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PROOF OF INSURANCE (2022 - 2022) CLOSED�r SPORT94 F--*"P ID: 1 Alt RO� DATE (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 02/25/2021 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 RPS Bollinger Sports & Leisure _ .. PHONE 800-446 5311 "� ...__ FAx 911-'9 1 8474 PO Box 1322 IAIc xll. Noi.. . Morristown, NJ 07960 "Ia" __c -- . ... - Will Krouslis _.. INSURER(SI AFFORDING COVERAGE _ __NAIC # ..' ..w .,..._,,... ..._-_.---- -� ........... ............_ .....�._._.� ,Markel Insurance Compan 38970 N�SlRER A:* ... ... INSURED INSURER B ........... .... .. __..... -� ..___ ._.. .. '�fb... Y3 Prt� yr 130 INSURER C . HermasafkVsuch, A 90254 INSURER DI: - INSURER,E: ..........._ _ kl INSURER F .. rnrL1=0A11_=Q CERTIFICATE hIlII1dBER• 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 ._ ... TYPE OF INSURANCE .......�.ADDL SUB._n ....... _ ......... ..�..._.__._. ... ...., ....._.__ POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY OCCURRENCE $..... 1,000,000I 1CCU, - . CLAIMS -MADE X OCCUR , X 3602AH0102923 03/05/2021 03/05/2022 6ACH m D'AMAOE'PCCe' EIS 100,000 _PRF 9��"�(E� 9caVr.r1 V $ . X Incl Participants MED EXP An "ne ,erson� $ ....... 5,000 . I.. 00,000 $ `..., ^... .....� ... ......1,000,000O GM LAGGREGA.1E LIMIT APPLIES PER......._ GENER"NAL&ADVINJURY ,000,000 ALAGGREG $, ..... PRO- ( LOC X P081CY �.. ...� JECT I� PRODl1CTS-OOMPATE " P /OP AGG . $ " .. OTHER' A COMBINED deBhIGLE LIMbT- 1OOOOO 0 AUTOMOBILE LIABILITY (p $ -. nnm ANY AUTO 3602AH0102923 03/05/2021 03/05/2022 , son UODiLy I JURYSF ew ,,,,,, 3 .. yn.n._. ...... AUTOS ONLY AUTOSSCDULED OWNED "B4ODILY IIN�JURY_LPer accident]"„ "„$ ....... .. _..... X HIRED NON -OWNED X PROPERTYAMAGE e'er uccl„d,�A,r(„ ., . AUTOS ONLY AUTOS ONLY _, ___$ _...... UMBRELLALUU3 CUR I.AGGREGATERENCE EXCESS LIAB CLAIMS -MADE ..' _ ..^_ DED RETENTION $ . $.... WORKERS COMPENSATION PER IU,T OTH Fib ANY 0 EDP ECUTIVE E, L. EACH ACCIDENT ..S OFFICER/MEMBER I NIA MAandatory in NH) E "•DISEASE - EAEMPLQYE _S_,.....,,m If yes, describe under � OESO'escrbNun OPERATIONS below L.. DISEASE - POLICY LIMIT A Accident Insurance 4102AH010291J 03/05/2021 03/0512022 Med Max:. 25,000 Full Excess Ded: 250 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 pprovided under these policies only for sponsored/supervised activities of the named insured for Which a premium has been pa d. C T'F C ION ELSEGUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 3602AH010292-3 COMMERCIAL GENERAL LIABILITY CG 20 26 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ,III I� I • � � I "" This endorsement modifies insurance provided under the following:. COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): The City of El Segundo its officers, officials, employees, agents, and volunteers 401 Sheldon St. El Segundo, CA 90245 Information re uired 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 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 0413 Copyright, Insurance Services Office, Inc., 2012 Page 1 of 1 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 08/30/2021 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 INSURERS , AUTHORIZED REPRESENTATIVE OR PRODUCER,, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. if SUBROGATIONIS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer ri, hts to the certificate holder in lieu of such endorsement(s). PRODUCER ''CONTACTNAME: PAYCHEX INSURANCE AGENCY INC PHONE (55) 389-7894 76210762 (800)472-0072 FAX (AM, No, Ext): tA��`., No): 150 SAWGRASS DRIVE E-MAIL ADDRESS: ROCHESTER NY 14620 INSURER(S) AFFORDING COVERAGE NAIC# INSURERA: Hartford Insurance Company of the Midwest 01410 INSURED RK SPORTS LLC 703 PIER AVE STE B310 HERMOSA BEACH CA 90254-3943 INSURER B wsURERC. INSURER D 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 INDICATEDAOTWITHSTAN DING 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. INS TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY' EFF POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS -MADE OCCUR DAMAGE TO RENTED MED EXP (Any one person) PERSONAL & ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE PRODUCTS - COMP/OP AGG POLICY � PRO I LOC JECT L......0 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT BODILY INJURY (Per person) ANY AUTO '.. ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) ''.. HIRED NON -OWNED PROPERTY DAMAGE AUTOS AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS- MADE AGGREGATE �� WORKERS COMPENSATION AND EMPLOYERS' LIABILITY _ PER OTH- X TAT T I E,L EACH ACCIDENT $1,000,000 ANY Y/N A PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NIA X 76 WEG AD5FJY 07/01/2021 07/01/2022 E.L DISEASE -EA EMPLOYEE $1,000,000 E..L. DISEASE - POLICY LIMIT $1,000,000 (Mandatory in NH) '... If yes, describe under DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. Blanket Waiver of Subrogation applies in favor of the Certificate Holder per the Waiver of Our Right to Recover from Others Endorsement WC040306, attached to this policy. CE TIFICATE IHOLDER CANCELLATION The City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 3501 MAIN ST BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED EL SEGUNDO CA 90245 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE cI'leal-2 Of ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD