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PROOF OF INSURANCE (2016) CLOSEDDATE (MWDDNYYY) ACCOR0 CERTIFICATE OF LIABILITY INSURANCE 6/10/2015 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 CONTACT DiAnna Martin All -Cal Insurance Agency Na,Ext) (916)784 -9070 FAX N�){ (916)784 -0150 g Y PH Pk ONE 505 Vernon Street E -MAIL dianna @all - calinsurance.com ADDRE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF EL SEGUNDO THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. EL SEQUNDO, CA 90245 AUTHORIZED REPRESENTATIVE ©1988 -2014 AOORO Cq_ROORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401) ss . _ INSUR Et S AEFQAD1N CPYERAGE NAIC # Roseville CA 95678 INSURER A VonprOfi tS ' Insurance Alliance of 011845 INSURED INSUREReState Cy'omDensation Insurance Fund 35076 Los Angeles Dream Shapers INSURERC P.O. Box 3831 INSURERD 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. �R - _ TYPE OF INSURANCE iC s L� awpv �OL�CY NUMSER so E I IMCLic ig' r Poud' -EXIT ._ .. _ LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 _ I X j OCCUR A CLAIMS -MADE d. DAW ,GECF'kE`rED $ PRY MIK$ (E� oce "rrravrre) , _ti,_ 500,000 X! LIQUOR LIABILITY X 2015- 08609NPO 6/13/2015 6/13/2016 MED EXP (Any ono ps sarb) $ 20,000 $ 1,000,000 / 1,000 000 PERSONAL & ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE w 2,000,000 X POLIC ' PRO - Y LOC PRODUCTS COMP /OPAGG $ 2,000,000 a OTHER., j $ AUTOMOBILE LIABILITY SINGLE _ LIMIT $ COMBINED s nt) 1,000,000 ANY AUTO BODILY INJURY Per person) A ALL OWNED SCHEDULED 2015- 08609NP0 AUTOS AUTOS 6/13/2015 6 /13 /2016DILYINJURY (Per accident) $ i X NON -OWNED OOPERTY DAMAGE I $ HIRED AUTOS AUTOS Pe I 1 1$ UMBRELLA LIAB OCCUR N EACid OOCL?uRENF $ EXCESS LIAR CLAIMS -MADE C AGGREGATE I$ ' ! DE❑ I � RETENTION g ' $ WORKERS COMPENSATION STA X � E IITF � 1 0TH- � T FR AND EMPLOYERS' LIABILITY � ANY PROPRIETOR/PARTNERIEXECUTIVE YIN E L EACH H ACCIDENT.,$ C3b0,_00 � OFFICER /MEMBER EXCLUDED? p NIA A . ,, . , B (Mandatory In NH 9015327 -15 ) 6/6/2015 6/6/2016 r E L DISEASE EA EMPLOYEE $ 1 000 4 000 If yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT {{ $ 1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS! VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) THE CITY OF EL SEGUNDO, ITS OFFICERS, AGENTS, EMPLOYEES AND VOLUNTEERS ARE NAMED ADDITIONAL INSURED UNDER THEIR CONTRACT TERMS. PROGRAM DATE AUGUST 5, 2015. FORM CG 20 11 APPLIES CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF EL SEGUNDO THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. EL SEQUNDO, CA 90245 AUTHORIZED REPRESENTATIVE ©1988 -2014 AOORO Cq_ROORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401) The Caljy�rnia Doadment of Motor Tleldkf � e:egisyprijq, -Your nbir& On the 110/10M of this P hr,00wnceform. I'leasepmride t)Vj �'arnvj to the DJW/ �ftl FARMERS filwn 1, "A F, A- P, M E R Sil. Wood insured Polly number: 29 183294224 LUMDA ALLSHOUSP. Wedive dale: 12-24-2014 b*a1km dole: 06-24-2015 NAIC number: 21667 MID CENTURY INSURANCE COMPANY, LOS ANGELES, CALIFORNIA .ii-iautb(.ivize.dC-.ilifotilia Insurer, in CoLnl)611ce With the California Financial Responsibility Act., cea.ifies that it has issued a policy in an amount not less than that required by the Qdifoniia Financial Itesponsibility Law for the described rnotor vel-.dcle(s), YANgla i6aipfim: - R*W&d owrw: 2012 HONDA civic 2t) coupi-, n 211GFG3084CII541595 LUCINDA ALLSHOUSE -Agent name: JOHNNIE WAGTER Phoneno: (310) 370-3631 25,640B 4-13 Keep Ais cartiftaffe In your vehide at tdl times. E0A!ER10 A640851 Ile Los Angeles DREAM The Los Angeles Dream. Shakers www.dreamsh,apers.org (888) 499 -1270 P.O. Box 3 83 1, Orange, CA 92865 ♦ SCHOOLS $ L113RARIES * PRESCHOOLS + FESTIVALS + COMMUNITY EVENTS To whom it may concern; This letter is to certify that Dream Shapers does not hire presenters as employees. Dan Allshouse (AKA Dan Crow) functions as an independent contractor; 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