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PROOF OF INSURANCE (2019 - 2019) CLOSED DATE(MM/DDIYYYY) A " CERTIFICATE OF LIABILITY INSURANCE I' 11i05i2018 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(ies)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 Jerry Glenn NAME: Western Sentry Insurance Brokers PHONE 805-577-8522 'FAX AIC,No, IAIC,Nol: 4212 E Los Angeles Ave#9 E-MAIL t ADDRESS westernsentry@gmail.com -.._......... ........ PRODUCER CUSTOMER 10: Simi Valley CA 93063INSURE AFFORDING COVERAGE NAIC# _vW ................... _ _ American Insura.............. INSURED INSURER A: nce Co/US Risk Bell Event Services Inc INSURER B: Firemans'Fund Insurance Co/US Risk 531 Main St #228 INSURER C: EI Segundo CA 90245 I INSURER D: �I 'INSURER E: N - INSURER F: COVERAGES CERTIFICATE NUMB' .E BEAR: REVISION NUMBER: THIS IS TO CERTIFY THATTHE 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 PAD CLAIMS. IN SR TYPE OF INSURANCE IN'�SR 'WVO POLICY NUMBER fMM'POWYYYY1 fMMI ICY EXP ADDL'V"sDkSR PULSCY EN-F PU DLl/YYYYI, LIMITS LTR 15IAW StE Vrr7�cc�ir ene ,r § 1;000,000 GENERAL LIABILITY . COMMERCIAL GENERAL LIABILITY 100,000; CLAIMS-MADE I OCCUR I MED EXP(Any one person) s 1.000 A x SH5ABC80924919 10/25/18 10/25/19 I PERSONAL BADV INJURY S 1,000,000 GLNI.RAIL,;GGH17 3,'4TE S 2,000,000 .GE'SN'LA';i&':z'REGATF LIMIT AI''I'I IES PIR PRODUCTS-COMP/OP AGO S 21000,000 �,.,.V POLICY w sJ- LOU AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S (Ea accident) ANY AUTO ALL OWNED AUTOS V BODILY INJURY(Per person) I,S I ALL OWNED AUTOS I BODILY INJURY(Per accident) S wROI..'LRI Y DAMAGE HIREDAUTOS (I'Err uG-.r..iJcni) S NON-OWNEDAUTOS I S S UMBRELLA LIAB OCCUR I EACH OCCURRENCE I s EXCESS LIAB CLAIMS-MADE AGGREGATE I S I DEDUCTIBLE EM RETENTION S A S WORKERS COMPENSATION AND � �1:1 tOR`LIIA/8` UfH- PLOYERS'LIABILITY Y/N TCYIZvL.IPIII7S BR ANY PROPRIETOR/PARTNER/EXECUTIVE NIA EACH ACCII)I NT" S OFFICER/MEMBER EXCLUDED (Mandatory in NH) I,F I )1s,[AIL I A fMPLGPLE s If yes,de,svi�bo under - I D SCRIPT'ION'OF OPERATIONS below I S I T E,L,DISEASE-POLICY LIMIT B Rented Equipment MSF07203777 9/25/18 9/25/19 ($2,500 Ded) $ 300,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of EI Segundo EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH Recreation and Parks Dept THE POLICY PROVISIONS. 401 Sheldon St AUTHORIZED REPRESENTATIVE EI Segundo CA 90245 Certified Signature------------------------Jerry Glenn 9 O 1988-2009 ACORD CORPORATION.All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD 11"anz @ Policyholder Message - 386636 08 17 Named Imsured:HL"LL EVENT SERVICES INC Policy Number:8 H5 ABC 80924914 Important Information for Policyholders If you have questions about your policy, please contact your independent agent or broker. If you have additional questions, you can contact the company issuing the policy listed on your Declarations page at the following address; Allianz Global Corporate & Specialty 225 W. Washington Street, Suite 1800 Chicago, IL 60606-3484 Toll Free Telephone: 1-(888) 466-7883 Toll Free Telephone for Claims: 14800} 870-8851 Website: http:+'/urvw.agcs.allianz.com/ Website Address for Support Services: http;liwww.aga;s.alliennz caro;global-officesiunited-s%tes/support-servimi The information above supersedes any other Company contact information you may have received with your pol- icy. 39606&17 C 2017 A li4w Global R"s US InSUM-ca COMParry. All 69W reeerond. UZYGOGUH p0 ff? Fimmajis Fund POLIC)' NUMBER 8 E5 ABC 8092 49 19 THE AMERICAN INSURANCE COMPANY, NOVATO, CA (18) Named TnsuTed Sequential Endorsement Number 002 BELL EVENT SERVICES INC AMERICAN BUSINESS COVERAGE CHANGE ENDORSEPUE!,NT Effective 11/07/18, 12:01. A.M. , Standard Time at the address of the insured in, an ul-hr.�r t.oan changes shown, al.1 other pEe rerna.�..n,-. i.rt fu].A. forc.� and offt?,cL., P.r..emAum arr,,� shi,mvn PREMIUM SUMMARY: ADDITIONAL PREMIUM DUE NOW Terrorism Risk Insurance Act ("The Act") - Certified Acts Coverage All Coverages Subject to the Act Excl WC and Umbrella Covered $0.00 THE FOLLOWING CHANGES APPLY TO PROPERTY/LIABILITY COVERAGE THE FOLLOWING OTREE PROPER Y/.LLABI L I TY ENDORSEMENT Is ADDED... ENDORSEMENT AB931.5 1 0504 ADDITIONAL INSURED - DESIGNATED PERSON Of? ORGANIZATION AB 93 15 05 04 17 NAME OF PERSON OR ORGANIZATIOr] CITY OF' EL SEGUNDO RECREATION AND P&RKS DEPARTNIENT 401. SHELDON STREETS ET., SEGUNDO, CA 90245 THE FOLLONING 13 ADDED TO PART I - Wi-ls:) IS AN INSURED IN THE BUSINESS LIABILITY SECTION OF THE POLICY� NHO IS AN INSURED (SECTION II) IS AMENDED TO INCI.,UDE AS AN INSURED THE PERSON OR ORGATITZATTON SHOWN IN THE SCHED11LE AS AN INSURED PUT ONLY NITH RESPECT TO LIABILITY ARISING OUT OF YOUR OPERATIONS OR PREM1SES OWNED BY OR REATED TO YOU., Countcnignatere of Authorized Agent: Dew Producer U.S. RISK, LLC 25201. PASEC DE A.r....ICIA, •STE 265 LAGUNA HILLS CA 92653 F,Tir) OF CHA11GE ENDORSEMENT Page I Additional Insured - Designated Person or Organization - AB 93 15 05 04 Policy Amendment Section II Insured: BELL EVENT SERVICES INC Policy Number: 8 H5 ABC 80924919 Producer: U.S. RISK, LLC Effective Date: 11-01-18 Schedule Name of Person or Organization (If no entry appears above, information required to complete this Endorsement will be shown in the Declarations as applicable to this Endorsement.) The following is added to Part I - Who Is an Insured Schedule as an insured but only with respect to liability in the Business Liability Section of the Policy: arising out of your operations or premises owned by Who Is an Insured(Section II) is amended to include or rented to you. as an insured the person or organization shown in the This Fonn must be attached to Change Fndorsement when issued after the policy is written. Onc of the Fireman's Fund Insurance Companies as named in the policy - �—Wl di . �4 L, Secretary President AB9315 5-04 AC CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY' ,. 06/05/2018 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(ies) 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Steven Griswold ON Griswold&Griswold Insurance Agency Inc. (AiCaa,,Extll (;'31 t$)377-7172 FAX No I; 25550 Hawthorne Blvd.#200 ADDRESS: stever griswoldin'srlrance.com INSURER(S)i AFFORDING COVERAGE NAIC# Torrance CA 90505 INSURERA: NATIONAL LIAB&FIRE INS CO 20052 INSURED I INSURER B: ., Bell Event Services INSURER C 531 Main Street#228 INSURER D; INSURER E EI Segundo CA 90245 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, TYPE OF INSURANCE ADDLCSUE LIMITS SHOWN MAY HAVE BEEN REDUCED IC YEFF IPO AIMS. ILTIEXCLUSIONS AND CONDITIONS OF SUCH tri POLICY NUMBER nm�Mr rvomm��s E%PLIMITS YYYYN COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S JAI,1A,,',E:TO FtE'T86 CLAIMS-MADE OCCUR PHEIASF£,(Ea uczw rrencg), $ MED EXP IAny rine parwn') S - PERSONAL&ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATEPRO- $ P�HOLIIC;Y f_...._ y J LOC PRODUCTS-COMP/OP AGG S $ OTHER C91I nGqtlAT AUTOMOBILE LIABILITY IEaarcigen!k ' S ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED ;r+_ PE if T Y'VD,r+�MAGE S J AUTOS ONLY AUTOS ONLY (Pgr ) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE '9 EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED F'FTEWTV)N$ ER WORKERS COMPENSATION X "TA r:JH, AFFICERJWEP4IBERlEX»d'LUDE YIN EL EACH ACCIDENT Pl.d;rYE $ 1,Cb01Y,000 A �Or�ar�r�ae� In NH) Y.. �ASaL �Ia„ AND EMPLOYERS'LIABILITY BTC $ 1.000,. 10 NIA A9WC936380 05/25/2018 05 25 I�f r`,s.dews bo un1T}��r " DVSCRIPTIO; J OF OPERATIONS be�lr� E L.i:tll'SE,ASF•r 04.IC rt'LItlNI"& 'S 1 MUM DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required( Waiver of Subrogation filed in favor of Certificate Holder per attached Blanket Endorsement,WC 04 03 06 ................. CERTIFICATE IHOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of EI Segundo-City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street AUTHORIZED REPRESENTATIVE EI Segundo CA 90245 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 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 frorn anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization narned 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 1.0_3 _% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Blanket Waiver-Any person or organization for whom the All CA Operations Named Insured has agreed by written contract to furnish this waiver 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 Policy No A9WC936380 Endorsement No. Insured Insurance Company Countersigned By U1998 by the Workers'Compensation Insurance Rating Bureau of California.All rights reserved. PROGRESSIVE lrl6' E 1F PO BOX 94739 COMMERCIAL CLEVELAND,OH 44101 649901 377 3 AB 0.408 PPACA01 M 004 000377 Named insured Policy number: 04315274-9 Underwritten by: Progressive Express Ins MICHAEL 1 BELL August 23,2018 BELL EVENT SERVICES Policy Period:Aug 21,2018-Aug 21,2019 531 MAIN ST#226 Page 1 of 3 EL SEGUNDO,CA 90245 progressive.com rlrllllrllllllFIN llrllll111111 lllllll1Ill I1111rlrl1lrlJill I Online Service Make payments,check billing activity,print policy documents,or check the status of a claim. Commercial Auto 1-80 �p Summary 0-895-2886 Insurance Coverage S u a ry Fday,7 da For customer service and claims service, ys a This is your Renewal Declarations Pae �-- 9 Your coverage began our August 21,2018 at 12:01 a.m. This polui.y exp4es oin August 21,2019 at 12:01 a.m. This coverage summary replaces your prior one.Your insurance policy and any policy endorsements contain a full explanation of your coverage.The policy limits shown for an auto may not be combined with the limits for the same coverage on another auto,unless the policy contract allows the stacking of limits.The policy contract is form 6912(06/10).The contract is modified by forms 1303CA (04/08), 1198(01/04),5701 (02/1 f),4852CA (10/04),4881 CA (12/04)and Z228(01/11). The named insured organization type is a sole proprietorship. Outline of coverage Description .... Deductible ,. Premium ... ............ ... Liability To Others $3,764 Bodily Injury and Property Damage Liability $750,000 combined single limit Uninsured/Undennsured Motorist Rejected .................. . Uninsured Motorist Property DamageRe ected ................................................. .... ..... . .. .....1.................. .................. Comprehensive 1' See Auto Coverage Schedule Limit of liability less deductible „ . . Collision 256 See Auto Coverage Schedule Limit of liability less deductible Subtotal policy premium $4,093.00 . . ................................. .......... ......... California Vehicle Assessment Fee 15,28 Fs 8'6'.60' eel.... .. . .............. ............. .... ........... Fee Total 12.month policy...em „m and fees $4,1. ..... p pr.... ?8.28 Discount if paid in full -614.00 Total 12 month policy premium if paid in full $3,564.28 Important information about fees - An installment fee of$3.00 has been included in each payment.You may avoid paying additional installment fees by paying your remaining balance in full by the due date.You may reduce the amount you pay in installment fees by paying your premium in larger amounts and fewer installments.Please call 1-800-895-2886 for details. The following additional fees may apply: Fee for returned checks or refused payments $20.00 Continued Form 6489 CA(06/10)