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PROOF OF INSURANCE (2024 - 2024) CLOSEDCC>R " CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) 03/05/2024 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. P'ORTANT: I the certificate holder Is an A06111TIONAL INSURED, the policy(Ies) must have ADDITI NAL INSURED provisions or be endorsed. I 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 endorsements . ONTACT NAME: PRODUCER MESS Merchandising Underwriting Fort Wayne, IN W804 epto s 26 2889 Aro, Nay; 1 260-459-5105 'Pr 1712 Magnavox Way No,Ex "— K&K Insurance Group,Inc. 8 y ADDRESS: "" p'orlsunstara'nae I.k COfn INSURER(S) AFFORDING COVERAGE NAIC # ........,-........................ ........._._ INSURED _ .-•......... - ..........-_ ."_. INSURER A. Nationwide MUIUaI Insurance Company _ 23787 ............... ........,..— _-..--- RK Sports LLC INSURER B: DBA: Sportball __".... INSURER C: 2008 W Carson St. Suite 107—"""""""- -- °°°° °°°°— ......_.-"""-"° Torrance, CA 90501 INSURER D: A Member of the Sports, Leisure & Entertainment RPG INSURER E: INSURER F rnvconr_oc rtFRTIPICATF NIIMRFR- ItnnnsiS43 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. f f LTR TYPE OF INSURANCE ADDL INSO. BR WVD POLICY NUMBER POLI MMIDDIYYYY) O C . MMIOR LIMITS A X COMMERCIAL GENERAL LIABILITY X 6BRPG0000007893500 06/05/2023 06/05/2024 EACH OCCURRENCE $2,000,000 ------ ..._. CLAIMS 04:55 PM EDT 12:01 AM A SES _.-. $1.000,000 MADE OCCUR PRFM IEa Occurrence),,,,, �..... w.----. MED EXP (Any one person) $5,000 ...... ------- .� ........- PERSONAL & ADV INJURY $2,000 ,000 GENERAL AGGREGATE $5,000 000 GEN'L AGGREGATE LIMIT APPLIES PER:. PRODUCTS - COMP/OP AGG $2,000,000 POLICY PRO-LOG PROFESSIONAL LIABILITY $2,000,000 L�. JECT OTHER: ,........ ....... Legal Liability to Participants ....... $2,000,000 A AUTOMOBILE LIABILITY 6BRPG0000007893500 O6/05/20 23COMBINED 06/05/2024 S L Ea accidenU $2,000,000 04:55 PM EDT 12:01 AM """""""""' ANY AUTO BODILY INJURY (Per person) ....-- "".- OWNED AUTOS "�"""- SCHEDULED .•_•.-� BODILY INJURY (Per accident) ONLY AUTOS HIRED NON -OWNED'— X AUTOS ONLY X AUTOS ONLY JEer accident,_„,,,,_ X Not provided while in Hawaii.HAWAII I UMBRELLALIAB ' OCCUR EACH OCCURRENCE _ ''. EXCESS LIAB CLAIMS -MADE REGATE ''.DED RETENTION WORKERS COMPENSATION AND N/A OTHER EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/ Y / N -ENT E.L, EACH ACCIDENT ..�...........r... __----- EXECUTIVE OFFICER/MEMBER E.L. DISEASE EA EMPLOYEE EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION E.L. DISEASE -POLICY LIMIT OF OPERATIONS below A MEDICAL PAYMENTS FOR PARTICIPANTS 6BRPG0000007893500 06/05/2023 06/05/2024 PRIMARY MEDICAL 04:55 PM EDT 12:01 AM EXCESS MEDICAL ".. $25,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Legal Liability to Participants (LLP) limit is a per occurrence limit. Sport(s): Motor Skills Development Age(s): 12 & Under Sexual Abuse Liability - $1,000,000 aggregate (included above) / $250,000 each occurrence (included above) The Certificate holder is added as an additional insured, but only for liability caused, in whole or in part, by the acts or omissions of the named insured. CERTIFICATE HOLDER IIV['# City of El Segundo HOU D ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 350 Main St THE EXPIRATION DATE THEREOF„ NOTICE WILL BE DELIVERED IN EI Segundo, CA 90245 ACCORDANCE WITH THE POLICY PROVISIONS., Owner/Manager/Lessor of Premises AUTHORIZED REPRESENTATIVE Coverage is only extended to U.S. events and activities, NOTICE TO TEXAS INSUREDS: The Insurer for the purchasing group may not be subject to all the insurance laws and regulations of the State of Texas ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 6BRPG0000007893500 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Persons Or Organization(s) City of El Segundo 350 Main St El Segundo, CA 90245 Named Insured: RK Sports LLC DBA: Sportball Information required to complete this Schedule, if not shown 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 your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. 