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PROOF OF INSURANCE (2016) CLOSED,q ZEBRA -1 OP ID: «J CERTIFICATE OF LIABILITY INSURANCE r OATE(MM)DDIYYYY) 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(Sh AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: if ttte certificate holder Is an ADDITIONAL INSURED„ the Poilcy(les) must be endorsed, If SUBROI3ATIOIp 13 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 lWu of such Gndorsamentlsl. PRODUCER Dick Wardlow Insurance Brokers LIC. 40899800 233 High Street Moorpark, CA. 93021 Dick Wardlow Ins Brokers INSURED Zebra Entertainment and Events Shelly Mazer 11024 Balboa Blvd #116 Granada Hills, CA 91344 rI Dick Wardlow Ins Brokers PN NIW — — - - - AI N *, E'ua).605.553.05ti5 AD 11EEB mattwQwardiowlnsurance.com - -- - INSURER(S APFORDINO COVERAGE INSURER A; Essex Insurance Company INS- U'RE.R a INS URE C INSURERD: _ - INSURER 9: FAX No); 805 - 553.0606 NAIC N THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO, THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM DR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RE'SP'ECT TO VLHIC1t 'TINS CERTIFICATE MAY BE ISSUED OR MAY PERTAK THE INSURANCE .AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUSIiECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOM MAY HAVE SEEN REDUCED BY PAID CLAIM'S, ADOL1teR RS _ TYPE OF INSURANCE POLICY OFF Pollcw Irsie GENERAL LIABILITY A X I- COMMERCIAL GENERAL LIABILITY CLAINWIMDE X OCCUR GEN L AGGREGATE LIMIT APPLIES PER X POLICY • P LOC AUTOMOBILE LIABILITY ANYAUTO ALL OWNED SCHEDULED ,AUTOS AUTOS HIRED AUTOS NON-OWNED AUTOS UMBRELLA LIAR EXCESS LIAR AND EMPLOYERS, OCCUR CLAIN1941ADE LIMITS EACH OCCURRENCE $ 1,000, X 30SE402•M729753 02106/2016 02/0012016 RA,MA15 TOREN Erance) s 100, MED EXP (Any one person) _ S E, PERSONAL d AOV INJURY $ 1,000, GENERAL AGGREGATE S 21000, PRODUCTS. COMP /OP AGO S 1,060, DIN (I*a A*LNd *nly I LIMIT_i f BODILY INJURY (Per ponon) S BODILY INJURY (Per *cadent) S PROPERTY DAMAGE S (P ON ACCIORNTI EACH OCCURRENCE S AGGREGATE S IN n NIA DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES -Ammer ACORD 1131, AddllmnAl Rona$ Srh;Idulo,1'1 more apaco is regaalraat} The City of El SggUncle, it# officers, officials, ern loyeos, agents and t volunteers are na ;aid ae an Add 1 nsured, but only neofar as the 1 operations under this Written COntraot are concerned, This Policy is Primary tm Non - Contributory, hLll Event Dates w City of El Segundo 350 Main Street El Segundo, CA 90245 ACORD 25 (2010105) CO-ES00 E L. EACH ACCIDENT S R L DISEASE - EA EMPLOYEE S SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZEDD , R''E'PR``BSENTATIVa 9W�Gtr, ®1968.2010 ACORI The ACORD name and logo are registered marks of ACORD CORPORATION, All rights reserved, Policy Number: 3DS5402- M729753 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 provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Section II — Who Is An Insured Is amended to In- clude as an addillonat Insured the person(s) or organi- zation(s) shown In the 'Sohedule, but only with respect to Ifability 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 25 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 O COMMERCIAL GENERAL LIABILITY POLICY NUMBER: 3DS5402- M729753 Essex Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED ENDORSEMENT - PRIMARY AND NON- CONTRIBUTORY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE FORM SCHEDULE ADDITIONAL INSURED City of El Segundo It's Officers, Officials, Employees, Agents and Volunteers 350 Main Street El Segundo, CA 90245 Please refer to each coverage form to determine which terms are defined. Words shown in quotations on this endorsement may or may not be defined in all coverage forms. SECTION II — WHO IS AN INSURED is amended to Include as an Additional Insured the person(s) or entity(s) shown In the Schedule above, but only as respects negligent acts or omissions of the Named Insured and only for "occurrences ", "claims" or coverage not otherwise excluded by this insurance. Where no coverage applies to the Named Insured, no coverage or defense applies to the Additional Insured shown In the Schedule above. No coverage applies to the Additional Insured scheduled above for any "bodily Injury", 'personal and advertising Injury", or "property damage" to any "employee" of the Named Insured or to any obligation of the Additional Insured to indemnify another because of damages arising out of such injury. Subject to the above, when coverage applies to the Additional Insured(s) listed above, it shall be primary Insurance as respects any "claim ", loss, or liability arising out of the Named Insured's operations as covered by this Insurance. If coverage applies under this policy, any other insurance maintained by the Additional Insured(s) as a Named Insured shall be excess and non - contributory to the coverage provided by this Insurance. All other terms and conditions remain unchanged. MEGL 0010 0311 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Jan 19 16 12:21 p Zebra Entertainment & Ev City of El Segundo - Recreation and Parks Manse Palacios 401 Sheldon Street El Segundo, CA 90245 Regarding: All Event Dates - 2016 Dear Ms. Palacios, 8183047558 p.4 This confirms that Zebra Entertainment and Events does not own or rent any vehicles, and therefore does not carry any Automobile Liability Insurance. We cannot cover vehicles privately owned by Independent Contractors. Our Insurance carrier does not offer coverage for hired and non owned vehicles for our class of business. The operators we contract with are all Independent Contractors, and not employees, so therefore we are not required to carry any Worker's Compensation policy for them, according to the Califomia Labor Code. Thank You, Shelly Mazer, owner Zebra Entertainment and Events 11024 BalboaBW Sella 118 Gmnada Hills, California 91344 818- 368 -2818 wtinv.ZabraEnlerialrro girt d8+raara.com