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PROOF OF INSURANCE (2019 - 2019) CLOSED
AC40R" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) kk.�' I 2/23/2018 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). PRODUCER CONTACT Lett Torres NAME: Y LBW Insurance & Financial Services, Inc. PHONE (661)702-6000 FAX (661)702-6060 WC,No,ExOp: (APC,No): 28055 Smyth Drive E.-MAIL lettyt@lbwinsurance.com A'DDR'ESS:, Y INSURERIS)AFFORDING COVERAGE NAIC# Valencia CA 91355 INSURER A:Philadelphia Indemnity Insurance 18058 INSURED INSURER B IncrediFlix, Inc., DBA: IncrediFlix INSURERC7 3042 Enterprise Street, Unit E INSURERD: INSURER E Costa Mesa CA 92626 INSURER F; COVERAGES CERTIFICATE NUMBER:2018 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 INSRADDL SUBR 'POLICY EFF POLICY EXP LTR TYPE OF INSURANCE lu"m WVn POLICY NUMBER IMMIDWYYYYI IMMI/DDIYYYYI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE X OCCUR aREMilc��L p("I I$tCd�Yf 100,000 I'�REMI„st;'�(Ea oec,In�rc�nce) $ X X PHPK1763145 3/1/2018 3/1/2019 MED EXP(Any one person) $ 5,000 AM Best: A++ (Superior) 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 S 2,000,000 OTHER: $ AUTOMOBILE LIABILITY 1,0108INED SI'I~931-t LIMIT' g 1,000,000 (Ea:accndont) A ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED PHPK1763145 3/1/2018 3/1/2019 BODILY INJURY(Perident $ AUTOS AUTOS accident) NON-OWNED PR,C)PER3Y'DAMAGE X HIRED AUTOS X AUTOS (Per $ $ X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 DEC) X R(:7ENTIONS 3.01000 PHUB614371 3/1/2018 3/1/2019 ,5 WORKERS COMPENSATION PER OT'H AND EMPLOYERS"LtABYIN STATUTE E.R' IN ANY PrC)P'I�,I&,T0R�,PAR,rpiE#VEXECI,J't'VE E L EACH ACCIDENT 5 Of'RCERWE'MBE.R E'XC'LUDED? N I A ('Mandatory In NH) E L DISEASE-EA EMPLOYEE $ IIP Yes,det csrbo under D SC:RIP'I'I'ON OF OPE,RAFIW*boloww 1 E L DISEASE-POLICY LIMIT A Abuse or Molestation PHPK1763145 3/1/2018 3/1/2019 Limit-per person $1,000,000 Sub 1 imi t Limit-Aggregate $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of E1 Segundo is named as additional insured, but only as respects to the liability arising out the work performed by the named insured. Provisions for additional insured are outlined in the attached additional insured endorsement and only apply when required by written contract. *10 day notice of cancellation for non-payment of policy premium. �rN CERTIFICATE HOLDER CANCELLATION hsheldoneelsegundo.org SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 401 Sheldon Street ACCORDANCE WITH THE POLICY PROVISIONS. E1 Segundo, CA 90245 AUTHORIZED REPRESENTATIVE Letty Torres/LETTYT ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) POLICY NUMBER: PHPK1609687 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, ADDITIONAL INSURED - DESIGNATED, 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) See Blanket Additional Insured Manuscript Endorsement 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 or- ganization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property dam- age" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 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 t PI-MANU-1 (01/00) IBIS JENUORSEN T CHA�NQEB JHE POLICY, PLEME BEAU IT CAREFULLY CG2026 Blanket Additional Insured Wording PER CURRENT ADDITIONAL INSURED CERTIFICATES HELD ON FILE WITH COMPANY. IF NO ADDITIONAL INSURED CERTIFICATE IS ON FILE, ADDITIONAL INSURED STATUS WILL NOT APPLY. IT IS UNDERSTOOD AND AGREED THAT THE CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED, BUT ONLY AS RESPECTS ITS LIABILITY ARISING OUT OF THE ACTIVITIES