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PROOF OF INSURANCE (2025 - 2026) (4)__ - ___ ..... CERTIFICATE OF LIABILITY INSURANCE ....... .... _------ .. ... _— DATE (MMIDDIYYYY) 01 /06/2025 ..... ..... l.. _-------------- 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. an INSURED, the policy(iss) must be endorsed. If SUBROGATION IS WAIVED, subject terms and conditions of the policy, certain policies may equ � � ��a ���� endorsement. certificate holder _ to the p y Ire an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 7 ------- _---- .......... ..................., PRODUCER CONTACT The Camp Team, LLC 800 747 9573 I FAX 303 422 1276 NAME 9035 Wadsworth Parkway, EMAIL exty ..... ..... ._ __ ADDRESS: inIo0 caftlpt'earn.co 1 Suite 3820, _ ...,. PRODUCER Westminster, CO, 80021�I TfI INSURERJSj AFFORDING mm COVERAGE NAIC# INSURED Sports Marketing ..............._ _.___......-..... ....., ..... ..,.,.... �_ _., _ ... .... ....... .... Program Management Inc. INSURER A: Accelerant Specialty Insurance Company � 16890 City of El Segundo INSURER B: INSURER C : 350 Main Street --- ..... ..... ... ........ ........__ -- — INSURER D : El Segundo, CA, 90245 INSURER INSURER E F„ CERTIFICATE NUMBER:-F' U2501 0 327552 R'i141thl NUMBER _ _ ....�.� COVERAGES C_m _ ............_ ---_ 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. iftm A GENERAL LIABILITY OP RANGE N .... G 0 4.......... .... 01I06 2025 0110612026 ERE DAMAGE OCCURRENCE PREMISEStMI°i6 1 0 '. ........ q� COMMERCIAL GENERAL LIABILITY F $ 300,000.00 X RENTEDAcl,y ozzra.,,prt�Llmrs+bs _ CLAIMS -MADE [E OCCUR MED. EXP (zany one paum,n) $ 5m000 00 X INliD6'4�S ATHLETIC PARTICIPANTS PINCLUDES ERSON.....�AL & ADV INJURY ... 1,000,OKOD.. .. .,. •� G.,, ENERALAGGREGATE.,... ... 3, .00000o .C�,.,. ..... GENERAL AGGREGATE LIMIT APPLIES PER: PRODUCTS CO s2,00 0„r„000,00' MP/OP AGG............. X POLICY PROJECT t,.00 $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) 1 ANY AUTO H HIRED AUTOS •••�• _--- - --------�` BODILY INJURY (Per person) $ ALL OWNEDNON-OWNED -- - AUTOS AUTOS Perav"cwdawlq (Per accident) $ BODILY INJURY (P ,.,=. q PRpP�'RTYDANtliNCC ..�. $ 4 SCHEDULED AUTOS .i,.... _-_ ..) __ .......... I._......_.... ......... W.;....._.... .... .... UMBRELLA LIAB OCCUR EACH-0 CCURRENCE $ ............. _. .....__ ...-_........... ..........,. EXCESS LU1B CLAIMS -MADE AGGREGATE $ ......... _,,,,..... .. ...,. .. ................-.......,,,,.......... , DEDUCTIBLE --- RI;TE'.WION S $ TION INC STATUI IT ANDENPLOYERTUABLQY T.fN,F",,;Y_LIM'tI:S...... ER.. ...... ....................... ... ANY PROPRIEfORIPARTNEWEJIECUTNE OFFICERMIEMBEREXCLUDED? M E.L. EACH ACCIDENT S Wandalnyn NH) .'., N I A If yes, describe under SPECIAL PROVISIONS below E I DNSh"wRsM` iF 0. EJ4tlPf o"YE'&' S ....._. u EL DISEASE POLICY tIMI1 .,_._�.E A Abuse/Molestation N N --- S0019GLo00001-04 mm� 01/06/2025 011 �.........._, _. OTHER 06/2026 Each Occurrence: $ 100,000.00 Aggregate: $ 500,000.00 _ s DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space i required) Liability Policy Deductible: $0,00 Deductible for Bodily Injury and $ 1000.00 per Property Damage Claim. ISO Occurrence forth CG 00 01 04 13 and company's specific forms. Coverage for Participant Legal Liability requires that every participant signs a waiver/release,. RE: Registered Drama participants: 01/0612025 - 01/06/2026; ...._..... ......... ........,. ....................... __.. ....... .. ...........�... ..,_ CERTIFICATE HOLDER CANCELLATION City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street AUTHORIZED REPRESENTATNE El Segundo, CA, 90245 p —� 1 Mark Di Perno ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ©1988- 2009 ACORD CORPORATION. All rights reserved. ©2008 ACORD CORPORATION. All rights reserved. ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: S0019GL000001-04 CERTIFICATE#: ASP-SU-25-01-06-327552_E1 NAMED INSURED: City of Ell Segundo POLICY PERIOD: January 06, 2025 to January 06, 2026 This Endorsement changes the Policy. Please read it carefully. Amendment - Primary and Non -Contributory - GEN 190005 0218 Policy Amendment — Commercial General Liability This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name of Person(s) Or Organization(s): Any person or organization if required by an insured contract provided such contract was executed prior to the occurrence or offense The City of El Segundo, its elected and appointed officials, employees, and volunteers 350 Main Street El Segundo, CA, 90245 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to the Person(s) or Organization(s) shown in the Schedule applicable to this endorsement provided that: (1) such Person(s) or Organization(s) is/are a Named Insured under such other insurance; and (2) you have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to such Person(s) or Organization(s). This Endorsement is otherwise subject to all the terms, conditions, exclusions, limitations, and provisions of the policy to which it is attached. S GEN 190005 02 18 Page 1 of 1 POLICY NUMBER: S0019GL000001-04 COMMERCIAL GENERAL LIABILITY CERTIFICATEM A-SP-SU-25-01-06-327552 CG 20 26 04 13 NAMED INSURED: City of El Segundo POLICY PERIOD: January 06, 2025 to January 06, 2026 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 Person(s) Or Organization(s): Any person or organization that you have agreed to include as an additional insured under an insured contract provided such contract was executed prior to the date of loss. City of El Segundo, its elected and appointed officials, employees, and volunteers 50 Main Street I Segundo, CA, 90245 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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. CG 20 26 0413 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 contractor 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. © Insurance Services Office, Inc., 2012 Page 1 of 1 CITY OF EL SEGU-NDO 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 perjury under the laws of California one of the following declarations: �) 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. (—Vi 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: Carrier Name of Agent Policy Number Expiration Date Phone # 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 to the workers' compensation provisions of Labor Code § 3700 1 must immediately comply with those provisions or the agreement will automatically become void.. Signature of Applicant �rraz ,"° Date 12/5/23 4 Print Name Agreement for: Dated: 12LRfiZ2 Reviewed by: