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PROOF OF INSURANCE (2024 - 2024)DATE (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 07/17/2024 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(les) 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' PHONE 9035 WADSWORTH PKWY STE 3820 0 N Ext ; (800) 747-9573 N (303) 422-1276 WESTMINSTER, CO 800214541 MAIL_ InleivA ,crF1rAmnIranm r.om INSURERA : INSURED SPORTS AND RECREATION PROVIDERS ASSOCIATION (PURCHASING GROUP) AND INSURER B : ITS PARTICIPATING MEMBERS! City of El Segundo INSURERC: 350 MAIN ST INSURERD: EL SEGUNDO, CA 90245-3895 INSURERE: INSURER F : INSURER(S) AFFORDING COVERAGE NAIC # Great American Insurance Company 16691 COVERAGES CERTIFICATE NUMBER: GAS148683 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 LTR TYPEOFINSURANCE ADDL IINSR SUBR WVO POLICYNUMBER POLICY EPP MMIODIYYY POLICY EXP MMIODIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $1.000,000 DAMAGE TO RENTED I�REMISES Ps accurrpr�cCe $300,000 +�,,r ✓v COMMERCIAL GENERAL LIABILITY CLVMs-MADE RXOCCUR MED EXP (Any one parson) $10,000 08/22/2024 08/23/2024 A X HOST LIQUOR LIABILITY INCLUDED PAC 4725036 12:00 AM 12:01 AM PERSONAL & ADV INJURY $1.000.000 GENERAL AGGREGATE $1.000.000 PRODUCTS -COMPIOPAGG $1,000,000 Ri5RLARIORWATELIMIT Ar.PPUE,EPER„ X] LOC �y POLICY Jim AUTOMOBILE LIABILITY D CEOs RA ANY ANY AUTO BODILY INJURY (Per person) ALL OWNED SCHEDULED BODILY INJURY (Per AUTOS AUTOS accident HIRED AUTO NON -OWNED PROPERTY DAMAGE AUTOS UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS LIAR CLAIMS -MADE AGGREGATE DED RETENTION $ 08/22/2024 08/23/2024 EACH OCCURRENCE $1,000,000 A Professional Liability PAC 4725036 12:00 AM 12:01 AM AGGREGATE LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS IVEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace Is required) Covered Activities: Songwriters Panel Scheduled Activities Exclusion Applies -Please Refer to Named Insured Member Certificate of Coverage CERTIFICATE HOLDER CANCELLATION Proof of Insurance 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 Tltiei Ccwv-p -rut+w ACORD 25 (2016103) © 1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and loco are reaistered marks of ACORD RCURY CAuFORNIAEVIUENCECIF LIABILITY INSURANCE X FjAM INSURANCE. ry" "Ury Insurance Company P'O'Elox 1073% SANTA ANA, CA, 02711.0736 F i 1�XbG4 Y �'VUN�EI4r'd AOERm dM1,TMOT OFkQW0 I NYYs SWi gY0.C9 a�,N 3'8 'plan I CAA 0060666417 EFFE&JV'F' 1,' EX,PiO ,If+Ok CArO, p. DIaF01121124 1110112b24 YkkR' OAAKk VIN 1. 2065 FCP^ICN 'A411111 I N S d,P �k Ws +JII SAiI4GIS 9 A£I�CiRjrd0 AI mNY4�xFRO °V; eMiC C V SFe R Tlilf, Iinsuraa CITY OF EL SEGUNDO WORKERS' COMPENSATION DECLARATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SUBJECTS AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN LABOR CODE § 3706, INTEREST, AND ATTORNEY'S FEES. I affirm under penalty of pedury under the laws of California one of the following declarations: U I have and will maintain a certificate of consent of self -Insure for workers' compensation, Issued by the Director of Industrial Relations as provided for by Labor Code § 3700 for the performance of the work set forth the agreement with the City of El Segundo. Policy No. () I have and will maintain workers' compensation Insurance as required by Labor Code § 3700 forthe performance of the work for which the agreement with the City of El Segundo is executed. My workers' compensation Insurance carrier and policy number are: Carrier Policy Number Expiration Date Name of Agent Phone # tZ I certify that, In the performance of the work set forth IZthe ement with the City of El Segundo, I will not employ any person In any manner s as to beco, subjecorker^s' compensation laws of California, and agree that, If I should become o the rkers' c on provisions of Labor Code § 3700 1 must immediately comply with those rov o r h atically become void. Signature of Applicant Date ID o2 • o� Print Name - - - EllAgreement for: Dated: Reviewed by: