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PROOF OF INSURANCE (2017 - 2018) CLOSED DRAYTON INSURANCE BROKERS 2500 COaM POINT ROAD,surm xn POST OFFICE BOX 94067 BIRMINGHAM,ALABAMA 352'15 BIRMINGHAM,ALABAMA 35= TELEPHONE (2%) 854-5806 FAM (M) 854409 CERTIFICATE OF INSURANCE No. 713157 We:certily,that insurance is afforded,as stated below, this Certificate do(-.;not affirmatively or negatively amend,extend or alter The covontge afforded by the insurance policy and the insurance afforded is subject to all the terms,exclusions and conditions of the policy. INSURER Admiral Insurance Company POLICY NO.CA000002771-31 NAMED INSURED Pyro Spectaculars,Inc. Pyro Spectaculars by Souza Pym Events,Inc. Pym Spectacular Industries,Inc. Pyro Spectaculars Productions,Inc. forth Ankerican Fhvwo&Co.,lac.(NAfCO)k P.O.Box 2329 Son Diego Fireworks Rialto,CaMmia 92377 POLICY TERM January 13,2017 to January 13,2018; Both Days 12:01 A.M.Standard Time COVERAGE Commercial Ciencral Liability: C9 Occurrence Basis ElClaims Made Basis LIMIT OF LIABILITY $5,000,000 each occurrence,$10,000,000 general aggregate,$5,000,000 products/couipleted operations aggregate 'rhe limit of liability Anil not be increased by the inclusion of more than one insured(-w additional insured. INSURED OPERATIONS Public fireworks display and special effects contractor It Is certified that,if named below,this policy Includes as Additional Insureds 1)the sponsor(s),promoter(s),organize4s)(including other entities having similar intemsts),of insured pyrotechnic events an&or 2)the owner(s)of're4l property(or barges)at which insured pyroteclinic events are held and/or 3)the owner(s),manager(s),tenark4s),morigagee(s)(including other entities having similar interests),of buildings,stadiums, amas and similar facilities at which insured pyrotechnic avents are held and/or 4)the licensing or permitting authority,or other authority having jurisdiction,issuing limisckul)ermits for insured pyrotechnic:events and/or 5)any other entity for which the insurance is requiral to be afforded under written contract. Coverage applies only as respWs the legal liability of such Additional Insured(s)for bodily injury and property damage caused by the operations of the Named Insured. I'lie insurance afforded any Additional Insured does not include coverage for arty bodily injury or property damage arising frons(Ike failure of such Additional Insured to luffill its obligations specified in its contract with the Named Insured. NAME&ADDRESS OF INSURED SPONSORS, PROPERTY OWNERS,LICENSORS City of El Segundo 401 Sheldon St. El Segundo,CA 90245-0989 ADDITIONAL INSURED(S)City of El Segundo,El Segundo High School,El Segundo Unified School District, El Segundo Fire Department and their officers, agents and employees when acting in their official capacity as such. DISPLAY LOCATION DISPLAY DATE(S) El Segundo High School October 7,2017 El Segundo,CA It iskmiffied that this policy requires a 30 day mutual inotice of cancellation bewccrt the Insurer and the Named Insured, In the event of'such cancellation we will endeavor to mail 10 days written,notice:to the Additional Insured(s),whose name and address is shown hem-on,but failure to mail such notice shall impose no obligation or liability of any kind upon the insurer and/or the undersigned. DRAYTON INSURANCE BROKERS,INC. DATE OF ISSUE A4.�rRINIGER. Policy Number:CAO 0 0 002771-31 Al 08 76 02 03 Effective Date:O 1/13/2 017 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COVERAGE AMENDMENT-PRIMARY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM COMMERCIAL PROPERTY COVERAGE FORM PROFESSIONAL LIABILITY COVERAGE FORM It is hereby declared and agreed that,if so stated in a certificate of insurance,the coverage afforded any entity included as an Additional Insured under the terms of this policy shall 1) Be primary and non-contributory with any policy of insurance(or self-insurance) issued directly to the Additional Insured. 2) Provide a waiver of subrogation in favor of such Additional Insured. AI 08 76 02 03 Page 1 of 1 13 Policy Number: CA000002771-31 CG 2010 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 Name Of Additional Insured Person(s) Or Organization(s): Location(s)Of Covered Operations P City of El Seprido,its officers,officials, employees, All locations for which coverage is required by agents, and volunteers. written contract. hilt dation required to eoaralfletc this Schedule.if not shown ab;,c,wr,^i0 he shown in the Declarations. A. Section Il—Who Is An Insured is amended to This insurance does not apply to"bodily injury"or include as an additional insured the person(s)or "property damage"occurring after: organization(s)shown in the Schedule,but only with 1. All work,including materials, arts orequipment � g P respect to liability for"bodily injury","property furnished in connection with such work on the damage"or"personal and advertising injury1°caused, project(other than service,maintenance or in whole or in pad,by: repairs)to be performed by or on behalf of the 1. Your acts or omissions;or additional insured(s)at the location of the 2. The acts or omissions of those acting on your covered operations has been completed;or behalf, 2. That portion of"your work"out of which the in the performance of your ongoing operations for the injury or damage arises has been put to its additional insured(s)at the location(s)designated intended use by any person or organization other above. than another contractor or subcontractor engaged in performing operations for a principal as a part B. With respect to the insurance afforded to these of the same project. additional insureds,the following additional exclusions apply: CG 20 10 07 04 (C)Ilia Prolxc.rtics, Inc..,200 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 OPELATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or OrQanization(s) Locatlorn And Description Of Completed Operations City of El Segundo,its officers,officials,employees,agents, All locations for which coverage is required by and volunteers. written contract. lnformadon required to comp'lcte ills Schedule,if not shown al)ove, 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 damage"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 E)lSC l"zoperVirs, Inc„2004 Page 1 of 1 0 DATEIMMIODIYYYY) CERTIFICATE 4F LIABILITY INSURANCE 111012017 1 11 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 e'ndorsement('s). PRODUCER rdAk �t31°ilton Gallagher Ik %o sxn1216-659-7.100 t k ranf�t One Cleveland Center, Floor 30 56 11,01.. I 1375 East 9th Street ARttR , 's, Cleveland OH 44114 INSURER(S)AFFORDING CO ERA E INsU, _Euerest Nd NAIc a IN t10,nra1.�It1S,USance.ompan 10120. .. v INSURED ... i� ,�.. MaXum,.�Indemnit -Company Pyro Spectaculars INSURE Pan. sego Fireworkso INSURER,..DD.... ............... ...m............,m,mm.._..........,_........._w— ... ...... . .............. ......................I'.............�.......•. w• Rialto CA 9.2377 INsuRW— INSURER F: m......._ COVERAGES CERTIFICATE NUMBER:1719383423 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 WaL°�06 :................__...m.._S+4'rILCC A"Nl............................................._ w ........._,._ ................,,,,,......,,.•.., �'_., AMBER IC.I .. V,1 Ir'P.111 dYYYY,L, .www EXP LIMITS NERAL LIABILITY EACH OCCURRENCE S 6 ak S.Q JL4 1161 ' •.._ CILAlM""-rinNAOIn '�Y,wAuI,1�I„XT'M ��wNrAne )a ........ rEO EYP(Ari $ U..,h9� .,NAVE Ns ryryII w.. ' ^* � �I) FoulR�g '' one pBrSori S • PERSONAL 8 ADV INJURY S ............. ENERALAGGRE,GATE,,,,,,,mm 5......... PiA A C t AEN,AlE LIMIT A'iPP IT I'1=1•r„ If CI�7YrV.UQ;Pr~'.,t Cil CY fu7'A e,e Y,, ', rrtrl. .. ......� A AUTOMOBILE LIABILITY S18CA00031-171 1113/2017 11/13/2018 ut�r,1'wdnrar,ar',Ir�'c�I.tLIMIi l IV dP""Il $11A00:000 II X ANY;MJ„ U IISOCTL1YINJUIR)iww' ri,oriy $ ALL OWNED HIRED AUTOS AUTCI}I i $ N d) I P I$Gr lY I1�VYr F"rar a i. .. AUTOS , hIDFOS 4 rwo-aruVy 'Y' HIRED NI T 'Mal. Ir .............. 6X UMBRELLA LIAR X EC6017995 1/13/2017 V13.2018 EACH CPCrl�lr , 0II000 UMBRELL1AB AGGREGATE 4 0U00 nrn Ptiw TI.N F)ON4 3 WORKERS COMPENSATION vwitICI U� I IIr?IIr AND EMPLOYERS'LIABILITY YIN �TOR' lall'MT5 V.LI .Y+IY "IhPF?dITN,IIV:'O P:aIL°G'RkIRTEWW.I3rY,;'"A w'�',V„I'411Ww ❑ ELyC.Ye'7 n ;.Sa, iVt °ICIA'E4I_hr".,I.u,➢I�.0..f_"J.7._._......�. . .. NIA NH) E N I AA4,t IrII r r =IOyr ONC I I lP ........w............... , mDESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) ITITIT ..._............ I CERTIFICATE HOLDERCANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of EI Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street EI Segundo CA 90245 AUTHORIZED REPRESENTATIVE d _ ©1988-2010 ACORD CORPORA11 RTION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD POLICYHOLDER COPY miu1 I I�VI SP • P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 04-10-2017 GROUP: POLICY NUMBER: 0803749-2016 CERTIFICATE ID: 1541 CERTIFICATE EXPIRES: 10-14-2017 10-14-2016/10-14-2017 CITY OF EL SEGUNDO SP 350 MAIN ST EL SEGUNDO CA 90245-3813 This is to certify that we have issued a valid Workers' Compensation insurance policy in a forrn 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 policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certwflcate of insurance may be issued or to which it may pertain, the insurance afforded by the ploiicy described heyem is subject to 4 the terms, exclusions, and conditions, of such policy. Authorized Representative President 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] MEV.7.2014) PRINTED : 04-10-2017 ENDORSEMENT AGREEMENT • WAIVER OF SUBROGATION RRP 25 803749-16 RENEWAL SP HOME OFFICE 5-41-39-14 SAN FRANCISCO PAGE 1 OF 1 ALL EFFECTIVE DATES ARE ji AT 12:01 AM PACIFIC EFFECTIVE APRIL 10, 2017 AT 12.01 A.M. STANDARD TIME OR THE TIME INDICATED AT AND EXPIRING OCTOBER 14, 2017 AT 12.01 A.M. PACIFIC STANDARD TIME PYRO SPECTACULARS, INC. PO BOX 2329 RIALTO, CA 92377 I I 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%. II I 4 I 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 2570 IJ'7'd WS131E1 RI P4I SEN'P' !VE PRESIDENT AND CEO SCIF FORM 10217 {REV.7-2014I OLD DP 217