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PROOF OF INSURANCE (2018 - 2019) CLOSED DRAYTON INSURANCE BROKERS, INC. 2500 CENTER POINT ROAD,SUITE 301 POST OFFICE BOX 94067 BIRMINGHAM,ALABAMA 35215 BIRMINGHAM,ALABAMA 35220 TELEPHONE: (205) 854-5806 FAX: (205) 854-5899 CERTIFICATE OF INSURANCE NO. 813088 We certify that insurance is afforded as stated below. This Certificate does not aflinnatively or negatively amend,extend or alter the coverage afforded by the insurance policy and the insurance afforded is subject to all the terms,exclusions and conditions ofthe policy. INSURER Admiral Insurance Company POLICY NO.CA000002771-32 NAMED INSURED Pyro Spectaculars,Inc. Pyro Spectaculars by Souza Pyro Events,Inc. Pyro Spectacular Industries,Inc. Pyro Spectaculars Productions,Inc North American Fireworks Co.,Inc.(NAFCO) P.O.Box 2329 San Diego Fireworks Rialto,California 92377 POLICY TERM January 13,2018 to January 13,2019; Both Days 12:01 A.M. Standard Time COVERAGE Commercial General Liability: ® Occurrence Basis ❑ Claims Made Basis LIMIT OF LIABILITY $5,000,000 each occurrence,$10,000,000 general aggregate,$5,000,000 products/completed operations aggregate The limit of liability shall not be increased by the inclusion of more than one insured or additional insured. INSURED OPERATIONS Public fireworks display and special effects contractor It is certified that,if named below,this policy includes as Additional Insureds 1)the sponsor(s),promotcr(s),organizer(s)(including other entities having similar interests),of insured pyrotechnic events and/or 2)the owner(s)of real property(or barges)at which insured pyrotechnic events are held and/or 3)the owner(s),manager(s),tenant(s),mortgagee(s)(including other entities having similar interests),of buildings,stadiums, arenas and similar facilities at which insured pyrotechnic events are held and/or 4)the licensing or permitting authority,or other authority having jurisdiction,issuing licenses/permits for insured pyrotechnic events and/or 5)any other entity for which the insurance is required to be afforded under written contract. Coverage applies only as respects the legal liability of such Additional Insured(s)for bodily injury and property damage caused by the operations of the Named Insured. The insurance afforded any Additional Insured does not include coverage for any bodily injury or property damage arising from the failure of such Additional Insured to fulfill its obligations specified in its contract with the Named Insured. NAME&ADDRESS OF INSURED SPONSORS, PROPERTY OWNERS,LICENSORS City, of El Segundo 350 Main St. El Segundo, CA 90245 ADDITIONAL INSURED(S) City of El Segundo, Chevron El Segundo Refinery, El Segundo Recreation Park,El Segundo Fire Department and their officers, agents and employees when acting in their official capacity as such. DISPLAY LOCATION DISPLAY DATE(S) El Segundo Recreation Park July 4,2018 El Segundo,CA ' J It is certified that this policy requires a 30 day mutual notice of cancellation between the Insurer and the Named Insured. In the event of such cancellation we will endeavor to mail 10 days written notice to the Additional Insured(s),whose name and address is shown hereon,but failure to mail such notice shall impose no obligation or liability of any kind upon the insurer and/or the undersigned. DRAYTON INSURANCE BROKERS,INC. Avril 9.2018 �Siii:GERRESIDI„` W DATE OF ISSUE CALIFORNIA LICENSE NOw(�Ilt'664 Policy Number: CA000002771-32 CG 2010 07 04 Endorsement No. 120 Effective Date: April 9,2018 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULE D 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): Location(s)Of Covered Operations City of El Seginido, its officers, officials, employees, All locations for which coverage is required by agents, and volunteers. written contract. Information required to complete this Schedule,if not shown above,will be shown in the Declarations. A. Section II—Who Is An Insured is amended to This insurance does not apply to"bodily injury"or include as an additional insured the person(s)or "property damage"occurring after: organization(s)shown in the Schedule,but only with 1. All work including materials parts or equipment respect to liability for"bodily injury",It furnished in connection with such work on the damage"or"personal and advertising injury"caused, project(other than service,maintenance or in whole or in part,by: repairs)to be performed by or on behalf of the 1. Your acts or omissions;or additional insured(s)at the location of the 2. The acts or omissions of those acting on your covered operations has been completed;or behalf; 2. That portion of"your work"out of which the in the performance of your ongoing operations for the injury or damage arises has been put to its additional insured(s)at the location(s)designated intended