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PROOF OF INSURANCE (2017) CLOSED AC"RD" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) '1111101 G 06/01/2017 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Western Sentry Insurance Brokers ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1720 E Los Angeles Ave #213 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 9 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Simi Valley CA 93065 805-577-8522 Fax INSURERS AFFORDING COVERAGE NAIC# INSURED (INSURERA Associated Indemnity Corp/US Risk Inc Michael Bell,dba INSURER B: Bell Event Services I INSURER C 531 Main St #228 El Segundo CA 90245 INSURER D: I INSURER E: COVERAGES 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 MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TRM°79= PULIC:Y EI.1-E—11VE F LIUY�Ey�PY TI IN LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE(MMIDD/YY) I DATE(MMID LIMITS A X GENERAL LIABILITY 81-15ABC80913070 10/25116 10125117 EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY -15-AM-A- T RENTED 100,000 �� PREMISES(Ea occurencel $ CLAIMS MADE u.. � OCCUR MED EXP(Any one person) $ � 10,000 PERSONAL&ADV INJURY I$ 1,000,000 GENERAL AGGREGATE $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: PRODUCTS-COMP/OPAGG $ / POLICY I I PROJECT I I LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANYAUTO (Ea accident) ...................._....__....................................................................................... ALL OWNED AUTOS - BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EAACCIDENT $ ANYAUTO EAACC $ OTHER THAN AUTO ONLY: AGG 1$ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE 1$ OCCUR CLAIMS MADE AGGREGATE Is DEDUCTIBLE I $ RETENTION $ cuI I$ WORKERS COMPENSATION AND WC SIA"I"U- 01'H- EMPLOYERS'LIABILITY II II TORYLIMITS ER ANY PRO PRIETOR/PARTNER/EXECUTIVE U E L EACH ACCIDENT 1$ OFFICER/MEMBER EXCLUDED? I ELDISEASE-EA EMPLOYEE L$.....,mm......................................................... If yes,describe under SPECIAL PROVISIONS below E L DISEASE-POLICY LIMIT 1$ OTHER tRIF°I IUN OF UPERA'T IUNS I LUC AYIUNS Y V'EHK:ILES/EXCLUSYUNS ADYSED 8Y iENDO14800.Y Y SHEC:WL PRUVYSIUN5 Additional Insured: City of El Segundo, its officials and employees. Insurance is primary/noncontributory. P� CERTIFICATE HOLDER CANCELLATION City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 350 Main St., RM 5 DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN El Segundo, CA 90245-3813 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. ........................ ._.._. AUTHORIZED REPRESENTATIVE I Certified Signature------------------------Jerry Glenn ACORD 25(2001108) ©ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25(2001108) POLICY NUMBER: 8H5ABC80913070 COMMERCIAL GENERAL LIABILITY CG 20 10 10 01 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 Name of Person or Organization: City of El Segundo, its officials and employees (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement) A. Section II — Who Is An Insured is amended to (1) All work, including materials, parts or include as an insured the person or organization equipment furnished in connection with shown in the Schedule, but only with respect to such work, on the project (other than liability arising out of your ongoing operations service, maintenance or repairs) to be performed for that insured. performed by or on behalf of the addi- B. With respect to the insurance afforded to these tional insured(s) at the site of the cov- additional insureds, the following exclusion is ered operations has been completed; added: or 2. Exclusions (2) That portion of"your work" out of which the injury or damage arises has been This Insurance does not apply to "bodily in- put to its intended use b jury" or"property damage"occurring after. p Y 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 10 01 0 ISO Properties, Inc., 2000 Page 1 of 1 13 PROGRESSIVE 90PREW11F PO BOX 94739 ( 7OAW W4,114L CLEVELAND,OK 44101 Named insured Policy number: 04315274-7 Underwritten by: Progressive Express Ins Company MICHAEL J BELL June 18,2016 BELL EVENT SERVICES Policy Period:Aug 21,2016-Aug 21,2017 531 MAIN ST#228 Page I of 3 EL SEGUNDO,CA 90245 progressive.com Online Service Make payments,check billing activity,print policy documents,or check the Status Of a Commercial Auto claim 1-900-895-2986 Insurance Coverage Summary For customer service and claims service, This is your Renewal 24 hours a day,7(lays a week Declarations Page `t,r5 Remewal Declarations Page is effective only if Oie rninimum arnotint due to ienew your policy is received or postmarked by Auqmt 21,2016. Your coverage begins on August 21,20 16 at '12:01 a rin, This policy Pxpirpr,on August 21,2017 at 17:01 a.rn, Your insurance(Oicy and early pohcyendoi,oments contain a full explanation of your covefago. I he policy limits shown for an auto way not be combined with the limils for the carne coverar.le,on anolhei auto,unless tfrp policy contract allows the stacking(if limils, I he policy contract 6 form 699 2(06(10). f he corOad is modified by forrrvs 1303CA (04108), 1198(0 ijD,I),48'12CA (10104),4881(A (1 2104)and 2228(01111)• The na!'ned imAncd organization type is pwpriploi,,hip. Outline of coverage Y�r;crq:alion Lin is DeduolJe Premmin Liability Io Other.,, $3,863 Bodily Injury and Propmly Damage Liability $750,Wniomlvnnd in ilr,hfio motorist (Nejeued Uninsined Mcgow;t Pioperiy Daniage i)'vjm'led 5ubtotial policy premiulin $3,883.00 Califoniir.r Vehk le Asses,.-,rnent Fee ... . ... . ... .. ............ Fees Total 12 rnonth policy premium and fees $3,928,29 Discount if paid in full -58000 total 12 month policy preirrilurn if paid in full $3,348.28 Important information about fees An installment fee of$3.00 has been included in each payment.You may avoid paying installment fees by paying your premium of$3,348.28 in full by Aug-List 21,2016.You may reduce the amount you pay in installment fees by paying your premium in larger amounts and fewer installments. Please call 1-800-895-2886 for details. The following additional fees may apply: Fee for returned checks or refused payments $20.00 Is r0im C CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 06/12/2017 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 have ADDITIONAL INSURED provisions or 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 NAME.. Steven Griswold Griswold&Griswold Insurance Agency Inc. ) 9 Y PHONE Ext): (310 377-7172 fmArcw NU)• 25550 Hawthorne Blvd,#200 E-MAnL ADDRESS: sleven @griswoldinsurance.com INSURER(S)AFFORDING COVERAGE NAIC p AFF RDI Torrance CA 90505 INSURERA: NATIONAL LIAB&FIRE INS CO 20052 INSURED INSURER B: Bell Event Services INSURER C: 531 Main Street#228 INSURER D: INSURER E: El Segundo CA 90245 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 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 'LTR TYPE OF INSURANCE j POLICY EFF POLICY EXP POLICY NUMBER 1 I (MM/DDlYYYYI D L' UB LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ GE 1'6AEN1'E0 CLAIMS-MADE OCCUR DAM REMISES„IEp,opirrennal $ MED XP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ E POLICY CT ( LOC PRODUCTS S-COMP/OP AGG �$ OTHER: $ AUTOMOBILE LIABILITY COMMNEWSINGp,.E LIMIT (ER'ArcldentR, $ ANY AUTO BODILY INJURY(Per person) $ OWNED ”SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident)I$ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Par nclridr nt) $ LIAR B NI' OCCUR EACH OCCURRENCE Is CLAIMS-MADE AGGREGATE $ .. DED i EXCESS LA LIA RETENTIONS $ WORKERS COMPENSATIN v EMPLOYERS'L ABILITY X V EACH ACCIDENT ERH AND EMPLO A OFFICER/MEMBER EXCLUDED?PROPRIETOR/PARTNER/EXECUTIVE YIN NIA A9WC861804 05/25/2017 05/25/2018 STATUTE IS 1,000,000 (Mandatory In NH) E L,DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo-City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street AUTHORIZED REPRESENTATIVE Room 5 El Segundo CA 90245 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 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 1.03_% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description B]anket Waiver-Anypersonororganizationf6iwhomthe All CAOpcmtions Named Insured has agreed by written contract to furbish this waiver, 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.) Endorsement Effective Policy No. A9WCB61804 Endorsement No. Insured Insurance Company Countersigned By ©1998 by the Workers'Compensation Insurance Rating Bureau of California.All rights reserved.