OF THE NAMED INSURED. All other terms and conditions of this Policy remain unchanged. Page 1 of 1 TRAVELERS WORKERS COMPENSATION AND ONE TOWER SQUARE HARTFORD, CT 06163 EMPLOYERS LIABILITY POLICY CHANGE DOCUMENT WC 99 99 98 ( A) POLICY NUMBER: (IJUB-4380T67-2-18) CHANGE EFFECTIVE DATE: 02-01-18 NCCI CO CODE: 13579 INSURER: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA INSURED'S NAME: INCREDIFLIX INC This change is issued by the Company or Companies that issued the policy and forms a part of the policy. It is agreed that the policy is amended as follows: An absence of an entry in the premium spaces below means that the premium adjustment, if any, will be made at time of audit. ADDITIONAL PREMIUM $ NIL RETURN PREMIUM $ NIL ADDITIONAL NON-PREMIUM $ NIL RETURN NON-PREMIUM $ NIL The following endorsement charge is added to the schedule: STATE OF CA LOCATION 001 01 WAIVER OF SUBROGATION SEE ENDT WC 04 03 06 (01) -004 ESTIMATED ANNUAL CLASSIFICATION CODE PREM. BASIS RATE PREMIUM SPECIFIC WAIVER SEE ENDT WC 04 03 06 (01) 004 CITY OF EL SEGUNDO WAIVER CALCULATION IS BASED ON CLASS CODE(S) PREMIUM X RATE. 0930 105 0.0500 5 Balance to Waiver Minimum Premium is assigned to read: STATE ANNUAL PREMIUM CA 241 DATE OF ISSUE: 01-12-18 BF CHANGE NO: 001 PAGE 001 OF MORE POL. EFF. DATE: 02-01-18 POL. EXP. DATE: 02-01-19 OFFICE: PAYROLL 70A PRODUCER: AUTOMATIC DATA PROC INS XV770 COUNTERSIGNED AGENT TRAVELERSJ WORKERS COMPENSATION AND ONE TOWER SQUARE HARTFORD, CT 06183 EMPLOYERS LIABILITY POLICY CHANGE DOCUMENT WC 99 99 98 A POLICY NUMBER: (IJUB-4380T67-2-18) The following endorsements are added: WC 04 03 06 (01) -004 WC 89 06 14 (00) -001 The following endorsement is deleted: DATE OF ISSUE: 01-12-18 BF CHANGE NO.: 001 PAGE: 002 OF LAST POL. EFF. DATE: 02-01-18 POL. EXP. DATE: 02-01-19 OFFICE: PAYROLL 70A STASSIGN: PRODUCER: AUTOMATIC DATA PROC INS XV770 TRAVELERS.!' WORKERS COMPENSATION ONE TOWER SQUARE AND HARTFORD, CT 06183 EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 89 06 14(00)— 001 POLICY NUMBER: (IJUB-4380T67-2-18) POLICY INFORMATION PAGE ENDORSEMENT Item 3.D. Endorsement numbers is changed to read "See Change Document or Information Page Schedule" ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. DATE OF ISSUE: 01-12-18 ST ASSIGN: TRAVELERV WORKERS COMPENSATION AND ONE TOWER SQUARE HARTFORD, CT 06163 EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 04 03 06 (01) — 004 POLICY NUMBER: (IJUB-4380T67-2-18) 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 5.000 % OF THE CALIFORNIA WORKERS' COMPENSATION PREMIUM OTHERWISE DUE ON SUCH REMUNERATION. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION CITY OF EL SEGUNDO MOVIE CAMP CAMP EUCALYPTUS MARCH - AUGUST 2018 401 SHELDON STREET EL SEGUNDO, CA 90245 4 ...M. DATE OF ISSUE: 01-12-18 ST ASSIGN: WORKERS COMPENSATION NET RATE SUPPLEMENT NAMED INSURED: INCREDIFLIX INC QUOTE NO: (IJUB-4380T67-2-18) POLICY PERIOD: 02-01-18 TO 02-01-19 DATE: 01-12-18 EXPENSE CONSTANT- FLAT CHARGE: $ INCLUDED LOSS CONSTANT- FLAT CHARGE: $ INCLUDED TOTAL- FLAT CHARGES: $ INCLUDED CLASS STATE LOCATION CODE DESCRIPTION NET RATE CA 001 0930 SPECIFIC WAIVER .0000 CA 001 0930 SPECIFIC WAIVER .0000 CA 001 0930 SPECIFIC WAIVER .0000 CA 001 0930 SPECIFIC WAIVER .0000 CA 001 8868 COLLEGES OR SCHOOLS-PRIVATE- 2.5652 CO 001 8868 SCHOOL: PROFESSIONAL .8184 CT 001 8868 SCHOOL: PROFESSIONAL .8795 MA 001 8868 SCHOOL: PROFESSIONAL .9650 MD 001 8868 SCHOOL: PROFESSIONAL .3420 NJ 001 8868 SCHOOL: PROFESSIONAL 1.8811 NY 001 8868 SCHOOL: PROFESSIONAL .8673 WUNM2D06 PAGE NO.: 1