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PROOF OF INSURANCE (2017 - 2018) CLOSED DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 5/8/2017 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 policy(ies) 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 CONTACT Carrie Harvith NAME: Insurance Solutions PHONE (949)348-7400 IPAc - AL ,Nr).(949)348-2373 .... License #0746539 AoDRESSCarrieH @ins—solutions.com 33302 Valle Rd, Suite 200 INSURER(S)AFFORDING COVERAGE NAIC# San Juan Capistrano CA 92675 INSURER A Nautilus Insurance Cc 17370 INSURED O ers Preferred Insurance 10346 Picnic Services LLC INSURER C: 3737 San Gabriel River Pkwy INSURERD: INSURER E: Pico Rivera CA 90660 INSURER F: COVERAGES CERTIFICATE N'OMBER:17-18 All 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. INSR X COMMERCIAL GENERAL LIABILITY AbbL 9UBk POLICY NUMBER POLICY IYYYY)� POLICY EXP EACH OCCURRENCE $ 1,000,000 TYPE OF INSURANCE IMMIDD fMOLICY XP LIMITS DAMAGE-TO RE=NTED A CLAIMS-MADE I X-1 OCCUR PRENkISES(E occurrence) $ 100,000 NN764093 2/1/2017 2/1/2018 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 P"8. PRODUCTS-COMP/OP AGG $ _ X JECT 1.(JO Included P6'3u.dti;'Y OTME:'R $ AUTOMOBILE LIABILITY COMBINED SINGL.I II,RRT $ .(Fa_aokideni'R ANY AUTO BODILY INJURY(Per person) $ ALL OWNED � SCHED ULED AUTOS AUTOS INJURY„ Per accident)) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS A O (Pea acadeny $ UMBRELLA LIAB EXCESS LIAB 'OCCUR LAIMS-MADE AGGREGATE DED I I RETENTION$ $ WORKERS COMPENSATION X V PER I OTH- AND EMPLOYERS'LIABILITY Y/N .STATUTE l I,ER ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ 1,000,000 B OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) EIG1344613 06 5/1/2017 5/1/2018 EL DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 11000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The City of E1 Segundo, its officers, officials, employees, agents, and volunteers are included as additional insured per the attached endorsement. 'A CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of E1 Segundo — City Clerk THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. E1 Segundo, CA 90245-3813 AUTHORIZED REPRESENTATIVE Tony Alessandra/WENL ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 rgmann COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, ADDITIONAL INSURED - PRIMARY AND NONCONTRIBUTORY - AUTOMATIC STATUS WHEN REQUIRED IN CONTRACT OR AGREEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II - Who Is An Insured is amended to include as an additional insured any person or organization when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured 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 for the additional insured; or 2. In connection with premises owned by or rented to you. But only for: 1. The limits of insurance specified in such written contract or agreement, but in no event for limits of insurance in excess of the applicable limits of insurance of this policy; and 2. "Occurrences"or coverages not otherwise excluded in the policy to which this endorsement applies. B. Status as an additional insured for the person or organization to which this endorsement applies: 1. Commences during the policy period and after such written contract or agreement has been executed; and 2. Ends when: a. Your ongoing operations for that additional insured are completed; b. The contractor's contract or agreement is terminated; c. The lease of premises expires; or d. Your policy cancels or expires; whichever occurs first. C. The following is added to 4.a. of Other Insurance of Section IV - Commercial General Liability Conditions: If required in a written contract, your policy is primary and noncontributory in the event of an "occurrence" caused, in whole or in part, by your acts or omissions, or the acts or omissions of those acting on your behalf that occurs while performing ongoing operations for