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PROOF OF INSURANCE (2015 - 2016) CLOSEDACCOR 5/14/2015 CERTIFICATE OF LIABILITY INSURANCE DA7E(MMlDDIYY5Y) 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 I DiAnna Martin All -Cal Insurance Agency PHt7Nu Fes. (916)784 -9070 x,(916)784 -0158 505 Vernon Street a;�,.alisha @all- calinsurance.com Roseville CA 95678 INSURERANonvrofits' Insurance Alliance INSURED INSURERB:State Fund Compensation Los Angeles Dream Shapers INSURERC: P.O. Box 3831 INSURER D: INSURER E: Orange CA 92865 INSURER F COVERAGES CERTIFICATE NUMBER:CL1551304518 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. INSR LTR I TYPE OF INSURANCE ADOLSUBR iucn wvn POLICY NUMBER POLL Y EPF Y' P L CY )(' LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE � OCCUR PRFMIRFA rFn nm imenrol $ 500,000 X 2015- 08609MR0 6/13/2015 ''6/13/2016 MEDEX3 (Any one Derson) $ 20,000 NO DEDUCTIBLE PERSONAL &ADVINJURY '$ 1,000,000 GEN'LAGGREGA7E LIMIT APPLIES PER: X POLICY ❑ PRO. ,YECT F1 LOC GENERAL AGGREGATE PRODUCTS . COMPIOP AGG $ 2 , 000, 000 $ 2,000,000 Increased Aggregate $ Ofiy.11 R: AUTOMOBILELIABILITY C 1 $ 1,000,000 BODILY INJURY (Per person) BODILYINJURY(Peraccident) OW E AM $ .. $ 3 A ANY AUTO ALL OWNED E SCHEDULED H RTEDAUTOS ALIT SWJED 2015- 08609NPO 6/13/2015 6/13/2016 X $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory In NH) El If yes, describe under DESCRIPTION OF OPERATIONS below N/A 9015327 -15 6/6/2015 6/6/2016 .crnnl'I'F ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYE -- E.L. DISEASE - POLICY LIMIT $ 1.000.000 $ 1100010,00 $ 1 000 .000 DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks SchedWe, maybe attached If more space Is required) THE CITY OF EL SEQUNDO, ITS OFFICERS, AGENTS, EMPLOYEES AND VOLUNTEERS ARE NAMED ADDITONLA INSURED UNDER THEIR CONTRACT TERMS. PROGRAM DATE JUNE 17, 2015. FORM CG 20 10 APPLIES CERTIFICA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF EL SEQUNDO THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 MAIN ST. ACCORDANCE WITH THE POLICY PROVISIONS. EL SEQUNDO, CA 90245 AUTHORIZED REPRESENTATIVE 01988.014 ACORACI. RA TiON. rights reserve/ ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS026 (201401) POLICY NUMBER: 2015- 08609NPO COMMERCIAL GENERAL LIABILITY CG 2010 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 CG 2010 07 04 ISO Properties, Inc 2001 Page 1 of 1 Named Of Additional Insured Person(s) Or Organization(s): Location(s) Of Covered Operations THE CITY OF EL SEQUNDO, ITS OFFICERS, AGENTS, EMPLOYEES AND VOLUNTEERS ARE NAMED ADDITONLA INSURED UNDER THEIR CONTRACT TERMS. PROGRAM DATE JUNE 17, 2015. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or Additional insureds, the following additional exclu- organization(s) shown in the Schedule, but only sions apply: with respect to liability for "bodily injury ", "property This insurance dose not apply to "bodily injury" or damage" or "personal and advertising injury" "property damage" occurring after: caused, in whole or in part by: 1. All work, including materials, part or equip - 1. Your acts or omission; or ment furnished in connection with such work 2. The acts or omissions or those acting on your on the project (other then service, maintenance behalf: or repairs) to be performed by or on behalf of in the performance of your ongoing operations for the additional insured(s) at the location of the the additional insured(s) at the location(s) desig- covered operations hs been completed; or nated above. 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended used by any person or organization other than another contractor or subcontractor engaged in performing operations for a princi- pal as part of the same project. CG 2010 07 04 ISO Properties, Inc 2001 Page 1 of 1 IM Allsta ortlibrook 1819 Electric Road SK Roanoke, r Paull!"o C a juanai A Moreno 9118 w ,� a' Pico RiVera CA 90660-2440 Allstate, You're in good hands. NAIL# 36455 This policy meets the requirements of the applicable California financial responsibility law(s). POLICY NUMBER YEAR / BAKE / MODEL 699 361075 2007 Sdon T EFFECTIVE DATE VEHICLE ID DUMBER 01/29/15 JT , . '177970178505 EXPIRATION DATE 07/79/15 This card must be carved in the vehicle at oil times as evidence of insurance DREAM SHAPE, The Los Angeles Dream Shapers w vw. reams apwers.org (888) 499 -1270 P.O. Box 3831, Orange, CA 92865 ♦ SCHOOLS + LIBRARIES ♦ PRESCHOOLS ♦ FESTIVALS ♦ COMMUNITY EVENTS + To whom it may concern: This letter is to certify that Dream Shapers does not hire presenters as employees. All presenters function as independent contractors. Arty Loon is one of our independent contractors; therefore, Dream Shapers does not carry worker's compensation on his behalf. We do carry a 2 million dollar general liability policy, which can be furnished upon request. If you have further questions, please let me know at info @dreamshapers.org or 888 - 499 -1270. Thank you, Valerie Gabriel General Manager 'm } �. f� V� \ � . \4 *�� �a ^� z . 'm } �.