOYERS' LIABILITY YIN - .'TORY LIMIT5 . _ LH ANY PROPRIETORIPARTNERIEXECUTIVE EL EACH ACCIDENT OFFICER /MEMBER EXCLUDED? NIA (Mandatory in NH) P- - -- 1 Iftess describe under EL DISEASE EA CIM p OYIi $ � 01 SC"RIPTIDN OF OPERATIONS below E I DISEASE • POLICY 4 WTI J $. I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Addlllanal Remarks Schedule, If more space Is required) 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 ACCORDANCE WITH THE POLICY PROVISIONS. City Clerk 350 Main Street AUTHORIZED REPRESENTATIVE El Segundo CA 90245 © 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD DRAYTON INSURANCE BROKERS, INC. 2500 CENTER POINT ROAD, 301 POST OFFICE BOX 94067 BIRMINGHAM, ALABAMA 35215 BIRMINGHAM, ALABAMA 35220 PHONE: (205) 854 -5806 EMAIL: dib @draytonins.com FAX: (205) 854 -5899 CERTIFICATE OF INSURANCE NO, 513021 We certify that insurance is afforded as stated below. This Certificate does not affirmatively or negatively amend, extend or alter the coverage afforded by the insurance policy and the insurance afforded is subject to all the terms, exclusions and conditions of the policy. NAME & ADDRESS OF INSURED SPONSORS, PROPERTY OWNERS, LICENSORS City of El Segundo 350 Main St. El Segundo, CA 90245 ADDITIONAL INSURED(S) City of El Segundo, Chevron El Segundo Refinery, El Segundo Fire Department and their officers, agents and employees when acting in their official capacity as such. DISPLAY LOCATION El Segundo Recreation Park El Segundo, CA DISPLAY DATE(S) July 4, 2015 It is certified that this policy requires a 30 day mutual notice of cancellation between the Insurer and the Named Insured. In the event of such cancellation we will endeavor to mail 10 days written notice to the Additional Insured(s), whose name and address is shown hereon, but failure to mail such notice shall impose no obligation or liability of any kind upon the insurer and/or the undersigned. DRAYTON INSURANCE BROKERS, INC. DATE OF ISSUE III"r�„ l'lg5t'I*t Policy Number: CA000002771 -29 CG 20 10 07 04 Endorsement No. 107 Effective Date: April 3, 2015 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 . . ............... Name Of Additional Insured Person(s) Or Organization(s): Locations) Of Covered Operations City of El Segundo, its officers, officials, employees, All locations for which coverage is required by agents, and volunteers. written contract. hitbrniaaiion recurred to complete this Schedule, if not shown above, will be shown in the Declarations, 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. CG 20 10 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 ❑ Policy Number: CA000002771 -29 CG 20 37 07 04 Endorsement No. 106 Effective Date: April 3, 2015 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES O CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENE' AL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Orizanization(s) Location And Description Of Completed Operations City of El Segundo, its officers, officials, employees, agents, All locations for which coverage is required by and volunteers. written contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products - completed operations hazard ". CG 20 37 07 04 0 ISO Properties, Inc,, 2004 Page 1 of 1 13 POLICYHOLDER COPY so P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 04 -06 -2015 CITY OF EL SEGUNDO 350 MAIN ST EL SEGUNDO CA 90245 -3813 GROUP: POLICY NUMBER: 0803749 -2014 CERTIFICATE ID: 1195 CERTIFICATE EXPIRES: 10 -14 -2015 10 -14- 2014/10 -14 -2015 SD JOB:CITY OF EL SEGUNDO 350 MAIN STREET EL SEGUNDO CA 90245 -3813 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form apprdved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer, We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT X2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10 -14 -2002 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT X2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2015 -04 -06 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF EL SEGUNDO EMPLOYER PYRO SPECTACULARS, INC. PO BOX 2329 RIALTO CA 92377 SD [P1 D,SDI (REV.7 -2014) PRINTED : 04 -06 -2015 HOME OFFICE SAN FRANCISCO EFFECTIVE APRIL 6, 2015 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING OCTOBER 14, 2015 AT 12.01 A.M. AT 12 :01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME PYRO SPECTACULARS, INC. PO BOX 2329 RIALTO, CA 92377 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, CITY OF EL SEGUNDO WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, PYRO SPECTACULARS, INC. IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER. IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH EMPLOYEES SHALL BE INCREASED BY 03 %. n NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: APRIL 8, 2015 2570 AUTMBOMZED REPRESENT IV E PRESIDENT AND CEO SCIF FORM 10217 (REV.7.2014) OLD DP 217 Ramos, Vina From: Garcia, Angelina Sent: Wednesday, April 29, 2015 10:23 AM To: Ramos, Vina; Nguyen, Trang Cc: Petit, Meredith; Bobbett, Jesse Subject: RE: Pyro Spectaculars Agreement fpfluroved Thanks, Angelina Gorci a From: Ramos, Vina Sent: Wednesday, April 29, 2015 9:18 AM To: Garcia, Angelina; Nguyen, Trang Cc: Petit, Meredith; Bobbett, Jesse Subject: FW: Pyro Spectaculars Agreement i -li Aan&, Attached arc� U�na�u n:or nlrale�te doc uir nen�ts for IPyiro Sll:uec�ua cuu�aars for ah O�HUU y foie review and aapprovall. thanks Vf naa From: Ramos, Vina Sent: Thursday, April 23, 2015 5:04 PM To: Garcia, Angelina Cc: Petit, Meredith; Bobbett, Jesse; Nguyen, Trang Subject: RE: Pyro Spectaculars Agreement Please see atlaadl)E:d ills surance d¢,au.mieaats foir ya"Qa.ur ueva e aaind ag:apu°ovA for the ,'p.`' aaf.Ua.aly a:.cbni:u °act with Pyro Spec'taack lrtars. hey larn:Dat" ded the sssartl"ne docu imelYnts as last year. °'i"Il'ney puulrchaased Waiver ofSnulbro but i aim stlllll waiting oin the aactuuaal u:erfl is "ate, MeanQse lent Irn,ae IIkIrnow it you need anything else, 1 Ihasrnk you, Vina From: Melonee Mares [r 7..dniit aMg are r , i mm a „Jx] Sent: Tuesday, April 07, 2015 8:14 AM To: Ramos, Vina Subject: Re: Pyro Spectaculars Agreement The actual endorsement gets mailed to us.. it will take a few days 1