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PROOF OF INSURANCE (2018) CLOSEDDRAYTON INSURANCE BROM" __ZINC. ZWCW"MPO1NrROAD,KMM3K PO9r OFMC13 BOX 94M WRWNGIUK ALAMMA 35n5 MRMNGHWALAMMA 35= TM MON& PIK) 0"M F'&X- ("" @"-"" CERTIFICATE OF INSURANCE No. 713069 We catlify dmt insurance is afforded as stated below. 'This Catiricate does not affin"atively or negatively amlood, "tend or WW the coverage afforded by the insurance policy and the insurance afforded isisubject to all the tervis, oxclusions =4 conditions ofthepolivy, INSURER Admiral Insurance Company POLICY NO. CA000002771-31 NAMED INSURED Pyro Spectacubus, Ew- Pyro Spectaculars by Souzz Pyre Events, inc- Py1ro SpectauWar hAntries, ine- Pyro spectandan Pmductions, EMC. North AxwA= Fneworb Co., Inc. (NAFCO) P.O. Box 2329 San Diego Fimvorb Rialto, Cafi&rnia 92377 POLICY TERM knuary 13, 2017 to January 13, 2018; Both Days 12:01 A.M. Standard Time COVERAGE Commercial General Liabifity: 0 Occurrence Basis 0 Claims Made Basis L941T OF LL42ILM $5,00,000 each occurrence, $10,000,000 general aurvoWc, $5,000,000 pmducWcouxpJAftd operations annIme The limit of liability shall not be increased by the inclusion of more than one insured or additional insured. INSURED OPERATIONS Public fireworks display and special efrem contractor It Is "M1104 that, N named: below, this policy factod" as Additional Insureds 1) the qmsor(s), promoter(4), orguti7a(s) (including other entities having similar intorests), of insured pywachniv events mid/or 2) the ownor0) of real property (or barges) at which iruared pyrotechnic events am held and/or 3) the, owna(sl manager(4 tenant(s), mortp&*s) (including other entities having similar interests), of buildinA staditmis, werias and shnilar fimilitics at which insui-ed pyrotechnic events are held and/or 4) the licensing or permitting authority, or other authority having jurisdiction, issuing licensedpermits for insured ryrotechnic events andVor 5) any other entity for which die insurance is required to be afforded under wriftert contract. Cova-age applies only as respects the legal liability of such Additional Insured(s) for bodily injury and property damage caused by the operations of the Named Insured. 7he insurance affordW any Additional Insured does not include coverage for any bodily injury or property damage wising from the failure of such Additional Insured to fidfill its obligations specified in its contract with the Named hunavd. NAME & ADDRESS OF INSURED SPONSORS, PROPERTY OWNERS, LICENSORS City of El Segundo 350 Main St. El Segundo, CA 90245 ADDITIONAL iNsuRMS) City of El Segundo, Chevron El Segundo Refinery, El Segundo Recreation Park, El Segundo Fire Department and their officers, agents and employees when acting in their official capacity as such. DISPLAY LOCATION El Segundo Recreation Park El Segundo, CA DISPLAY DATEM July 4,2017 It is caffled that this policy requires a 30 day mutual notice of cancellation between the Insurw and the Named hisumd. In the event of such cancellation we will endeavor to mail 10 days writtm notice to the Additional Insured(s), whose name and address is shown hereon, but failure to mail such notice shall impose no obligation or liability of any kind upon the izaamer and/or the undersigned. DRAYTON INSURANCE BROKERS, INC. Fj o 1i llr�'J mom 0 YY) AC"R" ATE "' NY CERTIFICATE OF LIABILITY INSURANCE 4/D 2( � Q%/ �017 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 pollcy(les) 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 CONTAC Britten Gallagher PHONE .... .. - — ------ FAX ;:�In'216-65R-71f)(7) N One Cleveland Center, Floor 30 mc�No . .............. E-MAIL 1375 East 9th Street . .................... Cleveland OH 44114 INSURER A:P:.vprp.qt Nnfininnl Inqi irqnrp- r.nmn:;nv inign I NSU RED INSURER I3AAnVI IM Inriannnitu rnmnnnv 7A7A*l Pyro Spectaculars Inc. INSURER C San Diego Fireworks INSURER D P. 0. Box 2329 Rialto CA 92377 INSURER E COVERAGES CERTIFICATE NUMBER: 1719383,423 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. A'01 'A" POLICYEFF POLICYEXP SR TYPE OF INSURANCE immmofyYyy] LTR I— WV!) POLICYN"MRrR IMMOOfYYYY1 LIMITS GENERAL LIABILITY EACH OCCURRENCE S .6KfMqnET6'1qI RTE.O-- — _­_­ ­­ . COMMERCIAL GENERAL UABIL�TY PREMISFSdFMrr­1 S CLAIMS-MADE OCCUR . .. . . ........ . . . ......... . . MED EXP tAnv one Dersonl S ENERAL AGGREGATE S GEN'L AGGREGATE LIMIT APPOES PER: PRODUCTS - COMP/OPAGG $ POLICY LOC A AUTOMOBILE LIABILITY S18CA00031-171 1/13/2017 1/13/2018 1B ell noo nnn ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Paracel dent) $ X NONOWNED 'R CRTYDAMAGE HIREDAUTOS AUTOS UMBRELLA LIAB x _EXC60117995 1/13/2017 1/13/2018 OCCUR — --------- - --- - EACH OCCURRENCE $4,000,000 EXCESS LAB CLAIMS-MADE . . ........... . . ......... ... ..... .... RETENTION 9 "S WORKERS COMPENSATION .. AND EMPLOYERS'LIABILITY YIN . ......... . . ............... . . . . . ANY PROPRIETORIPARTNERIEXECUTIVE t��H ACCIDENT z OFFICERIMENUER EXCLUDED? F NIA _t�L. .......... (Mandatory In N14) E.L. DISEASE - EA EMPLOYEF',S �( describe undoo ............ 0zSCK02rd)NOFOPERATIQNSb.I— pn�y�wLlmn $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space 1. required) CERTIFICATE HOLDER CANCELLATION City of El Segundo City Clerk 350 Main Street El Segundo CA 90245 ACORD 25 (2010/05) 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 REPRESENTATIVE 1988-2010 ACORD CORPORATION. All rights reserved, The ACORD name and logo are registered marks of ACORD Policy Number: CA000002771-31 CG 20 10 07 04 Endorsement No. 119 Effective Date: April 10, 2017 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE <i � Name Of Additional Insured Person(s) Or Oreanization(s): Location(s) Of Covered ODerations City of El Segundo its officers, officials, employees, All locations for which coverage is required by agents, and volunteers. written contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 — 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: 1. Your acts or omissions; or 2. The acts or oniissions of those acting on your behalf, in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 13 Policy Number: CA000002771-31 CG 20 37 07 04 Endorsement No. 120 Effective Date: April 10, 2017 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Comvleted Onerations City of El Segundo, its officers, officials, employees, agents, All locations for which coverage is required by and volunteers. written contract. Information requf red to complete this Schedule, if not shown above, will be shown in the Declarations. 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" or "property darnage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products- completed operations hazard". CG 20 37 07 04 (D ISO Properties, Inc,, 2004 Page I of I E3 POLICYHOLDER COPY SP P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 04-10-2017 CITY OF EL SEGUNDO SP 350 MAIN ST EL SEGUNDO CA 90245-3813 GROUP: POLICY NUMBER: 0803749-2016 CERTIFICATE 10: 1541 CERTIFICATE EXPIRES: 10-14-2017 10-14-2016/10-14-2017 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer, We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the poficy listed herein. Notwithstanding any requirement, term or condition of any contract or o�ther document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative Presi�deni and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2017-04-10 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF EL SEGUNDO ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-14-2002 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2017-04-10 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF EL SEGUNDO EMPLOYER PYRO SPECTACULARS, INC. SP PO BOX 2329 RIALTO CA 92377 [P1 D,SD] (REV.7-2014) PRINTED : 04-10-2017 HOME OFFICE SAN FRANCISCO ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION REP 25 803749-16- RENEWAL SP 5-41-39-14 PAGE I OF I EFFECTIVE APRIL 10, 2017 AT 12.01 A.M. AND EXPIRING OCTOBER 14, 2017 AT 12.01 A.M. PYRO SPECTACULARS, INC. PO BOX 2329 RIALTO, CA 92377 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, CITY OF EL SEGUNDO WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, PYRO SPECTACULARS, INC. IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER. IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH EMPLOYEES SHALL BE INCREASED BY 03%. NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: APRIL 12, 2017 A',; —Ilplo AUTHORIZED REPRESENT� �IVE PRESIDENT AND CEO SCIF FORM 10217 (REV.7-2014) 2570 OLD DP 217