Loading...
PROOF OF INSURANCE (2019 - 2020) CLOSEDDRAYTON INSURANCE BROKERS, INC. 2500 CENTER POINT ROAD, SUITE 301 POST OFFICE BOX 94067 BIRMINGHAM, ALABAMA 35215 BIRMINGHAM, ALABAMA 35220 TELEPHONE: (205) 854-5806 FAX: (205) 854-5899 CERTIFICATE OF INSURANCE NO. 902088 We certify that insurance is afforded as stated below. This Certificate does not affirmatively or negatively amend, extend or alter the coverage afforded by the insurance policy and the insurance afforded is subject to all the terms, exclusions and conditions of the policy. INSURER Admiral insurance Company POLICY NO. CA000002771-33 NAMED INSURED Pyro Spectaculars, Inc. Pyro Spectaculars by Souza Pyro Events, Inc. Pyro Spectacular Industries, Inc Pyro Spectaculars Productions, inc. North American Fireworks Co., Inc. (NAFCO) P.O. Box 2329 San Diego Fireworks Rialto, California 92377 POLICY TERM January 13, 2019 to January 13, 2020; Both Days 12:01 A.M. Standard Time COVERAGE Commercial General Liability: ® Occurrence Basis ❑ Claims Made Basis LIMIT OF LIABILITY $5,000,000 each occurrence, $10,000,000 general aggregate, $5,000,000 products/completed operations aggregate The limit of liability shall not be increased by the inclusion of more than one insured or additional insured. INSURED OPERATIONS Public fireworks display and special effects contractor It is certified that, if named below, this policy includes as Additional Insureds 1) the sponsor(s), promoter(s), organizer(s) (including other entities having similar interests), of insured pyrotechnic events and/or 2) the owner(s) of real property (or barges) at which insured pyrotechnic events are held and/or 3) the owner(s), manager(s), tenant(s), mortgagee(s) (including other entities having similar interests), of buildings, stadiums, arenas and similar facilities at which insured pyrotechnic events are held and/or 4) the licensing or permitting authority, or other authority having jurisdiction, issuing licenses/permits for insured pyrotechnic events and/or 5) any other entity for which the insurance is required to be afforded under written contract. Coverage applies only as respects the legal liability of such Additional Insured(s) for bodily injury and property damage caused by the operations of the Named Insured. The insurance afforded any Additional Insured does not include coverage for any bodily injury or property damage arising from the failure of such Additional Insured to fulfill its obligations specified in its contract with the Named Insured. NAME & ADDRESS OF INSURED SPONSORS, PROPERTY OWNERS, LICENSORS City of El Segundo 350 Main St. El Segundo, CA 90245 ADDITIONAL INSURED(S)City of El Segundo, Chevron El Segundo Refinery, El Segundo Recreation Park, El Segundo Fire Department and their officers, agents and employees when acting in their official capacity as such. DISPLAY LOCATION El Segundo Recreation Park El Segundo, CA DISPLAY DATE(S) July 4, 2019 It is certified that this policy requires a 30 day mutual notice of cancellation between the Insurer and the Named Insured. In the event of such cancellation we will endeavor to mail 10 days written notice to the Additional Insured(s), whose name and address is shown hereon, but failure to mail such notice shall impose no obligation or liability of any kind upon the insurer and/or the undersigned. DRAYTON INSURANCE BROKERS, INC. March 15, 2019 DATE OF ISSUE „ . STRINGER, PRESID CALIFORNIA LiCENSE NO, A18664 Policy Number: CA000002771-33 CG 20 37 07 04 Endorsement No. I IS Effective Date: March 7, 2019 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations City of El Segundo, its officers, officials, employees, agents, All locations for which coverage is required by and volunteers. written contract. 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 include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products - completed operations hazard". CG 20 37 07 04 �) ISO Properties, Inc., 2004 Page 1 of 1 E3 Policy Number: CA000002771-33 CG 20 10 07 04 Endorsement No. 114 Effective Date: March 7, 2019 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON 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): Location(s) Of Covered Operations City of El Segundo, its officers, officials, employees, All locations for which coverage is required by agents, and volunteers. written contract. 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 include as an additional insured the person(s) or organization(s) 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: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 13 AC<>RC 7►re CERTIFICATE OF LIABILITY INSURANCE L.316�20 19 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. ......... S 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 j certificate holder in lieu of such endorsement(s). PRODUCER PHONE T61a:u.�.M-658....71 Q0...................................,„,,..`......,....,.�.