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PROOF OF INSURANCE (2019 - 2020) CLOSED0 DATE (MMIDDIYYYY) '0.RL.R P CERTIFICATE OF LIABILITY INSURANCE 05/13/2019 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 Denise K Hudson Insurance Agency, Inc tateFarm License # OB86530 1045 W Katella Ave Ste 240 Orange, CA 92867 INSURED WESTERN A/V INC 1592 N BATAVIA ST STE 2 ORANGE, CA 92867 CONTACT Denise Hudson NAME PHONE 714-633-6118 1hAX WC, IPp, Fart) ........................................... „ INC,No) E-MAIL ADP44p.@eom enlse enls u sone O UDING COVERAGE NAIC # INSURER A:State Farm General Insurance Company 25151 INSURER B :State Farm Mutual Automobile Insurance Company 25178 INSURER C INSURER D INSURER E: INSURER F; COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TOCERTIFY 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 POLIC ESLIMITS OWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AWE SUSttd POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INS[-y,Vn I POLICY NUMBER WMMOAYYYY] IMM MOrYY'YY,, LIMITS COMMERCIAL GENERAL LIABILITY Y A 92 -EX -5166-6 05/16/2019 05/16/2020 OCCURRENCE $ 2,000,000 -X x _EACH DAMAGE10 RENTED 300,000 CLAIMS -MADE OCCUR PREMISE,(Es,gc:d,pwmrarlre) $,,,,,,, C MED EXP (Any one person)1 $ 5,000 „ PERSONAL &ADV INJURY � $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X, POLICY tCCT I_[MC $ ----- 4,000,000 .. BUSINESS PROP $' $ 234,500 OTHFR gAUT AUTOMOBILE LABILITY 611 1801 -D06-75 04/06/2019 10/06/2019 COMBINED SINGLE LIMIT �.$.......... 1,000,000II AN BODILYNJURY Per arson) $ X„ ALL OWNED .,,,,....... X SCHEDULED ..............................., BODILY INJURY (Per accident) $ AUTOS HIRED AUTOS X AUTOS NON -OWNED I� AMAOE.... I ....„ .,. a er occ $ ...PROP'EkfY gs,il ELLA A XX OCCUR 92 -XC -0351-6 12/14/2018 12/14/2019 EACH OCCURRENCE $ 5,000,000 p EXCESS SSLIAB, f L, CLAIMS -MADE AGGR,,,,,,,,, GATE $ ,DRETE, NTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? F-1 N I A (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below 92 -C7 -U203-2 01/01/2019 01/01/2020 X I. STOTH- A„TIJTF.- ----.PER I I.175 } E1, EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E,L. DISEASE -POLICY LIMIT I $ DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUDIO VISUAL SYSTEMS INTEGRATION CERTIFICATE HOLDER Information Systems Department City of EI Segundo 350 Main Street EI Segundo, CA 90245 CANCELLATION 1,000,000 1,000,000 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 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 1001486 132849 9 02-04-2014 V1" PolicyNo. 92 EX5166 6 3535—FB8A CMP -4787 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY CMP -4787 WAIVER OF TRANSFER OF RIGHTS OR RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92 EX5166 6 ,,,I . Named Insured: WESTERN A/V INC 1592 N BATAVIA ST STE 2 ORANGE CA 92867 3554 Name And Address Of Person Or Organization: CITY OF EL SEGUNDO - CITY, IT'S OFFICIALS, EMPLOYEES - INFORMATION SYSTEMS DEPARTMENT 350 MAIN STREET EL SEGUNDO CA 90245 The following is added to Paragraph 10.b. of SECTION I AND SECTION II — COMMON POLICY CONDITIONS: We waive any right of recovery we may have against the person or organization shown in the Schedule because of payments we make for injury or damage arising out of: a. Your ongoing operations; or b. "Your work" done under 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. All other policy provisions apply. CMP -4787 1006225 137715.1 11-19-2013 ©, Cop,ynghl, State Farm Mutual Automobile Insurance Company, 2008 Includes copy6ghted material of Insurance Services Olfc(;e, Inc., with its permission, 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 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 otherwise due on such remuneration. w. ,w w i w w CITY OF EL SEGUNDO-CITY, ITS OFFICIALS, EMPLOYEES - INFORMATION SYSTEMS DEPARTMENT 350 MAIN STREET EL SEGUNDO, CA 90245 5 % of the California workers' compensation premium Schedule SERVICE PROVIDER/AUDIO VISUAL SYSTEM SERVICE CALL 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 06/03/19 Policy No. 92 C7U203 2 Endorsement No. WC 04 03 06 Insured WESTERN A/V Insurance Company State Farm Fire and Casualty Company 1592 N BATAVIA ST STE 2 ORANGE CA Countersigned By WC 04 03 06 (Ed. 4-84) 1007722 124282.2 01-25-2019