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PROOF OF INSURANCE (2017 - 2018) CLOSED CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 111111'1 1 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. i Simi Valley CA 93065 i 805-577-8522 Fax INSURERS AFFORDING COVERAGE NAIC# INSUREDCorp/ .__........._ ........._......_................................_ NSURER A: Associated Indemnity Corp/US Risk Inc Michael Bell,dba _____...._..._w.......w.w.�.....................�a _ R_R...B .................................Bell Event Services INSURER C: 531 Main St #228 INSURER D: EI Segundo CA 90245 .... ............................. I INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS TfS9F@ FDvL ___-W ................. P(7LIl errtc:ttVhII Pyu WE11PfRA NIIII LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE{MM/DD/YY) V DATE(MMIDD V LIMITS A X GENERAL LIABILITY 81-15ABC80913070 10/25/16 10/25/17 �II EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY V SES(Ea occu e PREMISES $ 100,000 ® CLAIMS MADE OCCUR MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $� 0,000 2 00GENERAL AGGREGATE $ 0,000 ..................................... GEN'LAGGREGATE LIMITAPPLIES PER PRODUCTS-COMP/OP AGG $ 1,000,000 7 POLICY F-�PROJECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANYAUTO (Ea accident) ALL OWNED AUTOS y BODILY INJURY �!I SCHEDULED AUTOS (Per person) HIREDAUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EAACCIDENT $ ANYAUTO OTHEEAACC $ AUTO ONTHAN AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ® CLAIMS MADE -_.,.._..�... .. ...__._. - AGGREGATE $ DEDUCTIBLE $ RETENTION $ -___....... ........$ WORKERS COMPENSATION ANDLI "" I *'U S lA'I"U- �'U'I EMPLOYERS' ABILITY I TORYLIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED EL DISEASE-EA EMPLOYEE $..................................... W� If yes,describe under - - -------------------------------- i SPECIAL PROVISIONS below E L DISEASE-POLICY LIMIT $ OTHER DESLAiPTION OF OPERATIONS I LOCATIONS IVEHIC-ES!EXCLUSIONS ADDED BY ENDORSE VIEN"r'I SPECIAL PROVISIONS Additional Insured: City of EI Segundo, its officials and employees. Insurance is primary/noncontributory, 0` CERTIFICATE HOLDER, CANCELLATION City of EI Segundo SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 350 Main St., RM 5 DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN EI 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 u Certified Signature------------------------Jerry Glenn ACORD 25(2001/08) ©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 PARTd Mo 'y SCHEDULE Name of Person or Organization: City of EI 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 I to "bodily in- the injury or damage arises has been This Insurance does nota apply y put to its intended use by any person jury" or"property damage"occurring after 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 PROGRESSIVE *W4944GREWi14c' PO BOX 94739 C04WERCIAZ CLEVELAND,OH 44101 658614 600 3 AB 0.403 PPACA01 M 004 000600 Named insured Policy number: 04315274-8 Underwritten by: Progressive Express ins MICHAEL J BELL August 23,2017 BELL EVENT SERVICES Policy Period:Aug 21,2017-Aug 21,2018 531 MAIN ST#228 Page 1 of 3 EL SEGUNDO,CA 90245 progressive.com 1111111111111111111111111'1'11111'.II111'1111111.11i1 Online Service Make payments,check billing activity,print policy documents,or check the status of a Commercial �►uto 1-8001895-2886 Insurance Coverage S u rn m a ry For custom day,7 daandys a claims service, This is your Renewal Declarations Page Your coverage began on August 21,2017 at 12:01 am, This policy expires on August 21,2018 at 12:01 a.m. This coverage summary replaces your prior one.Your insurance policy and any policy endorsements contain a full explanation of your coverage.The policy limits shown for an auto may not be combined with the limits for the same coverage on another auto,unless the policy contract allows the stacking of limits.The policy contract is form 6912(06/10).The contract is modified by forms 1303CA (04/08), 1198(01/04),5701(02/11'),4852CA (10/04),4881 CA (12/04)and Z228(01/11). The named insured organization type is a sole proprietorship. Outline of coverage Description t,lrnill9 Deductible Premium ......................... ......... ,. Liability To Others $5,194 .Bo i y Injury and Property y Qamae Liability 75O,ff0.c.o..m.b.i.n..e.d...s.i.ngle limit .. ..... UninsuredAJnderinsured Motorist „,,., Retecty Uninsured. .......................... otorist Property Damage fteyectetl . Subtotal policy premium $5,194.00 California Vehicl. ........................ ......................... . .. ............. ..... ...... ... . .,..... .... , , . .. ,. . ..... . . ..., e Assessment Fee .... ...........I....................... ........... Fees 8,fy 0fy Total 12 ...,.policy I f 281.04 5...... .,. e . ............. Disco -77800„ . . . .... Discount if aid in full 8 00 Total 12 montholio re iu if paid in full $4,50104 Important information An installment fee of$3.00 has been included in each payment.You may avoid paying additional installment fees by paying your remaining balance in full by the due date,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 Incon"11150,11 Pow 6489 CA(06110) ASC`"ll '" 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 Steven Griswold ....7.., I FAX ... ...,,,,,,. IAICNo, 25550 Hawthorne Blvd.#200 'MAII ntasteveoro griswOtldmsuranc (A/c Nay. PHONE Griswold&Griswold Insurance Agency Inc. 310 377-7172 e com INSURER(S)AFFORDING, COVERAGE NAIC,# 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: EI 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. IL7R, .. TYPE OF INSURANCE '1M SUER°I .. POLICY NUMBER IMMIDDY/YYYY) IMML,pD/yyyICY EX . n( JWy 4 l LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ II OAW GF 1'0 Rl d'irb CLAIMS-MADE ( OCCUR PREMISE'S YEa paer � or� (Inre? $ ..,. MED EXP(An one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ l POLICY PE O LOC PRODUCTS-COMP/ OP AGG $ OTHF R $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ fEa accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY ,,,,, AUTOS BODILY INJURYPer accident) $ HIRED I NON-OWNED PRoPF.(�'ry OAtv4A,dc AUTOS ONLY AUTOS ONLY (Per accidpni) $ $ UMBRELLA LIAB I OCCUR EACH OCCURRENCE $ CESS LIAB Y CLAIMS-MADE AGGREGATE $ DED L_ RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITYR A (Mandatory in NH)EXCLUDED? N/A A9WC861804 05/25/2017 05/25/201 S ��E L EACH ACCIDENT $ 1,000,000ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N STATUTE I E L DISEASE-EAEMPLOYEF $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/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 EI Segundo-City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street AUTHORIZED REPRESENTATIVE Room 5 c - EI 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 i.o3_9'a of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Blanket Waiver-AnY Personoror anizationforwhomthe All CAOperations � ......, Named Insured has agreed by written contract to rUrnish 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 Pollcy No. A9WC861804 Endorsement No. Insured Insurance Company Countersigned By ©1998 by the Workers'Compensation Insurance Rating Bureau of California.All rights reserved.