��X Britton Gallagher � �Np............. .Tmm......^..................... One Cleveland Center, Floor 30 E-MAIL 1375 East 9th Street -App!!!! 1 ....•-............ Cleveland OH 44114 INSURER(S) .,,,,,,, _ ...,..._w .. .,.,., ........... ... .... ..... .... AFFORDING COVERAGE NAIC p ,NSURERAM%i.UR. lldr�t�l�,__Q.QmpanV ......,,. 2,674 ... ........ INSURED INSURER B:EV.ere.StNe„ttg.nal,ln,w_r.ar e_C9.r1 any w.. 10,120 ...., ..., ,. IPyro Spectaculars Inc. INSURERC: San Diego Fireworks INSURER D: P. O. Box 2329 Rialto CA 92377 "NSURER E,: INSURER F: COVERAGES CERTIFICATE NUMBER: 1574093055 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. .. (NSR (NSR LTR TYPE OF INSURANCE . .. $I yam.. POLICY NUMBER gIWP�M,01LICYPYEEFF PCSLICM EsiP fMMfODJMY"fYl J LIMITS GEN'E'RAL LIABIL)'rY EACH OCCURRENCE5 15AMAuP TO kiNWtG".............. ... ........ , COMMERCIAL GENERAL LIABILITYOCCUR p �M,B.5.5�1ffmSss" ?r°EI \ $ ,. .... l (_ i ED EXP (Any one person) $ .......... .................._.. PERSONAL... INJURY . $ .. .............,..... ... ... ENERAL AGGREVAT... E $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGO ... $ ..� POLICY�. ...� P�C�'Lt'X:' B AUTOMOBILE LIABILITY SIBCA00031-191 1/13/2019 1113/2020-U"11114LU 'N'” c L "A r 1,000,000 x'ANY AUTO BODILY INJURY (Per person) $ .......... ALL OWNED SCHEDULED BODILY INJURY (Per accident) S AUTOS _.................� ...,.,.,.,.,.,..................... X X... NON®OWNED PIzOPERI Y DAMAGE E � j ............. HIRED AUTOS ........... AUTOS A I UMBRELLA LIAB X OCCUR P, IEXC6017995 1113/2019 1/13/2020 EACH OCT EACH OCCURRENCE $4 000 000 ... X CE B � CLAIMS -MADE E $4 0 0 000 DEBES..RETENTILON$ $ WORKERS COMPENSATION WCSl'A1'i OIH- AND EMPLOYERS' LIABILITY YIN 1U- T ITS, „ R� ..._,W .............. .... ....,.. ANY E.L.EAUv CH AC ENT $ BER EARTNERIEXECUTNE Ll N 1 A ( ry” ) L DISE,A3EEA, EMPLOYEE. E.L............ $ If underSns, describe under ........................._ ns,OF OPERATIONS below, E L. DISEASE, POLICY LIMIT $ DESCRIPTIDN OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Certificate Holder is Named as an additional insured. CERTIFICATE (HOLDER City of EI Segundo City Clerk 350 Main Street EI Segundo CA 90245 ACORD 25 (2010105) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICYHOLDER COPY SP P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 03-07-2019 CITY OF EL SEGUNDO SP 350 MAIN ST EL SEGUNDO CA 90245-3813 GROUP; POLICY NUMBER: 0803749-2018 CERTIFICATE ID: 1859 CERTIFICATE EXPIRES: 10-14-2019 10-14-2018/10-14-2019 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer, We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to whrech it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy ell Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2019-03-07 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF EL SEGUNDO -� ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-14-2002 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2019-03-07 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF EL SEGUNDO EMPLOYER PYRO SPECTACULARS, INC. SP PO BOX 2329 RIALTO CA 92377 [P1Y,SDI (Rev.7-20141 PRINTED : 03-07-2019 ENDORSEMENT AGREEMENT ADDITIONAL INSURED EMPLOYER REP 25 803749-18 RENEWAL SP 5-41-39-14 PAGE 1 HOME OFFICE EFFECTIVE MARCH 7 2019 AT 12.01 A.M. SAN FRANCISCO r ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME PYRO SPECTACULARS, INC. PO BOX 2329 "ON,----- RIALTO, CA 92377 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT CITY OF EL SEGUNDO IS HEREBY NAMED AS AN ADDITIONAL INSURED EMPLOYER ON THIS POLICY BUT ONLY AS RESPECTS EMPLOYEES WHOSE NAMES APPEAR ON THE PAYROLL RECORDS OF PYRO SPECTACULARS, INC. (HEREIN CALLED THE PRIMARY INSURED) WHILE THOSE EMPLOYEES ARE ENGAGED IN WORK UNDER THE SIMULTANEOUS DIRECTION AND CONTROL OF THE PRIMARY INSURED AND THE ADDITIONAL INSURED EMPLOYER. IT IS FURTHER AGREED THAT THE PAYMENT OF THE FULL PREMIUM DUE AND PAYABLE UNDER THIS POLICY SHALL REMAIN THE SOLE RESPONSIBILITY OF THE PRIMARY INSURED. NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: MARCH 11, 2019 AUTHORIZED REPRESE'N'T EVE PRESIDENT AND CEO SCIF FORM 10217 IREV.4-2010 0015 OLD DP 217 ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION REP 25 803749-18 RENEWAL SP 5-41-39-14 PAGE 1 HOME OFFICE EFFECTIVE MARCH 7 2019 AT 12.01 A.M. SAN FRANCISCO i AND EXPIRING OCTOBER 14, 2019 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME PYRO SPECTACULARS, INC. PO BOX 2329 RIALTO CA 92377 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, CITY OF EL SEGUNDO WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, PYRO SPECTACULARS, INC. IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER. IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH EMPLOYEES SHALL BE INCREASED BY 03%. NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: MARCH 11, 2019 2570 w lJos yrs+ x�vl 'l AUTHOMUD REPRESENT WE PRESIDENT AND CEO SCIF FORM 10217 (REV.4-20181 OLD DP 217