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PROOF OF INSURANCE (2018 - 2019) CLOSED ,4f1�"C>R0 CERTIFICATE OF LIABILITY INSURANCE I DAT111/09/09//22018018 Y) � PRODUCER THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION East Main Street Insurance Services,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Will Maddux HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR PO Box 1298 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Grass Valley,CA 95945 Phone:(530)477-6521 Email:info@theeventhelper.com INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Evanston Insurance Company 35378 Acts of Creation INSURER B: Chris Shoemaker,dba: PO Box 602601 INSURER C: Santa Clarita,CA 91380 INSURER D: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ..................... INSRIADD'U POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR.INSRD TYPE OF INSURANCE DATE(MM/DD/YY) DATE(MMMONY) GENERAL LIABILITY EACH OCCURRENCE INCLUDES $ 1,000,000 ..„V INjyA Y&PROPERTY DAMAGE A Y ^X COMMERCIAL GENERAL LIABILITY 3DS5466-Ml520006 11/22/2018 12/27/2018 MED EXP(An e, rso ^M $, ..... 5,000 CLAIMS MADE OCCUR PERSONAL&"ADV INJURY $ 1,000,000 . ...............__ .x.. .Host... .q..............................................�............................. 3DS5466 M1520006 ii/22/2018 12/27/2018 Doo Liquor Liability GENERAL AGGREGATE $ , ....'G`EN'E AGGREG.. Xm........ ire,ITITITITITITITIT TIPRODUCTLE COMP/OP AGG $ 1,000,000 000. POLICY Retail JECT APPLIES OC. DEDUCTIBLE ................ ................... Retail L/glsor Liability ... . AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) .............,...........................,. PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ry AGG., $. ----- ......... OTHER THAN EA ACC .$ ......... ............. ANY AUTO i AUTO ONLY: .........---- ........................._....., EXCI¶IESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ i, $ DEDUCTIBLE $ RETENTION $ ..,,LI,,.... $ WC STATU- LIABILITY E L WORKERS ION AND ORY IMITS_ E EMPLOYERS' EACHACCIDENT $,,,„,,,,,,,,,,,,,,,,,,,,,,,,,,, ANY PROPRIETOR/PARTNER/EXECUTIVE „^ OFFICER/MEMBER EXCLUDED? E1.DISEASE-EA EMPLOYEE $ If yes,describe under SPECIAL PROVISIONS below EL DISEASE-POLICY LIMIT V $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Certificate holder listed below is named as additional insured per attached CG 20 26 07 04. Attendance:1500,Event Type:Holiday Event-Not Haunted-No Charge for Admission/Invite Only. Waiver of Subrogation applies per attached MEGL 0241-01 05 16. Primary/Non-Contributory wording applies per attached CG 20 01 04 13. Additional Insured: THE CITY OF EL SEGUNDO,ITS OFFICERS,OFFICIALS,EMPLOYEES,AGENTS&CERTIFIED VOLUNTEERS ;r CERTIFICATE HOLDER CANCELLATION CITY OF EL SEGUNDO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION PUBLIC LIBRARY DATE THEREOF,THE ISSUING INSURER WILL ENBEAM6R T9 MAIL 30 DAYS WRITTEN ATTN:LIBRARY DIRECTOR 111 W.MARIPOSA AVENUE NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,61614 FAI16161RETO 90 604KN” EL SEGUNDO,CA 90245 JJJJJJ AUTHORIZED REPRESENTATIVEpppppp"”"������f� I ACORD 25(2001108) 0 ACORD CORPORATION'1988 Policy Number:3DS5466-M1520006 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATIOIN. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s)Or Organizations) THE CITY OF EL SEGUNDO, ITS OFFICERS,OFFICIALS,EMPLOYEES,AGENTS&CERTIFIED VOLUNTEERS 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 organi- zations)shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omis- sions 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 COMMERCIAL GENERAL LIABILITY III POLICY NUMBER:3DS5466-M1520006 KEV EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORMxr` SCHEDULE Name Of Person Or Organization: THE CITY OF EL SEGUNDO, ITS OFFICERS,OFFICIALS, EMPLOYEES,AGENTS&CERTIFIED VOLUNTEERS Additional Premium: $ see Cert ............................ The following is added to Condition 8. Transfer Of Rights Of Recovery Against Others To Us under Section IV — Commercial General Liability Conditions: We waive any right of recovery we may have against any person or organization shown in the Schedule of this endorsement. This waiver applies only to the person or organization shown in the Schedule of this endorsement. All other terms and conditions remain unchanged. MEGL 0241-0105 16 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. POLICY NUMBER: 3DS5466-M1520006 COMMERCIAL GENERAL LIABILITY CG 20 0104 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE 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 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 l li loom CI LL- co LLJ LL itIN CL 0LLJr CL UJ CO) VIIIIIIIII'LU 5 LL WUJO ocno o ' �' � CITY OF EL SEGUNDO WORKERS' COMPENSATION DECLARATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SUBJECTS AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN LABOR CODE § 3706, INTEREST, AND ATTORNEY'S FEES. I affirm under penalty of perjury under the laws of California one of the following declarations: (__) I have and will maintain a certificate of consent of self-insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Labor Code§ 3700 for the performance of the work set forth the agreement with the City of EI Segundo. Policy No, (_)I have and will maintain workers'compensation insurance as required by Labor Code§3700 for the performance of the work for which the agreement with the City of EI Segundo is executed. My workers' compensation insurance carrier and policy number are: Carrier Policy Number Expiration Date Name of Agent Phone# ( f �lI certify that, in the performance of the work set forth in the agreement with the City of EI Segundo, I will not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the vyr6 r"s° compensation provisions of Labor Code § 3700 1 must imme Si nature ofApplicantly comply pith those"j5rvocnsWor th, '%r�eement will automaticanly become void.Date 9 r Agreement for: Dated; Reviewed by: 1