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PROOF OF INSURANCE (2018 - 2018) CLOSED
'` "' CERTIFICATE OF LIABILITY INSURANCE DATE,MM/ �" 11/29/2017 Y) 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 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 ondorsement(s). PRODUCER CONTACT Jerry Glenn Western Sentry Insurance Brokers NAMV�PHONE p ""' . A/c,No, BO5-577-8522 AIC Nod,,,,,,,,,,,,,,-_ 4212 E Los Angeles Ave#9 f� """"""'""' ""' ADDRESS westernsentry@gmail com .............................................__ w_ CUSTOMER ID: Simi Valley CA 93063 ___,.e. Ww.._... ................. INSURER(,,,,,,,)„AF,FORDING COVERAGE NAL.........................................,., INSURED INSURERA: American Insurance Co/US Risk Bell Event Services Inc INSURER B: Fireman's Fund Insurance Co/US Risk 531 Main St #228 ”."""""""""'.""""�` INSURER C: EI Segundo CA 90245 INSURER D: INSURER 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 PA D CLAIMS, 'ILTR ............................... 'J51 OL S ""UBR " rit;Y LFF PULIGY FXP . „�"... TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDDIYYYY),,,,,,,(MMIDD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE I$ 1,000,000 COMMERCIAL GENERAL LIABILITY a''"hM"w,GE 1`0 RENTED $ 100,000 l ra,Er1RSlm45,Ccrvurrncx: CLAIMS-MADE [Z OCCUR MED EXP(Any one person) I$ 1,000 A x x 8H5ABC80913070 10/25/17 10/25/18 a PERSONAL&ADV INJURY Is 1,000,000 GENERAL AGGREGATE I$ 2,000,000 „ ............................ -,......... t'aI:.P„'V.AGGREGATE LIMIT APPLIES PER. PRODUCTS I$ 2,000,000 PROJ- I �... POLICY ECTLOC AUTOMOBILE LIABILITY COMBINED SIIJGLE LIMIT ANYAUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY(Per peasmir. $ SCHEDULED AUTOS BODILY INJURY(Per accident) $ PROPERTY DAMAGE HIREDAUTOS (Per accident) $ NON-OWNED AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ .......... DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WCurATU- OT'H- EMPLOYERS'LIABILITY YIN TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A - (Mandatory in NH) IIIi A I-W� ,,,,,,,,.,,$ If yes,describe under •••-••••••• DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ B Entertainment Equipment Rented MSF 07007860 9/25/17 9125/18 ($2,500 Ded,) $ 300,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Additional Insured: City of EI Segundo,its officials and employees Insurance is primary/noncontributory CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of EI Segundo EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH 350 Main St Rm 5 THE POLICY PROVISIONS. EI Segundo CA 90245-3813 AUTHORIZED REPRESENTATIVE Certified Signature------------------------Jerry Glenn I ©1988-2009 ACORD CORPORATION.All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD Additional Insured - esignalled Person or Organization - AB 93 15 05 04 Policy AlTlendment Section 11 kn Insured: BELL EVENT SERVICES INC lollicv 8 HS ABC 80913070 Producer: U.S. RISK, INC HVlnke Dav 11/1/17 Schedule Narne of Person or Or}anizalion City of El Segundo,Its Officials&Employees City Clerk 350 Main St Rm 5 El Segundo—CA 90245 (11'no entry appearsaho%e. information rel.jlkliral w completefliv, �%fll lic sl' it In ON Dodaano", as applicable to this Endors;.-nient.) Tha liolkiming, i,, add,:d Ho llm,w I .. WA�o II., "llu lilima,,j 'o rob +0,141k"d 11W rssl. rmaz4r JrC,pCCl! pI,l In dic BvIN.0lv,, the lolicw: lQ %0010 a 1p':'.1114 lIll.. Or Whn h an hAwried U'Skxlilm 11h k t,twa,%lvj tl,, oy tk,614n0 nh all i0"Urcd the,Nr�4hll 01, 011_,.IIHIIAI&ln 'howl ilp th". 1�ilk i ji u I a rR 1rta v I[Ila all v I'k im p 11111 l", It 1:l it PROGRESSIVE FFRE1F PO BOX 94739 C0Af'/19!F`7S'"C14L 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 111111111111.I ..111.1.111111.X11'1'11111' I1111i111111.11i1 Online Service Make payments,check billing activity,print policy documents,or check the status of a Commercial Auto claim. 1-800-895-2886 Insurance Coverage Summary For customer ser24 hours a day,7days claims laim service, This is your Renewal Declarations Page Your coverage began on August 21,2017 at 12:01 a.m, 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(02/1 t),4852CA (10/04),4881 CA (12/04)and Z228(01/11). The named insured organization type is a sole proprietorship. Outline of coverage Description Limits Deductible Premium Liability To ....... .......... .......... .. .. .... . .. . .. . . . . .. .... .. . . .there .$5,194 Bodily Injury and Property Damage Liability �1500 0 romhin�d single lilmit re.d�. .nderinsured Motorist . .......... f�Ir:tMe ., .. . ....... . —....ue ................. , Uninsured otoristProperty Damage ..... riejected Subtotal policy premium $5,194A0 ........... ... ......... ....... .... . California Vehicle Assessment Fee 7,04 . . .. ......... .. ........ ....... ..... Fees 80.00 ...... an fs ...........$5,281.04. Total 12. .on lc re...iee Discount if paid in full _778.00 Total 12 monthpolicy premium if paidin full $4,503.04 Important information about fees 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 C®oHn'u�ai'' Foam 6489 CA,(06160) AC CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) r.. '' 1 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(les) 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. PHONE,IAICINo EMt); (310)377-7172 jAAic,No); 25550 Hawthorne Blvd.#200 E-MAIL sdeven riswoldinsLarairuce.cr�nro AraPRES ;, .. g ., INSURER(S),AFFORDING COVERAGE NA,I,C,#,,,,,,,,,,,,,,,,, Torrance CA 90505 INSURER A: NATIONAL LIAB&FIRE INS CO 20052 INSURED INSURER B Bell Event Services INSURER C 531 Main Street#228 INSURER D: INSURER E a EI Segundo CA 90245 INSURER 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 IN . TYPE OF INSURANCE IAD ODL'8UBR POLICY F I' POLICY EXP cD...µntn POLICY NUMBER IMMIOD DDIYYVVI LIMITS DAMAGE U RRENCE $ C H AC E CLAIMS-MADE LIABILITY EACH OCU COMMERCIAL GENERAL RENTED OCCUR ( y person) �$ MED EIXP.((Anone rson aperson $, ... PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JEC' LOC PRODUCTS I d'Or h4'C $ -,i;;OM,,,,;,,, OTHER $ AUTOMOBILE LIABILITYcafAOINED s d (Ea° ) ANY AUTO BODILYperson) Per .x ( p onp.,�$ OWNED SCHEDULED AUTOS BODILY INJURY(Per acudent) S HIRED AUTOS ONLY NON-OWNED PROPEI''41"Y DAMAGE, AUTOS ONLY AUTOS ONLY Pup,agxiq,nrrl) $ I $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ c DED .. RETENTION$ _ S . WORKERS COMPENSATIONR - AND �Y d X STATUTFPEEROIH (Mandatory in NH) N ANY TOR/PART EL EACH ACCIDENT $ 1,000,OOO A OFFICER/MEMBER EXCLUDEY PROPRIETOR/PARTNER/EXECUTIVE ER/EXECUTIVE NIA A9WC861804 05/25/2017 05/25/2018 D EL DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT S 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 CANC'ELLATIO'N 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 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_�a of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Blanket Waiver-Any person ororganimtionfbrivhomthe All CAOpcmtions Named Insured has agreed by wrillen contract to runtish this le 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. A9WCB61804 Endorsement No, Insured Insurance Company Countersigned By ©1998 by the Workers'Compensation Insurance Rating Bureau of California.All rights reserved.