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PROOF OF INSURANCE (2021 - 2022) CLOSEDSOCC-91 OP ID: RE ACORO°° CERTIFICATE OF LIABILITY INSURANCE ATE 09/15/2021Y) 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 RPS Bollinger Sports & Leisure PO Box 1322 CONTACT NAME PHONE FAX A/C No Ext : A/C, NO): Morristown, NJ 07960 AJ Morgan E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: `Markel Insurance Company 38970 INSURED Beginners Edge Sports Training ,LLC INSURERB: 29634 North 126th Avenue INSURER 7 INSURER D : Peoria, AZ 85383 INSURER E : 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE 1XI OCCUR X X 3602AH025251 11/05/2020 11/05/2021 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 X MED EXP (Any one person) $ 5,000 Inc[ Participants X Sexual Abuse/Mol PERSONAL & ADV INJURY $ 1,000,000 A $1MILL/$2MILL 11/05/2020 11/05/2021 GEN'L AGGREGATE LIMIT APPLIES PER : GENERAL AGGREGATE $ 3,000,000 POLICY ECT LOC PRODUCTS - COMP/OPAGG $ 1,000,000 $ OTHER I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER OTH- STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/M EMBER EXCLUDED? ❑ N/A E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ A Accident insurance 4102AH025250 11/05/2020 11/05/2021 Med Max: 25,000 Full Excess Ded: 500 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder is included as an additional insured. Coverage is Frprovided under these policies only for sponsored/supervised activities of named insured for which a premium has been paid. Waiver of Subrogation applies. This insurance is primary and non-contributory with any other insurance. CERTIFICATE HOLDER CANCELLATION CITYELS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The City of El Segundo, tY g , Its THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. officers, officials, employees agents and volunteers 350 Main St AUTHORIZED REPRESENTATIVE El Segundo, CA90245mm„wn,_.,._.�..°° © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 3602AH025251-13 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organ ization(s): The City of El Segundo 3501 Main St. El Segundo, CA 90425 I Information required to complete this Schedule, if not shown above, will be shown in the Declarations. I 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 omis- sions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing opera- tions; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional in- sured 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 in- surance afforded to such additional insured will not be broader than that which you are re- quired by the contract or agreement to pro- vide 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 Insur- ance shown in the Declarations; whichever is less. This endorsement shall not increase the applica- ble Limits of Insurance shown in the Declarations. CG 20 26 04 13 Copyright, Insurance Services Office, Inc., 2012 Page 1 of 1 C h wwwjcocj5jv� NA COMPENSATION P.O. BOX 8192, PLEASANTON, CA 94588 1 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 09-26-2021 GROUP: POLICY NUMBER: 9218577-2021 CERTIFICATE ID: 1 CERTIFICATE EXPIRES: 09-26-2022 09-26-2021/09-26-2022 CITY OF EL SEGUNDO NA 315 MAIN ST EL SEGUNDO CA 90245-3814 This is to certify that vve 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 10 days advance written notice to the employer. We will also give you 10 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 which it may pertain, the insurance afforded by the policy described herein is subject to all the terms,,, exclusions, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1951 - GOLDBERG,MITCHELL, MGR-MEMBR - EXCLUDED. EMPLOYER BEGINNERS EDGE SPORTS TRAINING NA 29634 N 126TH AVE PEORIA AZ 85383 PRINTED : 08-17-2021 (REV.7-2014) M0409