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PROOF OF INSURANCE (2019 - 2019) CLOSED • OP ID: RL
D/YYYY)
E(MM/D
CERTIFICATE OF LIABILITY INSURANCE DATE
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 Phone: 909-792-9190 CONTNAME Rose Gareau
Redlands 672 PlumInsurance Brokers Fax: 909-792-9195 PHONE ;909-792-9190 FAX No):
DQE s. .... �..._...dla dsib.com .
Redlands,CA 92374 PRODUCER
r AF GC.............
Gareau Insurance Services,Inc PR
L n
EVE-1
INSURERS AFFORDING COVERAGE NAIC#
INSURED G &C Event Productions INSURER A:Scottsdale Ins.Co. 41297
Interactive Games&Creations INSURER 8:American Zurich Ins.Company 40142
1030 Gladstone St INSURER C:Evanston Insurance Co. ................_...............
Azusa CA 91702 ......... 35.37.8......................___
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 PAID CLAIMS.
IIVSCt". .. ..... ..... .. ........... CYNUMBER IMO.....__.. - ........__._.. ......--- -................
LTR TYPE OF INSURANCE INSR_WVD.v, POL
........................ LICY EFF POLICY EXP
LIMITS
I MIDD/YYYYI (MMIDD/YYYY1,,,,_„
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00
AX COMMERCI L GENERA
� L LIABILITY OCCUR X X BCS0037271 08/09/18 08/09/19 MRO ESP ( y ocgp�r�son)$ 100,000
excl
CLAIM
ADE
m.......................... PERSONAL&ADV INJURY
$........................ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $
2,000,000
X POLICY LOC
PRO-CT $
.........
LIMIT
COMBINED SINGLE
AUTOMOBILE LIABILITY $
(Ea accident)
............
ANY AUTO BODILY INJURY ............................
Per person) $
A _..............
ALL OWNED AUTOS
................ BODILY INJURY(Per accident) $
SCHEDULED AUTOS
PROPERTY DAMAGE
.............
HIRED AUTOS (Per accident) $
................
NON-OWNED AUTOS
00
XUMBRELLA LIAB
X EACH„O RREN....C.....E..................._ $ 9, ,
.... .EXCESS LIAB CLAIMS-MADE AGGREGATE $ 9,000,
000
. ... .A XLS0107969 O8/O9/16 O6/O9/19
......
DEDUCTIBLE
RETENTION $ $
WORKERS COMPENSATION X WC STATU- I OTH-
AND EMPLOYERS'LIABILITY ,„"'(( f' ""
/N
B ANY PROPRIETOR/PARTNER/EXECUTIVEY WC10-17-911-02 04/01/18 04/01/19 E,L EACH ACCIDENT $ 1,000,000
OFFICERIMEMBER EXCLUDED? �� N/A X BLANKET WAIVER OF SUBRO
E,L,DISEASE-EA EMPLOYEE
(Mandatory in NH) $ 1,000,000
If yes,describe under _I
DESCRIPTION OF OPERATIONS below
E L,DISEASE-POLICY LIMIT $ 1,000,0
C Rented Equipment IMW19195 06/15/18 06/15/19 Blanket 300,000
All Risk Floater Max item 60,000
DESCRIPTION OF OPERATIONS I LOCATIONS/VEH'IC'LES(Attach ACORD 101,Additional Remarks Schedule,,If macro apace Is required)
The City of El Se ndo and, its officials and emplo aes are named
additional insures on a primary mora-contributory alis with a waiver of
subror ration, as required by written agreement, per the attached endts.
A workcomp waiver of subrogation has been orders and will follow from
carrier. _
CERTIFICATE HOLDER CANCELLATION
ELSEGUN
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of EI Segundo
350 Main Street AUTHORIZED REPRESENTATIVE
EI Segundo, CA 90245
u u
©1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD
Policy Number: BCS0037271
COMMERCIAL GENERAL LIABILITY
CG 20 33 0413
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL I NSU'RED - OWNERS, LESSEES OR
CONTRACTORS - AUTOMATIC STATUS WHEN
REQUIRED IRED IIN CONSTRUCTION AGREEMENT WITH YOU
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these
include as an additional insured any person or additional insureds, the following additional
organization for whom you are performing exclusions apply:
operations when you and such person or This insurance does not apply to:
organization have agreed in writing in a contract or
agreement that such person or organization be 1. "Bodily injury", "property damage" or "personal
added as an additional insured on your policy. and advertising injury" arising out of the
Such person or organization is an additional rendering of, or the failure to render, any
insured only with respect to liability for "bodily professional architectural, engineering or
injury", "property damage" or "personal and surveying services, including:
advertising injury"caused, in whole or in part, by: a. The preparing, approving, or failing to
1. Your acts or omissions; or prepare or approve, maps, shop drawings,
2. The acts or omissions of those acting on your opinions, reports, surveys, field orders,
behalf; change orders or drawings and
specifications; or
in the performance of your ongoing operations for b. Supervisory, inspection, architectural or
the additional insured. engineering activities.
However, the insurance afforded to such This exclusion applies even if the claims against
additional insured: any insured allege negligence or other wrongdoing
1. Only applies to the extent permitted by law; and in the supervision, hiring, employment, training or
2. Will not be broader than that which you are monitoring of others by that insured, if the
required by the contract or agreement to "occurrence" which caused the "bodily injury" or
provide for such additional insured. "property damage", or the offense which caused
the "personal and advertising injury", involved the
A person's or organization's status as an rendering of or the failure to render any
additional insured under this endorsement ends professional architectural, engineering or
when your operations for that additional insured surveying services.
are completed.
CG 20 33 0413 © Insurance Services Office, Inc., 2012 Page 1 of 2
Insured Copy
2. "Bodily injury" or "property damage" occurring C. With respect to the insurance afforded to these
after: additional insureds, the following is added to
a. All work, including materials, parts or Section III —Limits Of Insurance:
equipment furnished in connection with The most we will pay on behalf of the additional
such work, on the project (other than insured is the amount of insurance:
service, maintenance or repairs) to be 1. Required by the contract or agreement you
performed by or on behalf of the additional have entered into with the additional insured;
insured(s) at the location of the covered or
operations has been completed; or
b. That portion of'your work"out of which the 2. Available under the applicable Limits of
Insurance shown in the Declarations;
injury or damage arises has been put to its
intended use by any person or organization whichever is less.
other than another contractor or This endorsement shall not increase the
subcontractor engaged in performing applicable Limits of Insurance shown in the
operations for a principal as a part of the Declarations.
same project.
Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 33 0413
Insured Copy
COMMERCIAL GENERAL LIABILITY
CG 20 0104 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY AND NIONCONTRIBUTORY
OTHERS CONDITION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
The following is added to the Other Insurance (2) You have agreed in writing in a contract or
Condition and supersedes any provision to the agreement that this insurance would be
contrary: primary and would not seek contribution
Primary And Noncontributory Insurance from any other insurance available to the
additional insured.
This insurance is primary to and will not seek
contribution from any other insurance available
to an additional insured under your policy
provided that:
(1) The additional insured is a Named Insured
under such other insurance; and
CG 20 0104 13 Insurance Services Office, Inc., 2012 Page 1 of 1
Insured Com,
POLICY NUMBER: BCS0037271 COMMERCIAL GENERAL LIABILITY
CG 24 04 05 09
RIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Name Of Person Or Organization:
ANY PERSON OR ORGANIZATION WITH WHOM THE INSURED HAS AGREED TO WAIVE
RIGHTS OF RECOVERY, PROVIDED SUCH AGREEMENT IS MADE IN WRITING AND
PRIOR TO THE LOSS
Information required to comolete this Schedule. if not shown above. will be shown in the Declarations.
The following is added to Paragraph 8. Transfer Of
Rights Of Recovery Against Others To Us of Section
IV—Conditions:
We waive any right of recovery we may have against
the person or organization shown In the Schedule
above because of payments we male for Injury or
damage arising out of your ongoing operations or
"your work'done under a contract with that person
or organization and Included in the"products-
completed operations hazard". This waiver applies
only to the person or organization shown in the
Schedule above.
CG 24 04 05 09 4 Insurance Services Office, Inc., 2008 Page 1 of 1 ❑
Insured Copy
0 DATE(MMIDDIYYYY)
CC) CERTIFICATE OF LIABILITY INSURANCE 0911112018
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.
IMP'OiRTANT: 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 right's to the certificate holder in lieu of such en'd'orsement($).
�CC�^ONT CT . .Davalos
PRODUCER 1(HO Hp,�EXI) 626- �,,,, ... .,�,�,� „ ..._._... ... „la ,fid- .,....... -....05 ... .
uI 2 en 826 583 10
Stafefarm Nadine Kureghian Insurance Agency 626-583-1000
State Farm Insurance A001Rl ssr Iacg, ' --------
192
, LLt 26'.o1amLL _.r.
192 S Rosemead Blvd II SURE'RIS;hAFFOROIIWCOVERAGE NAIC0
Y Pasadena,CA 91107N u : State Farm Mutual Automobile Insurance Company 25178
INSURED
INSURER B
Interactive Games&Creations.Inc. INSURER C:
4343 Temple City Blvd INSURER D
Temple Ci CA 91780
P IY. IN-SORER E
INSURER F
COVERAGE'S CERTIFICATE NUMBERREVISION 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.
ILTli TYPE OF INSURANCE a 1-od SUaI� POLICY N _ .
WJ I UMBER P�DWCYEFI POLI myopryEXP
YN LIMITS
_....V
COMMERCIAL BENE LIABILITY CLAIMS-MADE RAL°OCCURITG+
EACH OCCURRENCE
1 000 000
MED EXPI�pe onMar.l..,,..j„5.................._....... _._.....,.......
PERSONAL&ADV INJURY S
OE'N'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $
OTHER &;:i:",; P,,: PRODUCTS-COAIPIOP AGG S
IPS�
M S
AUTOMOBILE LIABILITY OMIDINEO SINGLE LIMIt
( is Aenty y b 1.000,000
INJURY(Per person) 5
A I OWNED I SCHEDULED X 426-6189-A05-75A 1 5 BODILY INJURY(Peraccadenq
ANY AUTO BODILY
.(.ROP S
'X'
,AUTOS ONLY AUTOS
°�a°a� AUTOS OAtlLX' P���..Y�rC��I�AGE $,
HIRED t+00N-S7"+° ED
✓ AUTOS ONLY
b S
UMBRELLA LIAR p OCCUR EACH OCCURRENCE 5
EXCESS LIAR CLAIMS-MADE AGGREGATE 5
DED p "RETEIM1NTION S ....._
' i � $
WORKERS COMPENSATION PER
AND EMPLOYERS'LIABILITY YIN STATUTE 'ERH
......,,,,,,
ANYRI PARTNER7EXECUTIVE F-1E.L.EACH.EACHACCIDENT'JT 5
OFFICERIMEMBCERIMEMBER EXCLVDED7 NIA
'
(Mandatory in NH) E.L.DISEASE-EA E61PL0'1?I;I;X S
If Yse,describe under
DESCRIPTION OF OPERATIONS below E1 DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more apace Is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ADDITIONAL INSURED ACCORDANCE WIT E POLICY PROVISIOJJS.
i !1
CITY OF EL SEGUNDO
CITY CLERK 350 MAIN STREET ROOM 5 AUTHORIZED REPRS'SENTATIVE
EL SEGUNDO,CA 90245-3813 ;°y
©1968-201ACORIrC00PO TION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of AC' RD
1001466 132849 12 03-16-2016
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 per-
form 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 $0 of the California workers' compensation premium
otherwise due on such remuneration.
SCHEDULE
Person or Organization Job Description
IN FAVOR OF: Waiver of Subrogation in the favor of the certificate holder for the
City of EI Segundo following project:Ongoing Work
350 Main Street
EI Segundo,CA 90245
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: 09/07/2018 Policy No: WC 10-17-911-02 Endorsement No:
Insured: Interactive Games and Creations Inc.
Insurance Company: American Zurich Insurance Company Countersigned by
WC 04 03 06
Copyright 1983 National Council on Compensation Insurance