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PROOF OF INSURANCE (2026)► DATE (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE dll 01I06I2025 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 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). __ - ..-----..... d"t1�aTacro' ---- PRODUCER NAMF The Camp Team, LLC PHONE ..._ FAX A, R+o,,Ext)....800 7c�s9573 t aril com 9035 Wadsworth Parkway, E,4AIL Suite 3820, ADOf+tAmSS,:....__, ..... ...... ......... PR4tAA,tCiG'N Westminster, CO, 80021 CTOMrt D INSURER(5) AFFORDING COVERAGE ............ --- ....0 ... ..........m...... NAIC # P 9 9 INSURE . , ........__m_.._... m - ..., INSURED Sports Marketing Program Management Inc. Specialty Insurance Company 16890 City of El Segundo R A Accelerant S ec— P INSURER B INSURER c 350 Main Street INSURER D : El Segundo, CA, 90245 ......... .. . ............ . . -- -------------------------------- INSURE I! E : INSURER F : COVERAGES CERTIFICATE NUMBER. A P.»SU 25-01- 66 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. . MSR .w.w,..�.... ... ADDI, SUER ........ ... _... mm PrSLC"r'EFT POLK.YE1tP ......�.,,. - ....._.......... TYPE OF INSURANCE .,,..,..... LIMITS ...... OCCURRE A GENERAL LIABILITY X N N 50019GL000001-04 01/06I2025 01/06/2026 FIRERENDAMAGE (Any one premises) $ 3 OQOOQ 00 Q COMMERCIAL GENERAL LIABILITY 11 EACH TO PREMISES X MED EX person) S 5,000 00 CLAIMS -MADE OCCUR P (any one X INCLUDES ATHLETIC PARTICIPANT'S PERSON AL a... INJURY $t000,000.00 GENERAL AGGREGATE �, 3,O.Q,O,000 00 '.. GENERAL AGGREGATE LIMIT APPLIES PER: PRODUCTS COMP/OP AGG $ 2rQQQrQQQ QQ„ POLICY PROJECT LO,C $ ......... ..... ,.k ..... ........._ ......... _ ....... ............ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ''"'"'"""""""""' (Ea accident) ANY AUTO HIRED AUTOS ... ..........'. LYINJURY (Per person) .. $ ALL OWNED NON -OWNED BODILY _..... --- AUTOS AUTOS _ $,. NNLYINJURY,(Peraccldent)„ -..... ., ••••••- PROPERTY DAMAGE $ SCHEDULED AUTOS „(Per accident),. ..... W„„„„___ ........ ................ ........, ............_ �....... _. .... .......... -. ......_.... UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS -MADE........ AGGREGATE...... _ ..,-. ---.............. l$ ........ ._........ .._ __ ..... .._. ... .. _ ._ DEDUCTIBLE RETENTION $ $ � WC 57A7U ( - A DENPLOYERSUA9LRY ]. TORY.E.W1TS_.. .... k., ..ER-... ,.......................,. ANY PROPRIEfORPARTNERAD(ECUTIVE OFFICERNEIVEER,E74,G'LL D7 E.L. EACH ACCIDENT $ (Nurdaioryn" N I A If yes, describe under SPECIAL PROVISIONS below ITITIT m...._.W�... E.L_. DISEASE EMPLOYEE .. E.L. DISEASE -POLICY LIMIT $ ....,._ ......... ...........50...... 00001-04 __.. ..., Each .�..................... ............. OTHER A Abuse/Molestation N N 01/06/2025 01/06/2026 h Occurrence: $ 100,000.00 Aggregate: $ 500,000.00 DESCRIPTION�........_ ....._..__. ..._ .__.. ..........-...... ................. ........�. OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) 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 ._ _._ ...,_ CANCEL.._.,.. ..........._.,...._ ....�........._. CATION 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 �—r 1, /_1_, Mark Di Perno ACORD 25 (2016I03) 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 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: L_) 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 Policy Number Expiration Date Name of Agent Phone # (_1 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 thos provisi s or the agreement will automatically become void. Signature of Applicant Date Argil ( i Print Name /Alciinvloh Agreement for: Dated: Reviewed by: