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PROOF OF INSURANCE (2026 - 2026)CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 11 /5/2025 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 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 Phone: (804)354-9020 CONTACT Lori Isrntgha usen Fax: (866)352-L40i NAM�bunEc.................---...... �.� . .__...... FAX ........,..... _,,,,,,......,....... The Monument Sports Group 1365 Overbrook Road Suite #1 Richmond, Virginia 23220 INSURED Beginners Edge Sports Training LLC 29634 North Lake Pleasant Parkway Suite 103-405 Peoria, AZ 85383 (SO4)2.56-8335, 30i ....„. _................ Lori@rnonume nt5tspOrtS.CO[71 INSURERA: L101nsuraneeCompany INSURER B : COVERAGE .. ....,.... ..... ...,... ..�..�. �.... �� ... . ... 4lnd'3 0CV1Q1^k1 WIIIUI2C0- a 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. .. .... .......,,, ... ........,..._.- .. ......,, _._ ....... ......... ...E. ............. ,ADI7L. 54A1�rk ..TYPE #���� N� � YY 1 LIMITS 1-_ OF IN SURANCE POLICY NUMBER EA�fLd5CiYCY MM.rODfYE� t.T'R I ✓ COMMERCIALGENERALL (ABILITY L1.011000f341 3-00 11/5/2025 11�5�_O26 OCCURRENCE 1.000 OP10 A � CLAIMS -MADE ! ✓ OCCUR i �imxo t0_ it�N1"�tJ ,FtEMIS'EA_(Fss rl currenpe) 111l111I11� .... ✓ jjj� Inc Participants ✓ n MED EXP (Any one person) $ i 1,uou uuu j PERSONAL ADVINJUR_Y $ .. 3. ODU 00.. G LNI AGGREGATE LIMITAPPLIES PER. GENERAL AGGREGATE $ ... PRO-LOC PRODUCTS COMP OP ............... .. 2,OOU OOO ..... OTHER, Ab11 use/Mol - $ 1000,000 AUTOMOBILE LIABILITY C CC SINE'OSIINGLELWIT Is ANYAUTO BODILY INJURY (Per person) $ ' "ff OWNED SCHEDULED I BODILY INJURY (Per accident) $ . I 1 AUTOS ONLY --- Y AUTOS HIRED NON -OWNED DAMALaF' $ AUTOS ONLY I AUTOS ONLY (td +t,R3...... ,,._ ..........r...,...... . ..- LIAR E RRENCE EXCESS LIAB CLAIMS-M �....... ,UMBRELLA A GGREGATE, ..$ »$ -OCCUR ... DED I RETENTION$ PE WORKERS COMPENSATION COMRIPARTNER/EXECUTIVE STATUTE 1.,..,, „m°R" ...... ........... .. .... DEMPLCOMPENI AND�EMPLOYERS'LIABILITY YIN ' _.I Is EACH IPENTPOLICY OFFICERIMEMBEREXCLUDED? NIA` (Mandatory in NH) E.L D SEASE - EA EMPLOYEE( ...... ...... $ ... . ... ..... ... ................ If yes, describe under r DESCRIPTION OF OPERATIONS below -L, SE E -POLICY LIMIT E,L DISEASE $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Cextifi.cate holder is narnod as err:dlti.cnal insured i.:i° ierlu_i.r'esd Loy wu'it.L_eri contracl_ joer, foam CG° 001 0L 04 1.3, ed u d. an referencereferenceto then. namedd InsLA]'ed.s C?pe1'.:at_,!.3YYs andlub)ect to Lhe';'. 4:A. r'iiS, condl{'.':i :.ons, and named certificate A`.', issu of li.e" r p o I :I.CXl1s of. .ICJ} A t A LCKIIhIUAIL MULUt:.K. trA114�0� rIvrn Holder's Nature of Interest: Additional Insured SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE C'IT'Y OF EL SEGUNDO RECREATION„ PARKS AND LIBRARY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 401 Sheldon Stl El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE V lUtftf-LUID AI.UKU I,VKrVKAI IUIM- Au ngncs UVbVF VF7u. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD THE HARTFORD BUSINESS SERVICE CENTER THE 3600 WISEMAN BLVD HARTFORD SAN ANTONIO TX 78251 City of El Segundo Recreation, Parks and Library 401 SHELDON ST EL SEGUNDO CA 90245 Account Information: cy Holder Details : Beginners Edge Sports Training November 26, 2025 La Contact Us Need Help? Chat online or call us at (866) 467-8730. We're here Monday - Friday.. Enclosed please find a Certificate Of Insurance for the above referenced Policyholder. Please contact us if you have any questions or concerns. Sincerely, Your Hartford Service Team WLTRO05 CERTIFICATE OF LIABILITY ....INSURANCE1 /26/2025 1 THIS C..._ CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE C ERTIFICATE 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 (_) .".. ......__. - _... CERTIFICATE HOLDER. ISSUING INSURERS ,AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATIONIS 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� _....... e PRODUCER CONTACT NAME: INSURANCETRAK SERVICES/PAC PHONE (585 ITPY (877)871-7137 76251042 (AIC No, Ex1) ITITIT C'AIC, No) 4515 CULVER RD SUITE 206 E-MAIL ADDRESS: ROCHESTER NY 14622 . ... IN '. I SURER(S) AFFORDING G COVERAGE NAICIf .......... m — ..........� INSURER A: Hartford Fire and Its P&C Affiliates 00914 INSURED INSURER B BEGINNERS EDGE SPORTS TRAINING INSURERC: 7432 E TIERRA BUENA LN .......................... ................ ........ _....... SCOTTSDALE AZ 85260-1646 INSURER D mm INSURER E INSURER F : ....... .. ............-..,.m. ........ .........._...... __.. ��.. _.___... .........,.... COVERAt31S CERTIFICATE NUMBER: REVISION NUMB ........ 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. -_N _ ....- ..........._ _... ................ POLICY EXP LIMITS INSR AODL' SUBR POLICY EFF TYPE OF INSURANCE POLICY NUMBER T _.� INSR _. ...............-AM .Nip 12=1 . ............ _.. ......... COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS -MADE ❑OCCUR DAMAGE TO RENTED MED EXP (Any one person) PERSONAL & ADN INJURY — GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE p� ry PRO- _..... .._-.,,..... POLICY I W II LOC PRODUCTS - COMP/OP AGG 4 ..dd JECT III dI OTHER: .... .........._....._. ..... ...........___....._".NED ..__.. ........ ...._ —COMBISINGLE LIMIT ._ AUTOMOBILE LIABILITY .a acridenl... ._.......- ..._. ANY AUTO BODILY INJURY (Per person) BODILY INJURY.................... ALL OWNED SCHEDULED (Per accident) AUTOS AUTOS DAMAGE HIRED NON-OWNED PROPERTY '.. AUTOS'. AUTOS (Per accident) UMBRELLA LIAB � OCCURRENCE OCCUR EACH EXCESS LIAB CLAIMS- AGGREGATE MADE ED RETENTION $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS' LIABILITY STATt1TE ER ANY Y/N E.L.EACH ACCIDENT $1,000,000 A PROPRIETOR/PARTNER/EXECUTIVE NIA 76 WEG BX3ZPJ 11/04/2025 11/04/2026 .... ..... .. OFFICER/MEMBER EXCLUDED? E..L. DISEASE -EA EMPLOYEE $1,000,000 (Mandatory in NH) E,L. DISEASE - POLICY If yes, describe under LIMIT $1,000,000 ...........-..DESCRIPTION ,OF OPERATIONS below ......... .. .......... _ ....... _......._.,,,...,,,.,,. .......... ._................................................. ..._. ....... ... ... _..... DESCRIPTION OF OPERATIONS /LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's O. HOLDER ........ _ ..... _ ._..__.... _ _. ... OF THE OVE DESCRIBED POLICIES ANCELLED City of El Segundo Recreation, Parks SHOULD BEFORE THE XPIRATIONBDA E THEREOF, NOTICE WILLBBEC and Library DELIVERED P .....- 401 SHELDON ST PROVISIONS. IN ACCORDANCE WITH THE POLICY P EL SEGUNDO CA 90245 AUTHORIZED REPRESENTATIVE ._........................_. ........... __ --------- _......... © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 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. Lx_) 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 The Hartford Name of Agent 76 WEG BX3ZPJ Policy Number Expiration Date (866) 467-8730. Phone # 11 /4/2026 (_) 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. . 11 /26/2025 Signature of Applicant Date Print Name Mitchell Goldber Agreement for: Dated:. Reviewed by: