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PROOF OF INSURANCE (2022) CLOSEDDATE(M M/DDIYYYY) C"R'CERTIFICATE OF LIABILITY INSURANCE Ill I o2n vzo2z 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 endorsement(s). PRODUCER CONTACTErica James, AINS NAME: ... .............. Correll Insurance Group of Hilton Head fAiC.PHONE (843) 785-7733 CAI( PO Box 6869 ADDRESS: Erica correllhhi com INSURER(S) AFFORDING COVERAGE NAIC # Hilton Head Island SC 29938 INSURERA: Philadelphia Indemnity 18058 INSURED INSURER B : Professional Tennis Registry, Inc; Professional Pickleball Registry, Inc INSURER C : Professional Platform Tennis Inc; INSURER D : P. O, Box 4739 INSURER E Hilton Head Island SC 29938 INSURER F : COVERAGES CERTIFICATE NUMBER: CL2172931353 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. ILTR TYPE OF INSURANCE INSp -. yyyp POLICY NUMBERMMIDDIYYYY) .. ..... M L. MM/DDIYYYY LIMITS X' COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1.000,000 CLAIMS -MADE OCCUR DANIAGTRENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ N/A ......._._.._................. A PHPK2307627 09/01/2021 09/01/2022 PERSONAL & ADV INJURY $ 1,000,000 GEN'LAGGREGATE I. WI I APPI...I ES PER: GENERALAGGREGATE $ 3,000,000 X. POI...ICY PRO,i� LOC PRODUCTS COMP/OPAGG $ 3000,000 OTIHER: $ AUTOMOBILE LIABILITY C�;H�7 BNfdEO ":wgNG6E LIM.r7' Ea,accideni _. $ ANYAUTO BODILY INJURY (Per person) OWNED SCHEDULED BODILY INJURY (Per accident) .............. $ AUTOS ONLY AUTOS HIRED NON -OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident) .................m.. $ X'.. UMBRELLA LIAR X OCCUR ........ ........ ........ EACH OCCURRENCE _..-. $ 5.000.000 A EXCESS LIAB ..m...... CLAIMS -MADE _ .........�m.. PHUB779551 09/01/2021 09/01/2022 AGGREGATE .............................._._.._. $ 5.000,000 DEC) RETENTION 5 10,000 OR6tER5 COMPENSATION ..- - PER 01H- IT ND EMPLOYERS°A ITY Y / N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N IA E L EA"""""CH ACCIDENT S OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E L. DISEASE - POLICY LIMIT S ... �......_..__...,...,.�... .. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) ..�.W....................�.... [Job #: 1795 Job Type: ] 124090 - Certificate Holder is listed as Additional Insured # 1795 with respect to Member # 124090 - Rob Hutchins 90019 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo its officers, officials, employees, agents, & ACCORDANCE WITH THE POLICY PROVISIONS. 3501 Main St. AUTHORIZED REPRESENTATIVE El Segundo CA 90425 4mcn 6• umh.(,t' ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: PHPK2307627 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 Organization(s): City of El Segundo its officers, officials, employees, agents, and volunteers. 3501 Main St. El Segundo, CA 90425 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 For Roadside Assistance: 800-531 -8555 Report a claim, get coverage and deductible information, request a tow from the accident scene, schedule an appraisal or reserve a rental car using: . usaa.com, . USAA's Mobile App, or By calling 210-531-USAA (8722), our mobile phone shortcut number #8722 or 800-531 -USAA. California Evidence of Financial Responsibility This ID card is evidence of liability insurance for your vehicle. The card is valid only as long as liability insurance remains in force. Keep a copy of the ID card in your vehicle at all times. You may be required to produce your identification card at vehicle registration or inspection, when applying for a driver's license, following an accident, or upon a law enforcement officer's request. FCA 1 Rem. 6 -13 50781-0513 02 ................................................ -------------------- ---- -- --- ------------ -_- CALIFORNIA EVIDENCE OF FINANCIAL RESPONSIBILITY Name and Address of Insured NAIC 25968 RORFRT K WITCHINS California Evidence of Financial Responsibility ROBERT K S HUTCHINS Insurance Company USAA CASUALTY INSURANCE COMPANY Policy Number Effective Date Expiration Date 01498 73 41 C 7101 6 10/04/21 04/04/22 Vehicle Make/Vehicle Year HON DA 2012 This policy provides at least the minimum amounts of liability insurance required by the CA VEH CODE SECTION 16056 for the specified vehicle and named insureds and may provide coverage for other persons and other vehicles as provided by the insurance policy. Keep this card. IMPORTANT: The California Financial Responsibility Act (Section 16020) of the Vehicle Code requires every owner or operator of a vehicle subject to the requirements of the Financial Responsibility Act to carry evidence of financial responsibility in the vehicle at all times. Under vehicle code (Section 16028) every driver f involved in an accident must provide evidence of o financial responsibility at the scene. Failure to comply is I an infraction and shall be punishable by fines, d impoundment or license suspension. Additional copies available at usaa.com CONTACT US: 210-531-USAA(8722) OR 800-531-USAA 9800 Fredericksburg Road, San Antonio, Texas 78288