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PROOF OF INSURANCE (2022 - 2022) CLOSEDDATE (MMIDDNYYY) 02/24/2022 CERTIFICATE OF LIABILITY INSURANCE 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 310-533-8877 Tsuneishi Ins. Agency,lnc. 21235 Hawthorne Blvd., #200 Torrance, CA 90503 CONTACT Tsuneishi Ins. Agency, Inc. NAME PHONE 310-533-8877 FAX 888-821-8350 (AIC, No, Ext): (AIC, No): ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURERA: Scottsdale Insurance Company INSURED GSCAVENTURES LLC INSURER B : dba: Bricks 4 Kidz INSURER C : 115B S Lucia Avenue Redondo Beach, CA 90277 INSURER D : INSURER E INSURER F : COVERAGES CERTIFICATE NLIMRFR- REVISION KIHMRFR- 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 INSR SUB WVD POLICY NUMBER POLICY EFF MMIDD POLICY EXP MMIDD LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE FLAVF OCCUR X CPS7361456 05/11/2021 05/11/2022 DAMAGE PPEMISETO R TEDrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 ❑ PRO X ECT PRODUCTS - COMPfOAGG $POLICY 2,000,000 OTHER: AUTOMOBILE LIABILITY CEeOMBINED SINGLE LIMIT accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS INJURY Per accident $ BODILY (per eccdent DAMAGE $ HIRED ONLY R�TOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ EXCESS LIAB DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y f N PER OTH- STATUTE ER ANY PROPRIETORfPARTNERIEXECUTIVE E.L. EACH ACCIDENT $ OFFICERfMEMBER EXCLUDED? [7 (Mandatory in NH) N 1 A E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below EL DISEASE - POLICY LIMIT X SEXUAL ABUSE CPS7361456 05/11/2021 05/11/2022 X PHYSICAL ABUSE CPS7361456 05/11/2021 05/11/2022 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER NAMED BELOW IS ALSO,NAMED AS AN ADDITIONAL INSURED AS RESPECT TO THE LIABILITY ARISING OUT OF ONGOING OPERATIONS BY THE NAME INSURED. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo Parks & Recreation 401 Sheldon Street El Segundo, CA90245 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 'A' SCOTTSDALE INSURANCE COMPANY° CHANGE ENDORSEMENT NO. 3 Policy No. CPS7361456 Effective Date 04/18/2022 Named Insured GSCA VENTURES, LLC Agent No 04027 12:01 A.M. Standard Time COVERAGE PART INFORMATION —Coverage parts affected by this change as indicated by ® below: ❑ Commercial Property ® Commercial General Liability 0.00 ❑ Commercial Crime ❑ Commercial Inland Marine ❑ Commercial Liquor Liability ❑ OCP Liability CHANGE DESCRIPTION In consideration of no change in premium, it is hereby understood and agreed that the following amendments have been made to this policy. Additional Insured - Managers or Lessors of Premises added with "The City of El Segundo, its officers, officials, employees, agents, and volunteers" Waiver of Transfer of Rights of Recovery Against Others to Us (Waiver of Subrogation) added with "The City of El Segundo, its officers, officials, employees, agents, and volunteers" PREMIUM CHANGE Additional $ 0.00 Return $ 0.00 AUTHORIZED REPRESENTATIVE DATE UTS-244L 06-92 A, SCOTTSDALE INSURANCE COMPANY° SCHEDULE OF FORMS AND ENDORSEMENTS Policy No. CPS7361456 Named Insured GSCA VENTURES, LLC COMMON POLICY UTS-244L 06-92 UTS-SP-2 12-95 COMMERCIAL LIABILITY GLS-104L 06-92 CG 20 11 12-19 CG 24 04 12-19 Effective Date 0 4/ 18 / 2 0 2 2 12:01 A.M. Standard Time Agent No. 04027 CHANGE ENDORSEMENT FORM SCHEDULE OF FORMS AND ENDORSEMENTS SCHEDULE OF GENERAL LIABILITY CHANGES ADDITIONAL INSURED -MANAGERS OR LESSORS OF PREMISES WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) UTS-SP-2 (12-95) A, SCOTTSDALE INSURANCE COMPANY° SCHEDULE OF GENERAL LIABILITY CHANGES Policy No.: CPS7361456 Effective Date: 04/18/2022 12:01 A.M., Standard Time Named Insured: GSCA VENTURES, LLC Agent No.: 04027 CLASS CODE INFORMATION AFFECTED BY THIS CHANGE IS ADDED, DELETED OR CHANGED AS INDICATED. THE FOLLOWING CLASS CODE INFORMATION IS: ADDED Code No. 49950 Premium Basis INCLUDED Premises/Operations Premises Exposure 2 Rate INCLUDED Premium INCLUDED Classification: ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES PER FORM CG 20 11 Products/Completed Operations Rate Premium THE FOLLOWING CLASS CODE INFORMATION IS: ADDED Code No. 44444 Premium Basis INCLUDED Premises/Operations Premises Exposure 2 Rate INCLUDED Premium INCLUDED Classification: WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) PER FORM CG 24 04 Products/Completed Operations Rate Premium THE FOLLOWING CLASS CODE INFORMATION IS: Code No. Premium Basis Premises/Operations Premises Exposure Rate Premium Classification: Products/Completed Operations Rate Premium THE FOLLOWING CLASS CODE INFORMATION IS: Code No. Premium Basis Premises/Operations Premises Exposure Rate Premium Classification: Products/Completed Operations Rate Premium GLS-104L (6-92) POLICY NUMBER: CPS7361456 COMMERCIAL GENERAL LIABILITY CG 20 11 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designation Of Premises (Part Leased To You): PER FORM UTS-SP-3 Name Of Person(s) Or Organization(s) (Additional Insured): THE CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS, EMPLOYEES, AGENTS, AND VOLUNTEERS 401 SHELDON ST. EL SEGUNDO CA 90245 UNITED STATES Additional Premium: $ 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 you or those acting on your behalf in connection with the ownership, maintenance or use of that part of the premises leased to you and shown in the Schedule and subject to the following additional exclusions: This insurance does not apply to: 1. Any 'occurrence" which takes place after you cease to be a tenant in that premises. 2. Structural alterations, new construction or demolition operations performed by or on behalf of the person(s) or organization(s) shown in the Schedule. 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; whichever is less. This endorsement shall not increase the applicable limits of insurance. CG 20 11 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 POLICY NUMBER: CPS7361456 COMMERCIAL GENERAL LIABILITY CG 24 04 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Name Of Person(s) Or Organization(s): THE CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS, EMPLOYEES, AGENTS, AND VOLUNTEERS 401 SHELDON ST. EL SEGUNDO CA 90245 UNITED STATES Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV —Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. CG 24 04 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 ACoR" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 07/08/2021 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 endorsement(s). PRODUCER CONT-NAMEAutomatic Data Processing Insurance Agency, Inc. Automatic Data Processing Insurance Agency, Inc. vc°NN Ext : 1-800-524-7024 (A/C, No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # 1 Adp Boulevard Roseland NJ 07068 INSURERA : Property And Casualty Insurance Company Of Hartford 34690 INSURED Simone R Birbeire INSURER B INSURER C INSURER D : DBA: Bricks 4 Kidz INSURER E : 115b S Lucia Ave INSURERF: Redondo Beach CA 902773507 COVERAGES CERTIFICATE NUMBER: 2031048 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/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE OCCUR PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY ❑ PRO- JECT ❑ LOC PRODUCTS - COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE (Per accident) $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory in NH) N/A N 76WEGAM3D55 06/25/2021 06/25/2022 PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Insured Locations: 115b S Lucia Ave, Redondo Beach, CA 90277 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURED COPY AUTHORIZED `REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Policy Number: 76 WEG AM3D55 Endorsement Number: 1 Effective Date: 04/25/22 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: SIMONE R BIRBEIRE 115B S LUCIA AVE REDONDO BEACH CA 90277 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 5 % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description City of El Segundo 3501 MAIN ST EL SEGUNDO CA 01 90455 Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date: 04/25/22 Policy Expiration Date: 06/25/22