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PROOF OF INSURANCE (2017 - 2017) CLOSEDClient#: 32476 TRAINS DATE (MMfDDIYYYY) ACORM CERTIFICATE OF LIABILITY INSURANCE 10/31/2016 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. bill T, lb"WA"L INSURED, the pollcy(les) must be endorsed. If SUBROGATION 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 lieu of such ondorsoment(s). PRODUCER N Lauren Castellanos Arroyo Insurance Services F. E . ............ .. . No F C No "18� �,�au2 6 799-9632 626 294-9072 Albert C. Simonds & Company EWNC ronc@ar ro oins.com ..... ...... ___' __'y 1"', 1 . ..... ...... 440 E. Huntington Dr. #100 INSURER(SI AFFORDING COVERAGE Arcadia, CA 91006 INSURER A: Western World Insurance Co. INSURED INSURER 8: Bruce Sherman dba: Trains on the Move, A Plus Promotions & Collectibles INSURER C ............................... ... INSURER 17120 Ermanita Avenue . . .. . .......... ... ........... INSURER F; Torrance, CA 90604 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER* THIS 13 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 CONTRACTOR 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. __ AtdiOL P � _F LIMITS TYPE OF INSURANCE POLICY NUMBER D%'74 (Np A X COMMERCIAL GENERAL LIABILITY NPP3214946 06/10/2016 06/1012017 EACHOCCURRENcE s20 000 CLAIMS -MADE OCCUR RAN . . .. ............. .. fERSONAL &ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: G ENERALAGG R EGA T E $2,000,000 POLICY PRO- LOD j JECT 11 PRODUCTS -"COMPIO`PAGG s"Included FL__ _L�HF .. . .. . ........ AUTOMOBILE LIABILITY x(J- ANYAUTO 8 0 D iL I YINJU 11 R Y( P . a . r I person) $ WN ED SCHEDULED ALL O BODILY INJURY (Per awident) $ AUTOS AUTOS OWNED HIRED AUTOS ANON UTOS - -- ----- UMBRELLA LIAB OCCUR EIAC H OCCURRENCE S EXCESS LIAB CLAIMS MADE AGGREGATE DED, R T NTION.3 El "jbfk'_ ..... . . ...... WORKERS COMPENSATION ]PEW STATU ER AND EMPLOYERS'LMOILITY YIN I y PROPal PARINEWE KECUTIVE 'll E,L, EACH ACCIDENT EXCLIJOEVIP NIA OACERUALIA El I Mho'hdatory I I NK) E L DISEASE - EA EMPI Ryes describe under F OPERATIONS below . ... ...... . .. . ....... SEA SE - POLICY L ................... ............. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) The City of El Segundo, its officers, officials, employees, agents, and volunteers are named additional insured as respects general liability and this insurance Is primary and noncontributory with any other insurance of the additional Insured. 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 Segundo, CA 90245 AUTHORIZED REPRESENTATIVE Amp" L..) - (D 148-8.2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD #S97245/M96869 LMC This Endorsement Modifies Your Policy (Effective At Inception Unless Another Data Shown Below) PRIMARY INSURANCE - ADDITIONAL INSURED(S) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The insurance afforded by this policy for "bodily injury," "property damage" and /or "personal and advertising injury" shall also apply to the "additional insured" listed below for claims, suits, and/or damages made against the "additional insured," but only to the extent the "additional insured" is being held responsible for the acts, omissions and /or negligence of the "named insured." This insurance afforded shall not apply to claims, suits and /or damages arising out of the acts, omissions and /or negligence of the "additional insured(s)." This insurance afforded will be considered Primary Insurance and Noncontributing, but only if such claims, suits and /or damages arise out of the sole negligence of the Named Insured. The inclusion of the "additional insured(s)" shall not operate to increase the Limits of Insurance. To the extent, if any, that this policy affords coverage to an "additional insured," the "additional Insured" is subject to all of the terms of the policy. Our obligation to provide coverage to an "additional insured" is further limited by the interest of the "additional insured" as defined below. Interest of the Additional Insured(s) Defined: Client For the purpose of this endorsement, the "named insured" is the person(s) and /or party(ies) designated on the Declarations Page of the policy or on any endorsement. The "additional insured" is the person(s) and /or party(ies) identified below. Identity of Additional Insured(s): City of El Segundo, its officers, offcials, employees, agents, and vointeers 350 Main St. El Segundo, CA 90245 �........._. (Complete this section If endorsement is added after policy is issued.) NPP8214946 2 _ 10/31/2016 Policy Number Endorsement Number Endorsement . ........_.__ � Effective Date 00514 Signature of Authorized Representative Producer Number WW 419 (03/10) INSURED INFINITY,,, Infinity Commercial Auto 11700 Great Oaks Way, Suite 450 Alpharetta, GA 30022 Underwritten by: Infinity Select Insurance Company Customer Service: 800 - 722 -3391 Claims Service: 800 - 334 -1661 CERTIFICATE OF INSURANCE Named Insured Sherman, Bruce DBA A Plus Promotions 17120 Ermanita Ave Torrance, CA 90504 -2508 Producer Auto Club Services, Llc 2601 S. Figueroa Blvd # H302 Los Angeles, CA 90007 Phone: 888 - 416 -2402 Agency #: 33361 Certificate Holder City of El Segundo 350 Main Street El Segundo, CA 90245 This certificate of insurance is issued for informational purposes only and confers no rights upon the certificate holder. This certificate is not an insurance policy and does not amend, extend, or alter the coverage afforded by the policy listed below. The insurance coverages afforded by the policy listed below are subject to all the terms, exclusions, provisions, limitations, conditions, and endorsements of the policy. Policy Effective Date: 04/01/2016 Policy Expiration Date: 04/01/2017 Insurer: Infinity Select Insurance Company Policy #: 504 - 61003 - 3573 -001 NAIC: 20260 Combined Single Limit (each Bodily Injury (per person) Bodily Injury (per accident) Property Damage (per accident) accident) $1,000,000 R Scheduled Autos Only ❑ Hired Autos Included ❑ Non -Owned Autos Included ❑ Any Auto Cancellation In the event of cancellation of the policy described in this certificate, notice will be delivered in accordance with policy provisions. 50000CE101 Date: 11/09/2016 CITY OF EL SEGUNDO WORKERS' COMPENSATION DECLARATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SUBJECTS AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN LABOR CODE § 3706, INTEREST, AND ATTORNEY'S FEES. I affirm under penalty of perjury under the laws of California one of the following declarations: (_) I have and will maintain a certificate of consent of self- insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Labor Code § 3700 for the performance of the work set forth the agreement with the City of El Segundo. Policy No. (_) I have and will maintain workers' compensation insurance as required by Labor Code § 3700 for the performance of the work for which the agreement with the City of El Segundo is executed. My workers' compensation insurance carrier and policy number are: Carrier Name of Agent Policy Number Explratlon Date Phone # ('& I certify that, in the performance of the work set forth in the agreement with the City of El Segundo, I will not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, If I should become subject to the workers' compensation provisions of Labor Code § 3700 1 must Immediately comply with tho provisior t greement will automatically become void. Signature of Applicant _ Date 6 Agreement for: Dated: — Reviewed