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PROOF OF INSURANCE (2018 - 2018) CLOSED DATE(MMIDDIYYYY) �.,.ACCOR" CERTIFICATE OF LIABILITY INSURANCE I 9/27/2017 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 he 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'ndorsemont(s). PRODUCER kCONNTACT Sandy Badir Public Insurance Agency PHONEE g1r (310)234-8600 FAX No):! (424)24B-1291 10941 W Pico Blvd EMAIL A'DDRE'SS° INSUR'ERIS)AFFORDING COVERAGE NAIC# Los Angeles CA 90064 INSURERA:Colony Insurance company INSURED INSURERB:Financial Indemnity Company Advanced Party Rentals, Inc. INSURERC:State Compensation Insurance Fund 11962 Prairie Ave INSURER D: Hawthorne INSURER E: CA 90250 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1712400763 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 TYPE OF INSURANCE 'ADbL SuBR POLICY EFF I POLICY EXP LIMITS LTR. t D POLICY NUMBER dvl OD/Y�Y' IMMIDDPNYY'Y'A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE X OCCUR DAMAGE TORLN7ErJ 100,000 ��R(,�egIISaSES(Ea ecrt:uo're,n¢;ey, $ X 101-PKGO050188-01 3/16/2017 3/16/2018 MED EXP(Any one Pai'saaa7) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- JECT LOC PRODUCTS-COMP/OPAGG $ 1,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED 1682525 03/16/2017 03/16/2018 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS (Per accident) $ $ UMBRELLA LIAB OCCUR EACH OCCuRRENf'�E S, EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEL) RF,IENTWIN S S WORKERS COMPENSATION X PE OI"H AND EMPLOYERS'LIABILITY YIN S1"ATI,p E', FR ANY PROPRIETOR/PARTNER/EXECUTIVE Fy NI,A 9126985-16 03/10/2017 03/10/2018 EL EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? Y C (Mandatory in NH) u EL [flSEA.SE"EA EMPLOYE E S 1,000,000 It yes„describe under D S(::lr RPT'ION or OP E,RAi'IOf4$bcgrrvnv EL 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) Party Rental- Event Oct 07, 2017 'Certificate holder is Additional Insured per the Blanket A/I wording on Form U156 of the policy.-all persons or organizations as required by a written contract or agreement with the named insured" The City of E1 Segundo, its officers, officials, employees, agents, and volunteers are named additional insured as respects general liability and this insurance is primary and noncontributory with any other insurance of the additional insured; and waiver of subrogation applies as respects workers compensation as CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of E1 Segundo, its officers, THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN officials, employees, agents and volunte ACCORDANCE WITH THE POLICY PROVISIONS. Recreation Park 401 Sheldon S t. AUTHORIZED REPRESENTATIVE E1 Segundo, CA 90249 ...........- Elizabeth Gomez/ELI .,.°;°r`""'�"";""� �... .... ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) COMMENTS/REMARKS required by written contract, per endorsements attached. I OFREMARK COPYRIGHT 2000, AMS SERVICES INC.. 101 PKG 0050188-01 ENDT.#003 EFF: 01/20/2017 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES R CONTRACTORS - LAINIET COVERAGE INCLUDING PRIMARY Y 1 NON-CONTRIBUTORY AND WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s)or Organization(s) (Additional Insured): Location(s)of Covered Operations: All persons or organizations as required by a written Locations as required by a written contract or contract or agreement with the named insured. agreement with the named insured. A. SECTION II —WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule for whom you are performing operations 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: 1. your acts or omissions; or 2. the acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: Additional Insured Contractual Liability "bodily injury" or "property damage" for which the additional insured(s) are obligated to pay damages by reason of the assumption of liability in a contract or agreement. Finished Operations at Work "bodily injury" or "property damage" occurring after: 1. all work, including materials, parts or equipment furnished in connection with such work, on the project (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. Negligence of Additional Insured "bodily injury" or"property damage" arising directly or indirectly out of the negligence of the additional insured(s). U156A-0313 Includes copyrighted material of ISO Properties, Inc., Page 1 of 2 with its permission. 101 PKG 0050188-01 ENDT.##003 EFF: 01/20/2017 C. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 4. Other Insurance is amended and the following added: The insurance afforded by this Coverage Part for the additional insured required by a written contract or agreement with the named insured is primary insurance and we will not seek contribution from any other insurance available to that additional insured. D. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 8. Transfer Of Rights Of Recovery Against Others To Us is amended and the following added: We waive any rights of recovery we may have against any person or organization because of payments we make for injury or damage resulting from your ongoing operations or "your work" done under a contract with that person or organization and included in the "products-completed operations hazard" if: a. you agreed to such waiver; b. the waiver is included as part of a written contract or lease; and c. such written contract or lease was executed prior to any loss to which this insurance applies. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED, U156A-0313 Includes copyrighted material of ISO Properties, Inc., Page 2 of 2 with its permission. _ ENDORSEMENT AGREEMENT BROKER COPY Y WAIVER OF SUBROGATION 9126985-17 RENEWAL NA HOME OFFICE 7-66-75-33 SAN FRANCISCO PAGE 1 OF 1 ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC EFFECTIVE OCTOBER 13, 2017 AT 12.01 A.M. STANDARD TIME OR THE TIME INDICATED AT AND EXPIRING MARCH 10 , 2018 AT 12.01 A.M. PACIFIC STANDARD TIME ADVANCED PARTY RENTALS, INC. 11962 PRAIRIE AVE HAWTHORNE, CA 90250 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, ADVANCED PARTY RENTALS, 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%. 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: OCTOBER 16, 2017 2570 ��+ L r/1— ' " ��r-ate a AUTHORIZED R'EPRESEN'T 'IVP PRESIDENT AND CEO SCIF FORM 10217 (REV.7-2014) OLD DP 217 BROKER COPY 9126985-17 RENEWAL NA PLEASE KEEP THIS ENDORSEMENT WITH YOUR POLICY Dear Policyholder: These endorsements amend and are part of your policy. Please keep them with your documents for future reference. If you have any questions concerning these endorsements, Please contact your local State Fund office.