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PROOF OF INSURANCE (2024) CLOSEDDATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 03/21/2023 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 Acrisure, LLC dba The Whitmore Group, LTD 370 OLD COUNTRY RD STE 200 GARDEN CITY, NY 11530-1702 CONTACT NAME: PHONE /C.No Ext): (516) 746-4141 FAX I lemert@whitmoregroup. com; E-MAIL mcorry@whitmoregroup.com; ADDRESS: ygarcia@whitmoregroup.com; INSURERA INSURED SPORTS AND RECREATION PROVIDERS ASSOCIATION (PURCHASING GROUP) AND INSURERB: ITS PARTICIPATING MEMBERS: Athletic Grace Dance Studio INSURERC: 113 W. Grand Ave. INSURER D : El Segundo, CA 90245 INSURERE: INSURERF:. COVERAGES CERTIFICATE NUMBER: GAP109004 INSURER(S) AFFORDING COVERAGE NAIC # _.................................................. Great American Insurance Company 16691 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. INS TYPEOFINSURANCE ADDLSUBRI POLICYNUMBER POLICYEFF POLICY EXP '.LTR INSR WD MM/DDIYYYY MMIDDIVYYV LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PRREECsAGE ISES(Ea occu ence) $300,000 CLAIMS -MADE X OCCUR ny one person) $10,000 A ...., X PAC 4725034 04/01/2023 12:00 AM 04/01/2024 01 AM PERSO A(LA&ADV INJURY $1,000,000 GENERAL AGGREGATE ................ .........._.. $2,000,000 X INCLUDES ATHLETIC PARTICIPANTS PRODUCTS COMP/OP AGG $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- LOC 171 ,PENNY ............. ... .......m .... ..... AUTOMOBILE LIABILITY COMSINED SINGLE LIMN Ea accident). ANY AUTO BODILY INJURY (Per person) ALL OWNED SCHEDULED BODILY INJURY (Per ....W, .............................. AUTOS AUTOS accident HIRED AUTO NON -OWNED AUTOS PROPERTY DAMAGE '', (Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE '.. AGGREGATE ............................ EXCESS LIAB CLAIMS -MADE Ed DED RETENTION S A Professional Liability X PAC 4725034 04/01/2023 12:00 AM 04/01/2024 12:01 AM EACH OCCURRENCE AGGREGATE LIMIT $1,000,000 $1,000,000 A Abuse and Molestation X PAC 4725034 04/01/2023 12:00 AM 04/01/2024 12:01 AM EACH OCCURRENCE GENERAL AGGREGATE $1oD,000 $300,000 AD&D AGGREGATE $500,000 A Accident/Medical Coverage BSR-E948474-00 04/01/2023 04/01/2024 12:00 AM 12:01 AM AD&D MAXIMUM MEDICAL $100,000 $100,000 DEDUCTIBLE $100 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Dance Studio - Ballet/Pointe, Salsa, Ballroom, Jazz, Tap, Zumba (R) The Certificate Holder is added as an additional insured but only with respect to liability arising out of the named insured during the policy period. Scheduled Activities Exclusion Applies -Please Refer to Named Insured Member Certificate of Coverage CERTIFICATE HOLDER CANCELLATION The City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 300 Main St BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN L El Segundo, CA 90245 ACCORDANCE WITH THE POLICY PROVISIONS. ACORD 25 (2016/03) @ 1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AUTHORIZED REPRESENTATIVE Tkx, W k4w ore, Grot--, LTD ACORD 25 (2016/03) © 1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY POLICY NUMBER GAP109004/PAC 4725034 ADDITIONAL INTEREST SCHEDULE CARRIER Great American Insurance EFFECTIVE DATE NAMED INSURED(S) oa/ovzozs Athletic Grace Dance Studio ADDITIONAL INTEREST (Not all fields apply to all scenarios — provide only the necessary data) DATE (MM/DD/YYYY) 03/21/2023 NAIC CODE 16691 INTEREST NAME AND ADDRESS RANK: EVIDENCE: CERTIFICATE POLICY SEND BILL INTEREST IN ITEM NUMBER X ADDITIONAL..... LOSS PAYEE LOCATION: BUILDING: INSURED BEACH OF The Management Company WARRANTY MORTGAGEE 952 Manhattan Beach Blvd. #250 VEHICLE: BOAT: CO-OWNER OWNER Manhattan Beach, CA 90266 AIRPORT: AIRCRAFT: EMPLOYEE REGISTRANT AS LESSOR �ITEM ITEM: ASS:LEASEBACK TRUSTEE M DESCRIPTION OWNER LIENHOLDER REFERENCE / LOAN #: INTEREST END DATE: ._.._.._.. .......................................... LIEN AMOUNT: PHONE (A/C, No, Ex): ................................. ........... FAX (A/C, No): REASON ..._._._._._.._.._.._.................._...,..�,. FOR INTEREST: E-MAIL ADDRESS: INTEREST NAME AND ADDRESS RANK: EVIDENCE: CERTIFICATE POLICY SEND BILL INTEREST IN ITEM NUMBER X ADDITIONAL LOSS PAYEE LOCATION: BUILDING: INSURED BEACH OF The City of El Segundo ww...�. ..BO WARRANTY MORTGAGEE 300 Main St CLE: BOAT: ORT: AIRCRAFT: CO-OWNER OWNER EMPLOYEE El Segundo, CA 90245 SS; [FAX ITEM: REGISTRANT AS LESSOR DESCRIPTION LEASEBACK TRUSTEE OWNER REFERENCE I LOAN #: INTEREST END DATE: LIENHOLDER LIEN AMOUNT: PHONE (A/C, No, Ex): (AIC, No): ........................... ...................................................... REASON FOR INTEREST: E-MAIL ADDRESS: The above are added as additional insured but only with respect to liability arising out of operations of the named insured during the policy period. Page 1 of 1 ACORD 45 (2009104) © 1993-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD