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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