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PROOF OF INSURANCE (2023) CLOSED� mm' CERTIFICATE OF LIABILITY INSURANCE ww °'T06/21/2022 ' WWWW ACORO' 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. .......... — .. m.. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the olic -ies must be endorsed. If SUBROGATION IS WAIVED, y(' ) 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). ...................__................ ..............._................ .._�W..�_........................................................_CONTACT....................,,,,,,,,,,,,,,,,,,,,,,,,,,,,,-,...................................................._...................... __............. PRODUCER NAME: e Camp Team, LLC pNayNE wX LAC No �1O,_800 747-9573mmmmmm �� NpY 303-422-1276 9035 Wadsworth Parkway, E-MAIL Suite 3820, AI7DIikESSs ir,1pia c�ln10 pteafn com m PRODUCER.. ��... ..... ...... �............. Westminster, CO, 80021 cI A-1............................ _.�.�.�...._...... ________________________ INSURED SSEI Program Management Inc. INSURER A : HDI Global Specialty SE AA1340041 City of El Segundo .e INSURER B ................�.�.�.� 350 Main Street INSURER C El Segundo, CA, 90245 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER; A-SP- SU-2'2-Oar-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. TYPE OF INSURANCE P POUCYE7� �� LIMITS A GENERAL LIABILITY N N HDGL003700608 EACH occuRRENCmEmmmmmmmmmmmmmmmmmmmmm)m 0pp�ppmpmmp„p . X COMMERICAL GENERAL LIABILITY 06/21/2022 06/21/2023 DAMAGE TO PREMISES 300,000.00 RENTED (Any one premises $ CLAIMS -MADE X � OCCUR MED EXP (any one person) ......__ $ 5 000 00 ...................... X INCLUDES ATHLETIC PARI'ICIPANTS .m PERSONAL & ADV INJURY $1,p00,000.00 GENERAL AGGREGATE 3.00Q QQ0,0(J GENERAL AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMP/OP AGG mW $;200,0000.mQO,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, X POLICY PROJECT El LOC' w $ AUTOMOBILE LIABILITY N COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO HIRED AUTOS BODILY INJURY (Per person) $ ALL OWNED NON -OWNED .......----------------- d...e._ AUTOS AUTOS BODILY INJURY Per accident $ ( ) pgii AMAGE SCHEDULED AUTOS Peda cue t $ .._.......... .. ) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DEDUCTIBLE $ .- ............_............... RETENTION$ $................................................... WOWmiiSCONPBJSATpN WC STATU- O - ANDEMPLOYERS'LIABLRY . _.............Ilk.YLhMITS_..,,�,,.-_.,..E Y/N ANY PROPRIEfORIPARTNEREXECUTIVE OFFICERANEMBEREXCLUDED? [Man*imyInNI­Q N/A E„L. EACH ACCIDENT $ If yes, describe under SPECIAL PROVISIONS below i E.L.. DISEASE - EA EMPLOYEE $ E..L.. DISEASE -POLICY LIMIT $ OTHER A Abuse/Molestation N HDGL003700608 06/21/2022 06/21/2023 Each Occurrence: $ 100,000,00 Aggregate: $ 500,000.00 DESCRIPTION OF OPERATIONS I 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 CG 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 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 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# AC"1?1..; Y ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED The Camp Team, LLC City of El Segundo POLICY NUMBER HDGL003700608 350 Main Street ..�cARRieR................................. .�...�.�.�..............m, m,_.--_..._. �.m.....m.....................................�.�....�.� El Segundo, CA, 90245 NAIC CODE y HDI Global Specialty SE AA1340041 EFFECTIVE DATE: O6/21/ZO22 �.___ ......... �.�.�.�_...................._ �_�_� p ADDITIONAL REMARKS ©2008 ACORD CORPORATION. All rights reserved. ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD