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PROOF OF INSURANCE (2016 - 2016) CLOSEDCERTIFICATE OF LIABILITY INSURANCE PRODUCER East Main Street Insurance Services, Inc. Will Maddux PO Box 1298 Grass Valley, CA 95945 Phone: (530) 477 -6521 Email: info @theeventhelper.com ... INSURED...........- ._..�.., ..,­..___ .. .... .............................. Chris Shoemaker 146 W. Cypress Ave., Ste. 102 Burbank CA 91502 COVERAGES DATE (MMIDDIYYYY) 09/28/2015 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURERA: Essex Insurance Company 39020 INSURERB: INSURER C INSURER D: INSURER E: 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. .TYPE OF INSURANCE.. . �-.............",,, �......, �.______________ __......_�..,,___......_._.__._ INSR INSR POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION L_TR NNSR DATE IMM /DD/YYI DATE fMM /DD/YYI ._...._.......____ LIMITS GENERAL LIABILITY EACH OCCURRENCE INCLUDES BODILY INJURY & PROPERTY DAMAGE $ 1,000,000 A Y x COMMERCIAL GENERAL LIABILITY t a" /' ,i )_ t''aH�l"�U�G ° e�.;,_ 5 I (. 1 ;' 12/0 "I /"20 "I 5 i 1 �' � � (' I.', �� "i "fJ 'I:j .... MED EXP (Any one arson person) $ .... .5 ... ,000 CLAIMS MADE X OCCUR - PERSONAL & ADV.I.NJURY $ 1µ000µ000 X111 Host Liquor Liability 3I y S54,,ry,0 .1' 8, 043 2101 /20 1 5 0,� /01 / "o 1 t3 m GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 1,000,000 .. X POLICY JECT LOC 1:1 PRO- E.] ,..I ,....... ,......... DEDUCTIBLE ........ ........ ......... $ 1,000 Retail Liquor Liability m._ .mmmmmm _m_..mmmm „$..._m.,..�.�,,,,,m�,,,,,,,, AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ BODILY INJURY $ HIRED AUTOS NON -OWNED AUTOS (Per accident) - PROPERTY DAMAGE $ -- ....... ............................... (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ ...... .................... . ........— .._ ......... _ ..... � DEDUCTIBLE $ -- $ 6 %E'TECwI11CYN $ WC TATU- OTH• WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS' LIABILITY .... ...................,,,,,....... E L EACH ACCIDENT $ ANY PROPRIETOR/PARTNEWEXECUTIVE -» - ------ - - - - -- OFFICER /MEMBER EXCLUDED? E „L. DISEASE -EA EMPLOYE $ If yes, describe under ”" "` SPFCIAL PROVISIONS below E,L. DISEASE -POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Certificate holder listed below is named as additional insured per attached CG 20 26 07 04„ Attendance: 500, Event Type: Holiday Event - No Charge for Admission / Invite Only. 4+CK 1 IM1Gf4 1 C Ni"1kJLUr_K, THE CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS, EMPLOYEES, AGENTS & CERTIFIED VOLUNTEERS 111 West Mariposa Avenue El Segundo, CA 90245 I1,A.n15..CL.LA I IVN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FA1616IRS *0 80 60 GNA" *4 16 IIIGWAEA� FFG X14 AUTHORIZED REPRESENTATIVE Policy Number: 3DS5440- M855043 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. � ;4 044pi Mel 0. 0 Zte-ull VNMTAIEC�� i:M. 14wim � I This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Orqanization THE CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS, EMPLOYEES, AGENTS & CERTIFIED VOLUNTEERS 111 West Mariposa Avenue El Segundo, CA 90245 I Information required to complete this Schedule, if not shown above, will be shown in the Declarations. I Section II — Who Is An Insured is amended to in- clude as an additional insured the person(s) or organi- zation(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 or omissions or the acts or omis- sions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 ❑ Sep 30 15 02:31 p Freshimedia.com 18188471184 p.2 2015 Waiver of W q _ — __ A('� rk an'� GqPp)A9mJOR SANTA's Early 11olidiky 14vil is the name of a program Created and offeied by Acts of' Creation. It is performed at libraries, clubs, schools and for independent companies. Chris. Shoemaker, the owner of Acts of Creation, also performs the role of Santa in this delightful show. He is paid as independent contractor (1 099 status) for his performance work and, as such, is not %uject to workman's compensation. Payment is rngk_pLayable LQ,AKt,- SANTA Is Early Holiday Visit A Holiday Tradition SANTA's Early HofidaY "Sit is a 1-5 -'- 2 hour performance featuring, a visit from Santa CIaLlshimself Itisgut Interactive celebration of the holiday season f.eaturingoriginal storytelling, sing-a-long, Christmassongs and group danceswith the audience, At the climax of the event Santa invites the audience to sit in his lap and share their gift dreams he speaks to each child individually about their goals and successes, at the library, in school and beyond. This performance is a holiday celebration intended for pre-school and elementary-aged children, but is meant to also engage parents and adults alike. It has no religious references or orientation. Submitted and Signed by: Date: September 28, 2015 M: ,md a it � F p u a i pli StateFarm CALIFORNIA 04" INSURANCE CARD imam= moffmomffm= afflusWrimmom