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PROOF OF INSURANCE (2026).... CERTIFICATE.�.OF LIABILITY ........... .. .. E DA (MMIDD/YYYY) 01IO6I2025 INSURANCE.. 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 tNTe 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 endorsement(s). ..._ -- .... ... .......... _ ......... _._ _. .. .... _..... _ 66 PRODUCER NAM�ICT The Camp Team, LLC C N� ADDRESS: 4 sty 80fo@campl am COrT1 Y. l FAX t M.t�r 303 422 1276 9035 Wadsworth Parkway, F�M AIL Suite 3820, p ... Westminster, CO, 80021 �Ip INsuReR(s) A —FFORD..NG COVERAGE ..... V .�„NAICa ..,.., CI of El Segundo 9 INSURER B : Accelerant Specialty Insurance Company 16890 INSURED Sports Marketing Program Management Inc. p " tymmm� --- � " " __ - INSURER C 350 Main Street SUREIR.11 _ �............. .... "_ IND . El Segundo, CA, 90245— ............. ...._ ..........,.,.. ..... ....�.... ..... ..." INSURER E s. INSURER F COVERAGES CERTIFICATE NUMBER: A-SP-SU-25-01-06-327552 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.. ........... ... D ...�..--. 1NTR SR TYPE OF INSURANCE ........, Ate. SUBR 01/O�6 026 LIMITS AMR A COMMERCIAL GENERAL LIABILITY DAMAGE T NCE $ 1 QQQ QQQ 0Q GENERAL LIABILITY IT S0019GL000001-04 01/06/2025 FIRE HE ..IEN, $ 1 .� ..a...- N N AMAGETOPREMISES I$300,000.00 iNOO„UD-SATHLETICPARTICIPANTS PERSONAL&ADVINJUes) CLAIMS -MADE OCCUR MED EXPr(any one e, person) $1,000,000.00 GENERAL AGGREGATERY,_q $,QQQ QQQ QI)„ GENERAL AGGREGATE LIMIT APPLIES PER: COMP/OP �$2,000,QOO.00 PRODUCTS C,� X POLICY PROJECT LOC AUTOMOBILE LIABILITY E LIMIT ANY AUTO HIRED AUTOS ( ) . (Ea accident) $ .. ... --- ..._._ ------ ALL Per person) �$ ALL OWNED NON -OWNED .._. (... _------- .... ...... AUTOS AUTOS BODILY INJURY Per accident) $ ..."...--'. SCHEDULED AUTOS PROPERTY DAMAGE $(Peraccldenl) .. ... UMBRELLA LIAR OCCUR EACH OCCURRENCE $ ......... ,.....,._---- ........ ......... . ......... ,..... .....� EXCESS LIAB CLAIMS -MADE AGGREGATE DEDUCTIBLE $ RETENTION $ ,. _ I $ . .._._.. .__..__...._. _---- ......... ..... WORKERSCOMPENSAT10N WC STATU O fH- ANDS PLOYER UABLITY ... TORY.LIMITS , ...._-- EF3.. ,.. .......m, ANY PROPRIEfORiPARTNERID(ECUTNE OFFICERrMENBEREXCLUDED? E.L. EACH ACCIDENT $ (Msdaiory n NH) N I A If yes, describe under SPECIAL PROVISIONS below E,L. DISEASE - EA EMPLOYEE Is A .... ........... EL. DISEASE -POLICY LIMIT 4$ OTHER Abuse/Molestation N N S0019GL000001-04 01/06/2025 01/06/2026 Each Occurrence: $ 100.000.00 Aggregate: $ 600,000.00 _ e, "d more space is required) DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, Liability Policy Deductible: $0.,00 Deductible for Bodily Injury and $ 1000.00 per Property Damage Claim, ISO Occurrence form 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: 01/06/2025 - 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 REPRESENTATIVE El Segundo, CA, 90245 p --J, Mark Di Perno ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ©1988- 2009 ACORD CORPORATION. All rights reserved. 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 # (_A I certify that, in the performance of the work set forth in the agreement with the City of ICI 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 Print Name Agreement for: Dated, Reviewed by: Date n,mho. an 9ros