No preview available
PROOF OF INSURANCE (2018 - 2018) CLOSED JAMES-4 OP ID: MID CERTIFICATE OF LIABILITY INSURANCEI DATE(MMIDD/YYYY) 09/29/2017 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(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), i PRODUCER CONTACT 323-782 84 Hanasab Insurance Services Inc NAME° MichelleQuintero 54 ) CA License:OE08574 q�wlGC�iv,Ext): FAX,No: 323-297-4500 625 S.Fairfax Avenue �-AweAIL Los Angeles,CA 90036 ADDRESS: S Michelle Quintero iNsuRERI AFFORDING COVERAGE NAIC#I INSURER A:New York Marine&General Ins 16608 INSURED James Thomas Productions INSURER B:New York Marine&General Ins 16608 Events&Entertainment, Inc. INSURER C:New York Marine&General Ins 16608 ChrisSchuman .................... ................................................................... 1300 hland Avenue#204 INSURER Ma hattl enBeach,CA 0266 INSURER.. s E ......... .... 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. liKk ...F(O'r1L SU'E'P..................................................................................................................I PbLICY EFF POLICY EXP TYPE OF INSURANCE ."LIMITS.................................................................,,,,,, LTR INSD VJVD POLICY NUMBER IMMIDDIYYYY) (MMIDO/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 ---- AEAM SES F,.,,�.,,�NTED �G�........... $ ............... UU,000 CLAIMS-MADE X OCCUR X PK201700001202 05102/2017 05/02/2018 1 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POILICY COMP/OP AGG 5 c�r�o- ......1,000,000 LOC PRODUCT....s X... 01HER Event $ AUTOMOBILE LIABILITY COMBdNED'fl E LIMP $ 1,000,000 (I R..w�m,cc,I"d"ev),ISihVGL........... A ANY AUTO X AU201700001026 05/02/2017 05/02/2018 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED (per DAMA' X X 'E $ HIRED AUTOS ( X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 -------- A EXCESS LIAB CLAIMS-MADE UM201700001748 05/02/2017 05/02/2018 AGGREGATE $ 5,000,000 DED RETENTION$ $ , '' PER OH- WORKERS COMPENSATION E L EIEACH ERANDPYAROPRIERS� R7NII'FEYE4IIWC201700009207 06/27/2017 06/27/2016 LACCIIENT $...................................000,000ANIA (Mandatory mNH) EL DISEASE-EA EMPLOYEE $ 1,000,000 Ifes,describe under D ISCRIPTIO'N:OF C)PERAI'IONS below E L DISEASE-POLICY LIMIT S 1,000,000 A Business Personal PK201700001202 05/0212017 05/02/2018 Limit 100,000 Property Ded: 1,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder is included as additional insured as their interest may appear but only as respect's to negligent acts of the named insured. Waiver o' subrogation is included In favor o''the certificate holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CI of EI Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g ACCORDANCE WITH THE POLICY PROVISIONS. EI Segund Unified School District 641 Sheldon Street AUTHORIZED REPRESENTATIVE EI Segundo,CA 90245 ©1988-2014 ACORD CORPORATION. All rights reserved, ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: PK201700001202 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATE PERSON ORORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) City of EI Segundo and the EI Segundo Unified School District added as additional insureds. All said insurance shall be primary and noncontributing. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to in- clUde as an additional insured the person(s) or organi- zation(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 your acts or omissions or the acts or omis- sions of those acting on your behalf. it A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 ©ISO Properties, Inc., 2004 Page 1 of 1 ❑ WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule City of El Segundo, E1 Segundo Unified School District 641 Sheldon Street E1 Segundo, CA 9024 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. Endorsement No. 001 Insured James Thomas Productions WC201700009207 Premium Insurance Company Countersigned by M%cheVw-QuZintero New York Marine & General Insurance WC 00 03 13 (Ed.4-84) ©1983 National Council on Compensation Insurance.