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PROOF OF INSURANCE (2026)_ d _ ,.. . e x 3-�i^�*T:.A^�i�IfYT:.#riLRYT:#II[M.Yl.*S'i6!"J•I�r�CR."'��:7IrBI�'�+tai,*d'i�"'Bl�h1s*�l lwlla'rCI:.9�'.. 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. IN$R w�. ... t3 P'd EXP LI'Mfr'5 TYpE GF INSURANCE WIMP VAM ,.. .. 01/06/2026 NCE EACH -OCCURRENCE _ ...RENTED .... $ 0000 000'00_ GENERAL LIABILITY y N 50019GL000001-04 01/06/2025 A X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE TO PREMISES $ 300,000.00 A�Ceml5tfS. CLAIMS -MADE FX OCCUR MED EXP (an One pemon) INCLUDEIS ATHLETIC PARTICIPANTS PERSONAL 8 ADV INJURY $ � ��,N)� 000.00 �.... GENERAL AGGREGATE PRODUCTS - COMP/OP AGG $ 2 0000'OQ GENERAL AGGREGATE LIMIT APPLIES PER: '..... POLICY PROJECT LO'C $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO HIRED AUTOS ALL OWNED NON -OWNED AUTO BODILY INJURY (Per person) $ AUTOS BODILY INJURY (Per accident) $ SCHEDULED PROPERTY DAMAGE $ AUTOS F"riaceFdeflt. ......... _..... -_ UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB °- CLAIMS -MADE AGGREGATE I$ DEDUCTIBLE RETENTION $ $ ANDEMP TN ., PNYPf "TO;ART"NERIE74=CAJfIVE PRIIETDIRPA. OF iCE EXCLUDED? ACCIDENT E.L. EACH A $ okinyInNM N/A If yes, describe under P:.;L,DN'SEASE-FA EMPLOYEE: s SPECIAL PROVISIONS below E,1., DISEASE . POLICY L1MtT' S A OTHER Abuse/Molestation Y N S0019GL000001-04 01/06/2025 01/06/2026 Each Occurrence: $ 100,000.00 Aggregate: $ 500,000.00 ACORD Additional Schedule, if EST space s required) Endorsed Date :Mar 5 2025 12 ge IP Policy Deductible$0,00 Deductible orJBod Bodily Injury and nd $tt1000.00 per Prch for Liability operty Damage Claim, s SO Occurrence form CGe 00 01 04 13 and company's specific forms. Coverage for Participant Legal Liability requires that every participant signs a waiver/release. The certificate holder is named as Additional Insured with respect to (continued on next page) d[dJ The City of El Segundo, its elected and appointed officials, employees, and volunteers SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 350 Main Street DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo, CA, 90245 AUTW90RI7:ED REPRESENTATIVE 1 / — Mark Di Perno —] ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD ©1988- 2009 ACORD CORPORATION. All rights reserved. . ......... �...._ AGENCY NAMEDINSURED The Camp Team, LLC _ City of El Segundo POLICY NUMBER 350 Main Street S0019GL000001-04 ElSegundo, .........A.... ._ ............. ........ CA, 90245 CARRIER NAIC CODE Accelerant Specialty Insurance Company 16890 EFFECTIVE DATE: 01/06/2025 ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ©1988- 2009 ACORD CORPORATION. All rights reserved. POLICY NUMBER: S0019GL000001-04 CERTIFICATEM A-SP-SU-25-01-06-327552_E1 NAMED INSURED: City of El 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 0 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. 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. e City of El Segundo, its elected and appointed officials, employees, and volunteers Main Street 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 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. © Insurance Services Office, Inc., 2012 Page 1 of 1 0 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 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. (_) 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 # (,Z) 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 becorn subj ct to the workers' co, pensation provisions of Labor Code § 3700 1 must immediately comply with tho prov' ins r , e g eernent ill automatically become void. Signature of Apply"cant t "� Date Print Name Agreement for: Dated: Reviewed by: