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PROOF OF INSURANCE (2022) CLOSEDDATE (MM/DD/YYYY) C " CERTIFICATE OF LIABILITY INSURANCE 2/5/2021 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 endorsements . PRODUCER TACT NA David Irwin NAME; Keystone LC PHONE 4 �1F gx9r) VC 473-2151M7 E-MAIL1995PoinTowshDriveDlvinKeystorenrsgtp.dan..... Northumberland INSURED PA 17867 Little League Baseball Risk Purchasing Group, Incorporated EL SEGUNDO LL PO Box 112 EI Se undo CA 90245 COVERAGES CERTIFICATE NUMBER: E: INS (§),AFORDINGCOVERAGE ..r@ ........'"...19(ca Lexington n �437 ____ AIG SDetoItv Insurance ComoanvN 26883 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. w..—, .. iNSIt L'5I.f v' m_+^ LTR TYPEOFINSURANCE POLICY NUMBER l�OI{YtYEiF IfDCC3Y1rYYV LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE X OCCUR tiaaGwd ahil ...)?f'�4W116,�,'�.,(�a o4r'�#.frF�)_ _ 300,000 $ „ ._. �„ M ED EXP (An one parson $ Excluded A X 011405742 01 /25/2021 01 /01 /2022 P. ERSONAL &ADV INJURY $ 2,000,000 TAPPLIES PER: GEN"t..AGGREGATE LIMIIMI GENERAL AGGREGATE $ 2+000000 PLO" ❑ 2,000 000 POLICY , n LOC k PRODUCTS COMP/OP A „ _.___ _ -GG $ X Per League SEXUAL ABUSE OCC/AGG $ 1 M/$1 M AUTOMOBILE LIABILITY INGLELIMY COMBINED r R T $ _._ ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED .-.___- .. .- ._ BODILY INJURY (Per accident) $ HIRED NON -OWNED mm AUTOS ONLY AUTOS ROPERTY DAMAGE° -- $ m" AUTOS ONLY AUTOS ONLY......... ,,.., $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE'. ,,,..,.n.,.�..,.... - .� - .. AGGREGATE .,-...m.....m..... $ DED RETENTION $ $ WORKERS COMPENSATION PER TH STATUTE � AND EMPLOYERS' LIABILITY Y / N __ ,. . ANYPROPRIETOR/PARTNER/EXECUTIVE E..L. EACH ACCIDENT $...,.,., OFFICER/MEMBEREXCLUDED? N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Certificate Holder is named as Additional Insured per form CG 2026 (04/13) ........ CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo, Its Officers, Officials, Employees, Agents and Certified THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Volunteers ACCORDANCE WITH THE POLICY PROVISIONS. 401 Sheldon Street AUTHORIZEDR£PRES�r � 6 E ElSegundo CA 90245 ( , ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 011405742 COMMERCIAL GENERAL LIABILITY CG 20 26 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. go-Rzfflof •qz**Wfq1yS%1 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): City of El Segundo, Its Officers, Officials, Employees, Agents and Certified Volunteers 401 Sheldon Street El Segundo, CA 90245 I 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 your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional 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. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 26 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 W W W ...... ..............W ..... CERTIFICATE OF LIABILITY INSURANCE DATE 02/05/2105/21 7ridounEt Keystone Risk Managers, LLC CERTIFICATE #: 4053601-2021-1 4 05 36 1995 Point Township Drive .............. .°......... INSURERS AFFORDING COVERAGE; Northumberland, PA 17867 ADDITIONAL NAMED INSURED: INSURER A: Lexington Insurance Commpany ' INSURER B: National Union Fire Insurance Company of EL SEGUNDO LL Christibelle Villena(Non-Liability) Pittsbt,/tr h, PA PO Box 112 El Segundo, CA 90245 INSURER C: AIG Specialty Insurance Company C6VEIRA ES ''. 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. SUBJECT TO $5,000,000 AGGREGATE SUBLIMIT OF LIABILITY FOR ALL LEAGUES, COMBINED, UNDER THE MASTER D&O POLICY, FOR ALL LOSS ARISING FROM ALL CLASS ACTION CLAIMS AND COMMON LEAGUE CLAIMS, AS MORE FULLY DESCRIBED IN ENDORSEMENT #34 OF THE MASTER D&O POLICY. " SUBJECT TO $5,000,000 AGGREGATE SUBLIMIT OF LIABILITY FOR ALL LEAGUES, COMBINED, UNDER THE MASTER CYBER POLICY, FOR SPECIFIED DEFENSE COSTS, AS MORE FULLY DESCRIBED IN ENDORSEMENT #14 OF THE MASTER CYBER POLICY. INSR LTR NAMED TYPE OF INSURANCE POLICY NUMBER ''. POLICY EFFECTIVE DATE (MM/DD/YYYY) POLICY EXPIRATION DATE (MMIDD/YYYY) LIMITS INSRD $2,000,000 GENERAL LIABILITY EACH OCCURRENCE 011405742 01 /25/2021 01 /01 /2022 x $2,000,000 A X OCCURRENCE GENERAL AGGREGATE X INCL PARTICIPANTS Pro P y Damage uc ert Deductible: $250 PRODUCTS/COMP OPS AGGREGATE $2,000,000 Sexual Abuse $1,000,000 X SEXUAL ABUSE TAGGREGATE OCCURRENCE Sexual Abuse $1,000,000 MEDICAL PAYMENTS Any One Person EACH LOSS $1,000,000 C X DIRECTORS &OFFICERS 018194562 01/01/2021 01 /01 /2022 .. AGGREGATE -•• $* 1,000,000 C X CYBERLIABILITYCOVERAGE 018193395 01/01/2021 01/01/2022 LIMIT I IITOF LIABILI $100,000 PER MADETM LEAGUE AGGREGATE S&P SECURITY AND PRIVACY LIABILITY $100,000 PER LEAGUE SUBLIMIT OF LIABILITY ** RETROACTIVE DATE CONTINUITY DATE INSURANCE $11000 PER LEAGUE RETENTION REGULATORY ACTION SUBLIMIT OF $100,000 PER LEAGUE SUBLIMIT OF LIABILITY POLICY INCEPTION POLICY INCEPTION LIABILITY $1 000 PER LEAGUE RETENTION EM $100,000 PER LEAGUE SUBLIMIT OF LIABILITY ** NOTAPPLICABLE POLICY INCEPTION EVENT MANAGEMENT INSURANCE $1,000 PER LEAGUE RETENTION 9472626 01/01/2021 7772 EACH LOSS $35,000 A X CRIME COVERAGE Crime Deductible: $250 Property/$1,000 Money AGGREGATE NONE As in Master Policy: As in Master Policy SPORTS EXCESS ACCIDENT Med. Max. $100,000 Excess Deductible $50 tl�l6.LI1I........................ ADDITIONAL INSURED Who is an Insured (SECTION II) of the General Liability policy is amended to include as an insured the person or organization shown in the schedule, but only with respect to liability arising out of the above named Little League's maintenance or use of ball fields, or other premises loaned, donated, or rented to that Little League by such person or organizations and subject to the following additional exclusions: 1. Structural alterations, new construction, maintenance, repair or demolition operations performed by or on behalf of the person or organization designated in the Schedule and/or performed by the above named Little League; and 2. That part of the ball field or other premises not being used by the above named Little League. NAME AND ADDRESS OF PERSON OR ORGANIZATION: City of El Segundo, Its Officers, Officials, Employees, Agents and Certified Volunteers 401 Sheldon Street El Segundo, CA 90245 INSURED CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE Little League Baseball Risk Purchasing Group, Incorporated 539 U.S.RT. 15 Highway WITH THE POLICY 7 S. South Williamsport, PA 17702 :,2 AUTHORIZED "PRESENTATWE IMPORTANT DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. El Segundo Little League Board of Directors To: City of El Segundo Parks and Rec From: Christibelle Villena, President of El Segundo Little League RE: Auto Insurance Date: March 1, 2021 To Whom it May Concern: El Segundo Little League does not carry any Auto Insurance as we have no Vehicles that are owned or Operated by the League. Regards, Christibelle Villena ESLL President 2020-2021 PO BOX 112 El Segundo, CA 90245 christibellev mall,com 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: U 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 El Segundo. Policy No. . U 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 El Segundo is executed. My workers' compensation insurance carrier and policy number are: Carrier Policy Number Expiration Date Name of Agent Phone # I certify that, in the performance of the work set forth in the agreement with the City of El 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 workers' compensation provisions of Labor Code § 3700 1 must Signature of Applicant id. immediately comply with t t provisions or the agreement willautomatically become vo Date /! I'Z I Print Name QInv 'ts4T� 1.z V-1 Agreement for: F S�gv4��e L-'Ai le LpGtIv� Dated: Reviewed