the additional insured, or in connection with premises owned by or rented to you. D. With respect to the insurance afforded to the additional insured, the following exclusions apply: This insurance does not apply to"bodily injury" or"property damage" occurring after: 1. All work on this project, including materials, parts, or equipment furnished in connection with such work (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. All other terms and conditions of this policy remain unchanged. L805(05/09) Includes copyrighted material from Insurance Services Office, Inc.,with its permission. ............... DATE(MM/DD/YYY Y) ""R01" CERTIFICA TE �F LIABILITY INSURANCE 05/03/2017 w .. ..... _-_ ..... ... 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 policy(ies)must be endorsed. It 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 endorsernoalt'(,$). CONTACI PRODUCER PETE ADRIANCE INSURANCE NAME: SOFIA DURAN (AI/C,N,Ex1):323-722-3000 (n/c,No):323-722-5238 730 NEWMARK MALL EMAIL MONTEBELLO, CA 90640 ADDRESS SOFIA @PETEADRIANCE COM INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:State Farm Mutual Automobile Insurance Company 25178 INSURED PICNIC SERVICES, LLC INSURER B: 3737 SAN GABRIEL RIVER PKWY INSURER C: PICO RIVERA, CA 90660 INSURER 0: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF MSURANCE 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 13E 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 INSR ADDL SUER POLICY EPF POLCCY EXP LIMITS R I.TR TYPE OF INSURANCE ld+y," WN'VD 'PG)I Ir:,M NVPIBE,..N''d.. .....l yt hi�lt7kdJW V^'Y"fl 1Mfw9Ml'JD/"M"YN`✓I GENERAL LIABILITY I EACH OCCURRENCE 5 1 DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ CLAIMS-MADE OCCUR BED EXP(Any one person) 5 PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN°L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG S S AUTOMOBILE LIABILIR POLICY LOC ANYAU7o UtTC;t 5007990-D07-75A 0410 _.... .. ...'"a,,." alN�r�WE LIMIT A TY 4966923-D14-75 0411412017 10I14I2017 IEv pcc,�a,nr4 $ 7/2017 10107/2017 BODILY INJURY(Per person) E 1,000,000 X ALL OWNED SCHEDULED BODILY INJURY(Per accident) AUTOS AUTOS 4347663-E01-75 05/0112017 11101/2017 $ 1,000,000 NOIN OWNED q''R'�C?'PERTY DAMAGE X HIRED Au ros X MJ105 Illaw«r ncrartlrauiI) $ 100,000 s UMBRELLA LIAR OCCUR ` I EACH OCCURRENCE 3 EXCESS LIAB CLAIMS-MADE ..II AGGREGATE ;4 1NORr'IE�ID IN rTCNJ fI,CDN'.5 WORKERS COMPENSATION 'UR S'_IVIT• �I":ER AND EMPLOYERS°LIABILITY )CYfd"I ItrP I7,r ER - ANY PROPRIETOR/PARTNER/EX.ECUTIVE y E L EACH ACCIDENT S OFFICE/MEMBER EXCLUDED? ( N/A ry 1MI.ndaureo"r,n NH) E L DISEASE-EA EMPLOYEE 5 ys e,, -det s'! ,ti1'yFd;u Lo.;bryrw E L DISEASE-POLICY LIMIT $ G DESCRIPTION OF OPERATIONS 7 LOCATIONS/VEHICLES (Attach ACORD 101 Jule,if more space is require Additional Remarks Sche .... ......, d) .._....._ CERTIFICATE HOLDER CANCELLATION _ _. --- City of El Segundo City Clerk SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y 9 — y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo, CA 90245-3813 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 1001486 1328496 11-15-2010 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2 % of the California workers'compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description ANY PERSON OR ORGANIZATION FOR WHOM ALL JOBS IN California THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER. This policy is subject to a minimum charge of$250 for the issuance of waivers of subrogation This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) This endorsement, effective 05/01/2017 at 12:01 AM standard time, forms a part of Policy No. EIG 1344613 06 Of the EMPLOYERS PREFERRED INS. CO. Carrier Code 00920 Issued to PICNIC SERVICES LLC Endorsement No. Premium Countersigned at on By: Authorized Representative WC 04 03 06 (Ed. 4-84) ©1998 by the Workers'Compensation Insurance Rating Bureau of California.All rights reserved.