use by any person or organization other above. than another contractor or subcontractor engaged in performing operations for a principal as a part B. With respect to the insurance afforded to these of the same project. additional insureds,the following additional exclusions apply: CG 20 10 07 04 0 ISO Properties,Inc.,2004 Page 1 of 1 Policy Number: CA000002771-32 CG 20 37 07 04 Endorsement No. 121 Effective Date: April 9,2018 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AI ITIONA , INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE _—........... ...w, � ................... lug Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations City of El Segundo,its officers,officials,employees,agents, All locations for which coverage is required by and volunteers. written contract. 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 include as an additional insured the person(s)or organization(s) shown in the Schedule,but only with respect to liability for"bodily injury"or"property damage"caused,in whole or in part,by"your work"at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the"products- completed operations hazard". CG 20 37 07 04 0 ISO Properties,Inc.,2004 Page 1 of 1 13 ACQR � CERTIFICATE OF LIABILITY INSURANCE1....4/912018 DATE(MM,DDIYYYn j 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 certificateholder In lieu of such endorsement(s), PRODUCER CON1ACt .. .... ",., Britton Gallagher One ClevelanCleveland ISAelu �0- �0 1375 East 9th Street ISI:I......................................... . . Cleveland OH 44114 INSURERS)AFFORDING COV AC# A� COVERAGE I ....,,, N... ..... In-SUraan, ..Cornparly, .0120......, ........... INSURED INSURER B.Mexurri,indar1)nity Company2074.-3.,.,...................... ,, INSURE San DiegotFlreworksInc. INSURERc,.. P.O.Box 2329 R°'' Rialto CA 92377 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:54573664 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 Ab6L Sd6ft PO.. .. LTR TYPE OF INSURANCE INSR MMD POLICY NUMBER (MMOYpjrChdY'MPtlF” ,(,f�p�BP Dr"Yyl LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIALOAK1ACai TO RENJTE' GENERALOR MED� XPSLa �crrgnur„',V,( 4 CLAIMS-MADE 1 ..JCCU LIABILITY EXP (Anyone person) $ ...., PERSONAL a ADV INJURY $ GENERAL AGGREGATE $ GEN1.AGGREGAT'E'LIMIT APraI WS PER: PRODUCTS-COMPIOP AGG $ POV.1S'Y' ., P'RO-. .,„ry LOC $ A AUTOMOBILE LIABILITY S18CA00031-181 1/13/2018 1/13/2019 50 4 Qi NROI� 41,000a00Q,,,,,,, XANY AUTO BODILY INJURY(Per person) $ ALL OWNED ILED BPODrt aItLYINJURY(Peraccident) $AUTOS pNON-OWNED OPERI- , HIRED AUTOS $ B UMBRELLA LIAB J�OCCUR EXC6017995 1/13/2018 1/13/2019 EACH OCCURRENCE $4.000.000$ 4 EXCESS LIAR CLAIMS-MADE AGGREGATE ,000,000 X . DEO RETENTION$. ... .,, . ... .... WO_:KERS COMPENSATION WC STATU- OTH- YBEXCLUDED' PR ANY NRIPRTNEED/E%ECUTIVE EACH 7 NIA -.^-E.L. �JI?'�'��I,1� �,. �............. I IN in H OFFICER/MEMBERYIN E.L.DISEASE IDEA EMPLOYEE...S..................................... .. I;R, DYSCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT .a........................ ...,,,,,,,,,,,,,,,,,I D DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more apace is required) CERTIFICATE'HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of EI Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street EI Segundo CA 90245 AUTHORIZED REPRESENTATIVE ©1988.2010 ACORD CORPORATION, All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD POLICYHOLDER COPY SP STATE P.O. BOX $192, PLEA5ANT0N, CA 94588 -FEUM ■ CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 04-09-2018 GROUP: POLICY NUMBER: 0803749-2017 CERTIFICATE ID: 1704 CERTIFICATE EXPIRES: 10-14-2018 10-14-2017/10-14-2018 CITY OF EL SEGUNDO SP 350 MAIN ST EL SEGUNDO CA 90245-3813 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer, We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2018-04-09 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF EL SEGUNDO ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-14-2002 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2018-04-09 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF EL SEGUNDO EMPLOYER PYRO SPECTACULARS, INC. SP PO BOX 2329 RIALTO CA 92377 [P11,SP] iREV.7-2014) PRINTED : 04-09-2018 ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION REP 25 803749-17 RENEWAL INSURANCE SP FUND 5-41-39-14 PAGE 1 HOME OFFICE SAN FRANCISCO EFFECTIVE APRIL 9, 2018 AT 12 . 01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING OCTOBER 14 , 2018 AT 12 . 01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME PYRO SPECTACULARS, INC. PO BOX 2329 RIALTO, CA 92377 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, PYRO SPECTACULARS, 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: APRIL 11 , 2018 2570 r Z!: .RCw.t�� AUTHORIZED REPRESEN"1. dVE PRESIDENT AND CEO SCIF FORM 10217 (REV.7-2014) OLD DP 217