PROOF OF INSURANCE (2025)CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD,YYYY, 08/19/2024 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 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 . PRODUCER CONTACT The 9035 amp Tea RTH PKWY STE 3820 gH�(800) 747 9573 � A/C No_ PHOWAD NE FAX (303)422-1276 WESTMINSTER, CO 80021-4541 E-MAIL nnntal"•q— jstevens ..campteam,com INSURERA: ..., ..... .......,. ...... _...... . ......... _.._ INSURED SPORTS AND RECREATION PROVIDERS ASSOCIATION (PURCHASING GROUP) AND INSURER B : ITS PARTICIPATING MEMBERS: """ City of El Segundo ....RC 350 MAIN ST INSURERD: EL SEGUNDO, CA 90245-3895 INSURERE: INSURER F INSURER(S) AFFORDING COVERAGE NAIC # ...._ ................ Great. ._... American Insurance Company 16691 ____ ____ ..-...�.�....��... .....�.._ i+wn�rn�oo DC\/ICIr\AI 1V11MRFR• 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. EXP INIS TYPE OF INSURANCE SUBR POLICYNUMBER RPAdO1p yCYEYYE11 pPOLpgy YYY LTR INSR NSR 11ND LT LIMITS EACH OCCURRENCE 11,000,000 GENERAL LIABILITY ' .... DaMaGE Y�J FCCAl1a LT $300,000 X COMMERCIAL GENERAL LIABILITY I'RI;,MpSE,"",{Eyrw�rrrnerr' CLAIMS -MADE OCCUR MED EXP (Any one person) $10,000 08/14/2024 01/01/2025 A X HOST LIQUOR LIABILITY INCLUDED PAC 4725036 12:00 AM 12:01 AM PERSONAL & AD INJURY PERSONAL $1,000,000 ... _-.......... .._.._.._..., GENERAL AGGREGATE $1,000,000 .. ......._... GEN L AGGREGATE LIMIT APPLIES PER: ......, PRODUCTS-COMP/OP AGG .........m...m.. .. $1,000,000 ... R- X . PPOLICY JE&O:"- LOS SONIMNED SINGLE ILII«rA1" AUTOMOBILE LIABILITY „ JAR!w,,,;e dw o . ... .... ANY AUTO BODILY INJURY(Per person) ALL OWNED SCHEDULED AUTOS BODILY MJURY ACClday:[Y1 .,,. AUTOS '... NON -OWNED _...................... PROPERTY DAMAGE .....„ HIRED AUTO AUTOS nor rndmnq ITIT-....- ......�...'." '.. UMBRELLA LIAB OCCUR CE EACH OCCURREN ,..... EXCESS LIAB CLAIMS -MADE AGGREGATE DED RETENTION $ 08/14/2024 01/01/2025 EACH OCCURRENCE $1,000,000 A Professional Liability PAC 4725036 12:00 AM 12:01 AM AGGREGATE LIMIT $1,000,000 08/14/2024 01/01/2025 EACH OCCURRENCE $100,000 A Abuse and Molestation PAC 4725036 12:00 AM 12:01 AM GENERAL AGGREGATE $300,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Covered Activities: Board Games, Live Music Events Scheduled Activities Exclusion Applies -Please Refer to Named Insured Member Certificate of Coverage rcDTIorATo unl nGD CANCELLATION Proof of Insurance SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE TPL,P, Ca4 y Te a vw ACORD 25 (2016/03) © 1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CITY OF a SF-GUNPC WORKERS' COMPENSATION ON OLARATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE I$ UNLAWFUL AND SUBJECTS AN EMPLOYER TO CRIMINAL NAL PENALTIES AND CIVIL PLANES UP" TO ONE HUNDRED THOUSAND DOLLARS (`' ,000), IN ADDITION TO THE COST OF -COMPENSATION, DAMAGES AS ;NPR WDED FOR AN 1ABOR,CODE § 3706, INTEREST, AND ATTOR N.E'Y'S -FEES. I affirm under penalty of perjury under the laws of California one of the following declarations; U l h4va awl wllN 1*014111 qodifimoaf p1 1s Cif f elf .lrl lr for wp6pfs' 1ppnsgjipn, tssgpct y Nhe I I( of r of Industrial Relations as provided for by tabor Code § 3700 for the perfOrmanoe of the work set forth the agreement with the City of El Segundo. Poffoy No L j} I have and will maintain workers' compensation insurance as required by Labor Code § 3700 for the performance of the worts for which the agreement with the City of El Segundo is executed, My workers' compensation insurance .carderoiid poIIrcy ritlMmr-Arid_ Carrier Nania of Agent Policy Number Expiratlon Date Phone # j I certify that, in the performance of the work set forth in the agreement with the City of El Segundo, I will not employ any person In any manner so as to become subject to the workers' compensation laws of California, and agree that, If I should become subject tas his warkwo' aKiMPansa[fa n praAllaris Of Wtxr Cade 9 3700 i must Immediately comply with those provlsl ns or the agreement will automatically become void. Signature al'A lZlicant t Date Print Dame AX411 PjakW Agreement for - Dated: -711- �11,-;'02' Reviewed b � " / fi alvfe-ly