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PROOF OF INSURANCE (2023) CLOSED........ . . ;A�ii (;MIDD[Y YYYI_ ACORO'CERTIFICATE OF LIABILITY INSURANCE 06/21/2022 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 .................... . ...................... . . . . . . . ............... . CONTACT NAME, The Camp Team, LLC PHONE FAX IA&No,EKAi: 800747-9573 Nxal303-422-1276 9035 Wadsworth Parkway, E-MAIL ADDRESS� i�ifo@campteai7i.com Suite 3820, PRODUCER Westminster, CO, 80021 . . SURER . .......... !� NAiC # INSURED SSEI Program Management Inc. INSURER A: HDI Global Specialty SE AA1340041 City of El Segundo I INSURER B INSURER C: 350 Main Street El Segundo, CA, 90245 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: A-SP-SU-22-06-21-255680 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 POUCYEFF POUCYEXP LTR TYPE 9 INSURANCE ......... ....... LIMITS GENERAL LIABILITY EACH OCCURRENCE $1 0 00,00 A N N HDGL003700608 06/21/2022 06/21/2023 - - - ---------------- - COMMERICAL GENERAL LIABILITY DAMAGE TO PREMISES $300,000.00 f�I�T�D (,Any 9 CLAIMS -MADE F_X ] OCCUR MED EXP (any one person) $ 5 00000 UDES ATHLETIC PARTICIPANTS PERSONAL & ADV INJURY $ 1,000,000.00 GENERAL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $200 000.00 --I PROJECT F] LOC POLICY F ------ ____L__A ----------- $ AUTOMOBILE LIABILITY IN COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO F1 HIRED AUTOS BODILY INJURY (Per person) $ ALL OWNED NON -OWNED . . . ............. ........ ................. .............................................. AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTYDAMAGI: -------------- .......... SCHEDULED AUTOS ............................ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE ____ . . .......................................... $ XC EXCESS E ESSLIAB CLAIMS -MADE AGGREGATE $ $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION WC; STAI U- H- AND EMPLOYERS LIABILITY _T.QRYUNTS_ .... . ......... ER Y/N ANY PFN)F!RX"TO#?A AFVNERIEXECUTIVE OFRCERMEMBER EXCLUDED? (MOrdS110FyinNI-0 N/A E L EACH ACCIDENT $ If yes, describe under SPECIAL PROVISIONS below EL DISEASE -EA EMPLOYEE EL DISEASE - POLICY LIMIT 1$ OTHER A Abuse/Molestation IN HDGL003700608 06/21/2022 06/21/2023 Each Occurrence: $ 100,000.00 Aggregate: $ 500,000,00 DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Liability Policy Deductible: $0.00 Deductible for Bodily Injury and$ 1000.00 per Property Damage Claim. ISO Occurrence form CIS 00 01 04 13 and company's specific forms. Coverage for Participant Legal Liability requires that every participant signs a waiver/release. RE: Registered Theatre participants: 06/21/2022 - 06/21/2023; . . ........................... . ...... . .. . ............ . ...................... . ...... _. CERTIFICATE HOLDER City of El Segundo 350 Main Street El Segundo, CA, 90245 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. __J, Mark Di Perno ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD @1988-2009 ACORD CORPORATION. All rights reserved. AGENCY CUSTOMER ID: A-SP-SU-22-06-21-255680 LOC# ACOR'" `f ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCYNAMED INSURED The Camp Team, LLC City of El Segundo .......�w�w............................................... ................................ .................... ..................................... POLICY NUMBER HDGL003700608 350 Main Street CARRIER- �•.......---._— El Segundo, CA, 90245 NAIC CODE HDI Global Specialty SE AA1340041 EFFECTIVEDATE: 06/21/2022..__.................._........................_.................................����........�_.....................� ADDITIONAL REMARKS ©2008 ACORD CORPORATION. All rights reserved. ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD