Loading...
PROOF OF INSURANCE (2023 - 2024) CLOSED, ; "DATE(MMIDDNYYY) CERTIFICATE OF LIABILITY INSURANCE 08/23/2023 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 CONTACT The Camp Team NAME' 9035 WADSWORTH PKWY STE 3820 PHONE Extol (800) 747-9573 iNG, No); (303) 422-1276 WESTMINSTER, CO 80021-4541 E-MAIL ADDRESS: jstevens@campteam.com INSURERA : ........ INSURED SPORTS AND RECREATION PROVIDERS ASSOCIATION (PURCHASING GROUP) AND INSURERB: ITS PARTICIPATING MEMBERS: City of El Segundo INSURERC: 350 MAIN ST INSURER D: EL SEGUNDO, CA 90245-3895 INSURERE: INSURER F INSURER(S) AFFORDING COVERAGE NAIC p Great American Insurance COmoanv 16691 COVERAGES CERTIFICATE NUMBER! GAS120714 RFVISION NUMRFR- 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 ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE POLICY NUMBER LTR INSR WVD MMIDDIYYYY MMIOOIXYYY '''. LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 )( COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED .... �...... _ .mm...... $300 000 PREMISES (Ea occurrence CLAIMSWADE X OCCUR MED EXP (Any one person) $10,000 A X 08a6/ 08/27/ X HOST LIQUOR LIABILITY INCLUDED PAC 4725034 12:00 AM AM 12:01 AM AM PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE ............................................... $1,000,000 '.. GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP(OP AGO $1,000,000 ',. X POLICY .IECT PRO- LOC ...............................................� ..... .......... '.. AUTOMOBILE ..,_....... LIABILITY COMBINE" SINGLE LIMN (Ea accident) '...... ANY AUTO BODILY INJURY (Per person) ALLOWNED SCHEDULED INJURY (Per AUTOS AUTOS accident HIREDAU70 NON -OWNED PROPERTYDAMAGE AUTOS Per aorident) UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS -MADE AGGREGATE DED RETENTION $ A Professional Liability X PAC 4725034 08/26/2023 08/27/2023 EACH OCCURRENCE $1,000,000 12:00 AM 12:01 AM AGGREGATE LIMIT $1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Covered Activities: Art Display 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 El Segundo Public Library SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 111 W Mariposa Ave BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN El Segundo, CA 90245 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Tl�z Gam.�y Tecww ACORD 25 (2016/03) © 1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AC AGENCY ADDITIONAL INTEREST SCHEDULE CARRIER Great American Insurance POLICY NUMBER EFFECTIVE DATE NAMED INSUREDS) GAS120714/PAC 4725034 081 ooAM City of El Segundo ADDITIONAL INTEREST (Not all fields apply to all scenarios — provide only the necessary data) DATE (MMIDD/YYYY) 08/23/2023 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 El Segundo Public Library ------ MORTGAGEE 'VEHICLE: BOAT: WARRANTY 111 W Mariposa Av�e,1 CO-OWNER EMPLOYEE OWNER El Segundo, CA 90245 AIRPORT: AIRCRAFT: AS LESSOR REGISTRANT ITEM ITEM: CLASS; LEASEBACK TRUSTEE ITEM DESCRIPTION OWNER LIENHOLDER REFERENCE F LOAN'i INTEREST END DATE: ._.. ............ LIEN AMOUNT: .._.W�....W_................................._.. PHONE (A/C, No, Ex): ......... ( ..,._._............. FAX 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 (2009/04) © 1993-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Safeco CALIFORNIA INSURANCE IDENTIFICATION CARD COMPANY Insurance SAFECO INSURANCE COMPANY OF AMERICA 62 MAPLE AVENUE KEENE NH 03431 POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE A3405089 AUG. 23 2023 AUG. 23 2024 YEAR MAKEIMODEL VI CLE IDI= '' NkBER 2016 AUDI AGENCY/COMPANY ISSUING CARD NAIC 24740 THE J MOREY CO INC INS AGENTS I8483ACKSONSST SAN JOSE CA 95112-5107 INSURED SR 0 3ANIE CA IL90046-1320 CN-7042/CAEP 6/13 SEE IMPORTANT NOTICE ON REVERSE SIDE z r CALIFORNIA INSURANCE IDENTIFICATION z Safeco COMPANY 'Insurance SAFECO INSURANCE COMPANY OF AMERIC z' 62 MAPLE AVENUE KEENE NH 03431 z Safeco CALIFORNIA INSURANCE IDENTIFICATION CARD COMPANY Insurance SAFECO INSURANCE COMPANY OF AMERICA 62 MAPLE AVENUE KEENE NH 03431 POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE A3405089 AUG. 23 2023 AUG. 23 2024 YEAR MAKEIMODEL �f'h���x'TI r UMBER 2016 AUDI AGENCY/COMPANY ISSUING CARD NAIC 24740 T((HE J MOREY CO INC INS AGENTS I8483ACKSONSST SAN JO E CA 95112-5107 INSURED 3366 0o bA L053ANGELESWCAIL90046-1320 CN-7042/CAEP 6/13 VEHICLE REGISTRATION COPY CARD f Safeco CALIFORNIA INSURANCE IDENTIFICATION CARD COMPANY A Insurance SAFECO INSURANCE COMPANY OF AMERICA 62 MAPLE AVENUE KEENE NH 03431 ior POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE w A3405089 AUG. 23 2023 AUG. 23 2024 YEAR MAKEIMODEL VEHICLE IDENTIFICATION NUMBER 2015 TOYOTA AGENCY/COMPANY ISSUING CARD Nmt w THE J MOREY CO INC INS AGENTS r-J408 280-5551 84 ACKSON ST SAN JOSE CA 95112-5107 0 w wuNsuREDdmmmmmmmmuL;�NAAN E C' 90046-1320 3 D N �a!ILSON DR POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE A3405089 AUG. 23 2023 AUG. 23 2024 YEAR MAKEIMODEL VEHICLiE I/r iq ' = !li", IYIN NUMBER 2015 TOYOTA AGENCY/COMPANY ISSUING CARD NA1C 247 THE J MOREY CO INC INS AGENTS 23ACKSONSST 848 SAN JOSE CA 95112-5107 INSURE 66•'a'A V LAOUoFER L053ANGELESWCAIL90046-1320 CN-7042/CAEP 6/13 SEE IMPORTANT NOTICE ON REVERSE SIDE CN-7042/CAEP 6/13 SEPARATE ID CARD(S) ON THE PERFORATIONS. ONE COPY MUST BE KEPT IN THE INSURED VEHICLE AND PRESENTED UPON DEMAND. THE OTHER COPY SHOULD BE PRESENTED TO THE MOTOR VEHICLE DEPARTMENT CN-7042/CAEPC 6/13 WHEN RENEWING YOUR VEHICLE REGISTRATION. VEHICLE REGISTRATION COPY