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PROOF OF INSURANCE (2025 - 2025)CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 09/04/2024 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 have ADDITIONAL INSURED provisions or 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 CON NAME: c Michele Reitz Correll Insurance Group of Hilton Head PHONE (843) 785-7733 AX P. o.. 1 ;,...... APC. Noy PO Box 6869 hor mreitz@correllhhi.com Hilton Head Island INSURED SC 29938 INSURER A: Philadelphia INSURER B. AFFORDING COVERAGE NAIC # mnity 18058 Professional Tennis Registry, Inc. INSURER c ; Professional Pickleball Registry, Inc. INSURER D c Professional Platform Tennis Registry, Inc. PO BOX 2516 INSURER E Zephyr Hills FL 33539 INSURER F s COVERAGES CERTIFICATE NUMBER: 2024-2025 Master 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 CONTRACTOR 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, TN_§W POLICY EFF POLICY EXP AM( TYPE OF INSURANCE SO WVD POLICY NUMBER MMIDDIYYYY MM/DOM'YY LIMITS X'. COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000.000 $ CLAIMS -MADE � OCCUR PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ Excluded A PHPK2584296 09/01/2024 09/01/2025 PERSONAL & ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPUES PER: GENERAL AGGREGATE $ 3,000,000 PRO.❑ JECT LOC POLICY EC't PRODUCTS-COMP/OPAGG 3,000,000 $ OiHEfa": $ AUTOMOBILE LIABILITY COipwCBINEt7'SVk,YC„LC. t,It,A1T $ ANYAUTO BODILY INJURY (Per person) $ OWNED r__J SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED '.. PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident X UMBRELLALIAB OCCUR I EACH OCCURRENCE $ 5,000,000 A EXCESS LIAR PHUBB75223 09/01/2024 09/01/2025 .. CLAIMS -MADE AGGREGATE $ 5,000,000 DED X 10,000 m RETENTION $ S WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY YIN , STATUTE, _I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE N / A E-L- EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) _ E.L, DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT-1 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) [Job #: 612 Job Type: ] 136530 - Certificate Holder is listed as Additional Insured # 612 with respect to Member # 136530 - Eric Stenberg , 690 West Palm Avenue, El Segundo CA 90245 The City of El Segundo, its Officers, Officials, Employees, Agents and Volunteers CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of El Segundo,its Officers, Officials, ACCORDANCE WITH THE POLICY PROVISIONS. Employees, Agents and Voluntee 401 Sheldon St AUTHORIZED REPRESENTATIVE El Segundo CA 90245 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD INSURANCE WAIVER Pursuant to Section 4 of El Segundo City Council Resolution No. 4813, the undersigned authorized the waiver of commercial auto insurance for the City of El Segundo instructor contract with Eric Stenberg. Date: � Auto Insurance Confirmation Please use this as confirmation of auto insurance; however, this doesn't take the place of an insurance identification card. Registered owner: Address: Policy number: Policy effective date: Policy expiration date: Vehicle: k'"k, ERIC J STENBERG CIC 006415997 7102 December 1, 2024 June 1, 2025 2023 TESLA MDL Y 4D Bodily injury liability limit: $30,000 each person / $60,000 each accident Property damage liability limit: $50,000 each accident Comprehensive deductible: $500 Collision deductible: $500 Meets California minimum statutory liability requirements This confirmation of coverage neither affirmatively nor negatively amends, extends or alters the coverage given by the policy issued by USAA Casualty Insurance Company. i,,,,i to Contact Thank you for choosing us for your auto insurance needs. If you have any questions, please contact us using one of the following options: Phone: 210-531-USAA (8722), our mobile shortcut #8722 or 800-531-8722 Fax: 800-531-8877 Thank you, USAA Casualty Insurance Company I affirm under penalty of perjury under the laws of California one of the following declarations: L j I have and will maintain workers' compensation insurance as required by Labor Code § 3700 for the 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: Carver Policy Number Expiration Date Name of Agent Phone # L 1 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 Califomia, and agree that, if I should be o sub'ed to t workers' compensation provisions of Labor Code § 3700 1 must Immediately comply with tho a owri 'ons or agreement will automatically become void. `I ' Signature of Applicant Date Print Name Agreement•