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PROOF OF INSURANCE (2020) CLOSED DNY A� " 1' 2/12/201YY) 9 DATE(MM D THIS CERTIFICATE IS ISSUED AS A MATTER OFFN ORMAEONOONLLAAN CONFERS NO RIGHTS UPON RAN 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). PRODUCERa:UWu o'A'f"I S'UZie Nichols V NAME: ['"C_ NE 661)702-6000 FAX' teea>7o2-eoso LBW Insurance & Financial Services, Inc, INo Fxl1 ( rAd'C,Not 28055 Smyth Drive AD.RIILESS: suzien@lbwinsurance.com INSURER(S)AFFORDING COVERAGE NAIC q Valencia CA 91355 IINSURER A;Philadelphia Indemnity Insurance Compar 18058 INSUREDINSURER B:Travelers Insurance Company ,.„ 58501 IncrediFlix, Inc., INSURERC: dba: IncrediFlixINSURER D: 6623 Vista Loma - A INSURERE: W Yorba Linda CA 92886 �INSURERF: COVERAGES CERTIFICATE NUMBER:19/20 West 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 CONTRACTOR 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, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. .......... ADOL.SUSR POLtlCY EFF POLoCY'E�XP INSR TYPE OF INSURANCE LIMITS LTR p�� + rY„ POLICYNUMBER BE'd+w' tMMY�YDfYYYY1 pMMd1D�YY,t ., X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 MAMAA CLAIMS-MADE � OCCUR SES l a 5rcurrrremceh $ 100,000 X X PHPK1931699 3/1/2019 3/1/2020 MED EXP(Arty,one parnon) $ 5,000 N PERSONAL&ADV INJURY ^ 1,000,000 GIIENI AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE I 2,000,000 GENERALAGGREGATE POLICY I� a PRO ❑LOC 5 2,000,000 X dEC1' OTHER: $ AUTOMOBILE LIABILITY ft001IN "dawl'ISINOI.E.t,IMIT $ 1,000,000 ANY AUTO Y INJURY(Per person) $ A — ALL OWNED SCHEDULEDAUTOSAUTOSPHPK1931699 3/1/2019 3/1/2020 Y INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Pur acrAdentl - X UMBRELLA LIAB OCCUR «.. I EACH t.;fCU'iRR PACE 'S 2,000,000 A .� EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 DED I X I RVE',NTIION'S 7.0,00f) PHUB662081 3/1/2019 3/1/2020 I PER $ WORKERS COMPENSATION I, x S'F'A'T'41;FE I, V ERH AND EMPLOYERS'LIABILITY Y I N ANN''PROPRIETOR/PARTNER/EXECUTIVE N/A EL EACH ACC'IDEN1 S 1,000,000 OF�V CEWMEM(lER EXCLUDED? (Mandatory in NH) [7B2N357637 2{1/2019 2!1/2020 B p EL DISEA'S'E-EA EMPLOYEE $ 1,000,000, "ywi,describe undw O'ESCRiP'TION OF OP'ERA71ONS below 1 E:L DISEASE•PO $ A Abuse or Molestation �— PHPK1931699 3/1/2019 3/1/2020 Limit-perperson $ 1,000,000 Sublimit Limit-Aggregate $ 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of E1 Segundo is named as additional insured, but only as respects to the liability arising out the work performed by the named insured. Provisions for additional insured are outlined in the attached :additional insured endorsement and only apply when required by written contract. *10 day notice of (cancellation for non-payment of policy premium. ..,- CERTIFICATE HOLDER CANCELLATION hsheldon@elsegundo.org SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of E1 Segundo THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 401 Sheldon Street E1 Segundo, CA 90245 AUTHORIZED REPRESENTATIVE Letty Torres/SUZIE I M ©1988-2014 ACORD CORPORAT'IO'N. All rights reserved, ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401) POLICY NUMBER: PHPK1931699 COMMERCIAL GENERAL LIABILITY CG 20 26 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON SON 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): See Blanket Additional Insured Manuscript Endorsement x 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 B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III—Limits Of Insurance: with respect to liability for"bodily injury", "property If coverage provided to the additional insured is damage" or "personal and advertising injury" required by a contract or agreement, the most we caused, in whole or in part, by your acts or will pay on behalf of the additional insured is the omissions or the acts or omissions of those acting amount of insurance: on your behalf: 1. In the performance of your ongoing operations; 1. Required by the contract or agreement;or or 2. Available under the applicable Limits of 2. In connection with your premises owned by or Insurance shown in the Declarations; rented to you. whichever is less. However: This endorsement shall not increase the 1. The insurance afforded to such additional applicable Limits of Insurance shown in the Declarations. insured only applies to the extent permitted by law;and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 26 0413 0 Insurance Services Office, Inc.,2012 Page 3 of 3 Aftk TRAVELERS WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY MRTPORD CT 06183 ENDORSEMENT WC 04 0306(01) — 004 POLIICYNUMBER: UB-2N357637-19-42-C; WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA We have the fight 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- is agreement applies only to the extent thatyou perform work under awritten 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 s.00% OF THE CALIFORNIA WORKERS' COMPENSATION PREMIUM OTHERWISE DUE ON SUCH REMUNERATION. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION CITY OF EL SEGUNDO CAMP TO FOLLOW EUCALYPTUS 401 SE[ELDON 9TRSST EL SEGUNDO, CA 90245 DATEOFISSUE: 02-08-19 ST ASSIGN: Page 1 oft