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PROOF OF INSURANCE (2016) CLOSED4, DATE (MWDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE CE 06/10/2016 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 cerlificate hoidsr is an ADDITIONAL INSURED, the policy(les) must he endorsed. If SUBROGATION IS WAIVED, suhjeot 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 endDTs,ement(I ). PRODUCER HCC Specialty P _. 10 No 401 Edgewater Place, Suite 400 ULICE Wakefield, MA 01880 s) I^ IN02RE S) AFFORDINO COVERAGE' NAIL INSURED INBURERA: New Ham shirr lnsllranCe tom an 23841 Jason Lohrke (As Early Neil Diamond) INBURERB: United States Fire Insurance Com an 21113 24861 Via Santa Cruz INBURERC: Mission Viejo, CA 92692 INBURERD. City of El Segundo, Its officers, officials, employees, agents, and Volunteers 350 Main St El Segundo, CA 90245 _ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATR/ ACORD 25 (2010105) 01988 -2010 ACORD CORPORATION. All rights reserved. INSURER F : COVERAGES CERTIFICATE NUMBER: 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 CONDrrION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, �HE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN i IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, TYPE OF INSURANCE INSR Wyo POLICYNUMBER h1Ml IY lam) LIMITS A GENERALLIABILIY X SEL064082662 06/20/2016 07/27/2018 EACH OCCURRENCE To RENI E 11 1,000,0001 COMMERCIAL GENERAL LIABILITY ISES IEA goU i 300,000 CLAIMS-MADE FX—J OCCUR 5,000 Host Liquor PERSONAL & ADV INJURY $ 11000,000 B Medical Expense I U8575761 06/2012016 07/27/2016 GENERAL AGGREGATE s 2,000,000 GEUL AGGREGATE LIMIT APPLIES PER: PRODUCTS . COMP/OP AGO t 1,000,000 X POLICY P' E LOC AUTOMOBILE LIABILrrY COMBINED SINGLE LIMIT s (Ea aoddent) ANY ALTO BODILY INJURY (Par parson) S ALL OWNED AUTOS BODILY INJURY (Per seddent) $ SCHEDULED AUTOS PROPERTY DAMAGE i HIRED AUTOS (Peraeddenq NON-OWNED AUTOS : f UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DEDUCTIBLE $ RETE TION i WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROP E.L. EACH ACCIDENT $ BETOR(PAXRRTNERl0E7XECUTIVE Li (Mandatory In NH) E.L. DISEASE . EA EMPLOYE E II VndorPERAT M d4PaedbeN Ll E L DIS E - POLICY U AT I DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (AHamh ACORD 101, Additforal Rametics9ahadula, N more epaw Is raqulnd) The CwMWe Holder Is added as Addt wW bwured wkh mspeds la aw Insweds opangions only. This Insumm Is pr[msry and norrconb cry as required by w WAn wnW& This eoverago Is with respell lo Cky of El Segundo- Concert In dw Pwk went to be held 712112016.712412016 el Library Park EI Segundo CA City of El Segundo, Its officers, officials, employees, agents, and Volunteers 350 Main St El Segundo, CA 90245 _ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATR/ ACORD 25 (2010105) 01988 -2010 ACORD CORPORATION. All rights reserved. POLICY NUMBER: 64082662 COMMERCIAL GENERAL LIABILITY CG 20 26 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. A IM 1 0 1 I W� U :I Z 901 ON0,40IN This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE ����� � �p✓ 6a .- .� -iiia -ice e� Qdu'Se�- . 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 your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However. 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the Insurance afforded to such additional insured will not be broader then that which you are required by the contract or agreement to provide for such additional Insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 26 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: 64082662 COMMERCIAL GENERAL LIABILITY CG 20 110413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. IIII X w This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designation Of Premises (Part Leased To You): City of El Segundo, its officers, officials, employees, agents, and volunteers, 350 Main St, El Segundo, CA, 90245 Name Of Persons) Or Organization(s) (Additional Insured): City of El Segundo, its officers, officials, employees, agents, and volunteers, 350 Main St, El Segundo, CA, 90245 Additional Premium: Included Information reauired to comDlete this Schedule. if not shown above. will be shown in the Declarations. A. Section II — Who Is An Insured Is amended to 2. If coverage provided to the additional insured include as an additional insured the person(s) or is required by a contract or agreement, the organization(s) shown in the Schedule, but only insurance afforded to such additional insured with respect to liability arising out of the will not be broader than that which you are ownership, maintenance or use of that part of the required by the contract or agreement to premises leased to you and shown in the provide for such additional insured. Schedule and subject to the following additional B. With respect to the insurance afforded to these exclusions: additional insureds, the following Is added to This insurance does not apply to: Section III — Limits Of Insurance: 1. Any "occurrence" which takes place after you If coverage provided to the additional Insured is cease to be a tenant in that premises. required by a contract or agreement, the most we 2. Structural alterations, new construction or will pay on behalf of the additional insured Is the demolition operations performed by or on amount of insurance: behalf of the person(s) or organization(s) 1. Required by the contract or agreement; or shown in the Schedule. 2. Available under the applicable Limits of However. Insurance shown In the Declarations; 1. The insurance afforded to such additional whichever is less. insured only applies to the extent permitted This endorsement shall not increase the by law; and applicable Limits of Insurance shown in the Declarations. CG 20 110413 0 Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: 64082662 COMMERCIAL GENERAL LIABILITY CG 2012 07 98 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. '". This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Political Subdivision: As submitted to company and required by written contract. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section II — Who Is An Insured Is amended to include as an insured any state or political subdivi- sion shown in the Schedule, subject to the following provisions: 1. This insurance applies only with respect to opera- tions performed by you or on your behalf for which the state or political subdivision has issued a permit. 2. This insurance does not apply to: a. "Bodily Injury," "property damage" or "personal and advertising injury' arising out of opera- tions performed for the state or municipality; or b. "Bodily injury' or "property damage" included within the "products- completed operations hazard ". CG 2012 07 98 Copyright, Insurance Services Office, Inc., 1997 Page 1 of 1 O L 4 �j Z6 1 " Ais dec� -F'J---� -.'-�nzal perjulr� under 'h:- CA ';ali crni3 one c—, larajom. 1c,* hryufkcm' L;iwipaca;aJun, sialwad by Vib =&-Wlnm;.�:: pr-rw PA'cr by I at:--rC(x-m 7CM-thn park rmance of • 6 41 rain am w--rkers'co.m,-ensztion -r-surznce as required by Labo, Coce § 3730 for Me peftmance JIj 'jt� ;lk -, - . :7i,., C exec:.;'ed. %A -v ccrrpansalicm nsurance ' campf ao-ld RcAlcy numter are: % m r li W', •OLZly ;J.'T;:'er r-xj;l' a Lon Ake TTT f r ajACc 36 .1 i- Y-e or lrse wo-k set forth i� 1�,a agreament with the City of n Segundo, I will not ll 4�' ' V .jai " A ',c ,-4- *.).,:r--1 1,-.) lh�� w ;rkl.,l;' cmpe-valion aws of Califcrnia, and aq r iu, t; hi) I sho.lb bwx)rne subjecl tc the wo•Kerrj' --ompensetian provisions of ' abor Code § 3700 must - nn 1, or y cy— w1l i-,!rrrat J rslly bc---me vci, ra Date Trion k-c— A5 Ewlvr lJa:tl D�m+,diS 4-1Z ,,% & Y".e'o r"+ V-j"Mao /,.X• 444 ti Jul �frMV p �eo �o "7, Ar /x- 4(4 4 e! u�dL M