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. will be shown in the Declarations. 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 shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 26 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 THE HARTFORD BUSINESS SERVICE CENTER THE `' 3600 WISEMAN BLVD HARTFORD SAN ANTONIO TX 78251 City of El Segundo 350 MAIN ST EL SEGUNDO CA 90245 Account Information: Policy Holder Details RK Sports LLC March 8, 2024 La Contact Us Need Help? Chat online or call us at (866) 467-8730. We're here Monday - Friday. Enclosed please find a Certificate Of Insurance for the above referenced Policyholder. Please contact us if you have any questions or concerns. Sincerely, Your Hartford Service Team WLTR005 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 03/08/2024 _.................... 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 SUBROGATIONIS 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: PAYCHEX INSURANCE AGENCY INC PHONE (800) 472-0072 �............... FAX 76210762 (A/C, No, Ext): (A/C, No): 225 KENNETH DR STE 110� E-MAIL ADDRESS: ROCHESTER NY 14623 ............................... ( ._........... - ........ INSURER S) AFFORDING COVERAGE NAIC# INSURED RK SPORTS LLC 2008 W CARSON ST .................. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HA VE 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 POLICY NUMBER INS ADDLSUBR m ............. POLYCYEFF POLICY EXP LIMITS IN R LTR WVD MIDD '.... (NeYtYYY]Q1Y 'YYY. .., , ,,,,,_„_„ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE .._ _ .................. ................: CLAIMS -MADE OCCUR DAMAGE TO RENTED MED EXP (Any one person) ..._... PERSONAL $ ADV INJURY .......... ........ ........,_.... GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE �9 r _.._ . POLICY I PRO- Itl� LOC PRODUCTS - C.............. OMPIOP AGG LEI JECT ll OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT nt ANY AUTO BODILY INJURY (Per person) ALL OWNED i SCHEDULED ITBODILY INJURY (Per accident) AUTOS AUTOS HIRED NON -OWNED PROPERTY DAMAGE AUTOS AUTOS (Per accident) ,_._._ _ ' m ........_...............-.............._ ...__ UMBRELLA LIA9 OCCUR EACH OCCURRENCE ............. ....... EXCESS LIAB CLAIMS- AGGREGATE .MADE DED 'RETENTION $ .........._, ............... ...... ...... WORKERS COMPENSATION X PER OTH- ' AND EMPLOYERS' LIABILITY I sTAT T.1=' - •••••••••••• ANY Y/N E.L. EACH ACCIDENT $1,000,000 A PROPRIETOR/PARTNER/EXECUTIVE N/A X 76 WEG AD5FJY 07/01/2023 07/01/2024 __ OFFICERIMEMBER EXCLUDED? E..L. DISEASE -EA EMPLOYEE $1,000,000 (Mandatory in NH) ._..... ......_... If yes, describe under E.,L, DISEASE -POLICY LIMIT $1,000,000 DESCRIPT11I?N QF Q ERATlp below u_..............-,. ........................ .......... _. ...... ._......_. DESCRIPTION OF OPERATIONS /LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. Waiver of Subrogation applies in favor of the Certificate Holder per Waiver of our Right to Recover from Others Endorsement WC040306 attached to this policy. ................. ....-,_ CERTIFICATE HOLDER. � _..� CANCELLATION City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 350 MAIN ST BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PRO EL SEGUNDO CA 90245 .......... SIGNS. AUTHORIZED REPRESENTATIVE 1988 2015 ACORD CORPORATION. AII� _-.._ p rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD