PROOF OF INSURANCE (2012) CLOSED�1 OP ID: WK
AC�RO' GATE (MM /DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 02/15111
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).
PRODUCER 800 -526 -1379 CONTACT
Bollinger, Inc. NAME:
101 JFK Parkway 973- 921 -2876 C41CNNo F-xl. _I (FAA/_ No):
Short Hills, NJ 07078 -5000 E-MAIL -- - - - - -
John T. Spiotta PRODUCER
INSURED UK International Soccer Camps,
Inc
PO Box 1838
Redlands, CA 92373
C�13TQMER�D N: UKINT -2
INSURER(S) AFFORDING COVERAGE NAIC 0
INSURER A: Markel Insurance Company _ 38970
INSURER e.: Markel Insurance Company 138970
INSURER C
- - - -- -
INSURER D
INSURER E: _
INSURER F:
COVFROnFS CFRTIFICOTF Nt1MRFR, RFVISIAN NIIMRFR-
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.
350 Main St
AUTHORIZED REPRESENTATIVE
- - - - -- - IA�L�SI�I _.. __ _ .. -- - POLICY EFF POLICY EXP
ILT R
LT TYPE OF INSURANCE POLICY NUMBER MM /DD/YYYY MMIDD/YYYY
LIMITS
GENERAL LIABILITY ! I
—1
EACH OCCURRENCE $
I D7WAOE -To PENTFE ._
1,000,00
A X COMMERCIAL GENERAL LIABILITY X 8502AH238111 02/01/11 02/01/12
PREMISES.(Ea occurrence) $
100,00
I I
5,00
CLAIMS -MADE X OCCUR
MED EXP (Any one person) $
X Incl Participants 1 I I I
PERSONAL & ADV INJURY $
1,000,00
GENERAL AGGREGATE $
3,000,00
GENT AGGREGATE LIMIT APP_ LIES PER: I
PRODUCTS - COMP /OP AGG $
1,000,00
1 1
I PRO-
-.. -- .- $
POLICY LOC
AUTOMOBILE LIABILITY i
i COMBINED SINGLE LIMIT
$
(Ea accident)
, ANY AUTO
IBODILY INJURY (Per person) ! $
ALL OWNED AUTOS
J I
F BODILY INJURY (Per accident) $
SCHEDULED AUTOS I
PROPERTY DAMAGE '$
HIRED AUTOS
(Per accident)
-�
$
NON - OWNEDAUTOS
-
1
_ -
UMBRELLA LU16 OCCUR I
l
EACH OCCURRENCE $
r.
—.
1 EXCESS LIAB CLAIMS-MA
AGGREGATE
1 -_.
-I DEDUCTIBLE
RETENTION
$
WORKERS COMPENSATION
OR SLIM T EEL
I- TORYIIMITS ER
-. .
AND EMPLOYERS' LIABILITY YIN N I
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT $
" - "-
-
1 OFFICER/MEMBER EXCLUDED? ❑ N / A
(Mandatory In NH)
I I
- "-- "'
E.L. DISEASE - EA EMPLOYEE $
_ _ _ I
If yes, describe under
DESCRIPTION OF OPERATIONS below
I
E.L. DISEASE - POLICY LIMIT $
B Accident Insurance 4102AH238110 02/01/11 02/01/12
iMed Max:
100,00
Full Excess
Ded:
$50 /Clal
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
The certificate holder is named as an additional Insured under the liability
policy. Coverage is provided under this policy only for sponsored /supervised
activities of the named Insured for which a premium has been paid.
f%AL1t%MA 1 ATIPIW
ELSEGI
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of El Segundo
City Clerk
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
350 Main St
AUTHORIZED REPRESENTATIVE
El Segundo, CA 90248
v U 1988 -2009 AGUKU GUKPUKA11UN. All ngni3 reserved.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
Page 1 of 2
Ramos, Vina
From:
Ramos, Vina
Sent:
Thursday, February 17, 2011 9:52 AM
To:
Dave Thomas
Cc:
Bobbett, Jesse
Subject: Re: UK International Camp agreement 2011
Thanks Dave. I will get with Risk Manager and get back to you next week.
Vina
On Feb 17, 2011, at 9:26 AM, "Dave Thomas" <david.thomas @uksocca.com> wrote:
Hey Vina
I am going back and forth with our insurance and this is the response I received.
I am not familiar with insurance policies, so not sure how to proceed with this.
Dave
Begin forwarded message:
From:
Date: Fe ruary 17, 2011 9:19:58 AM PST
To: "'Dave Thomas "' <david.thomas ®uksocca.com>
Subject: RE: UK International Camp agreement 2011
From: Dave Thomas [ mailto :david.thomas @uksocca.com]
Sent: Thursday, February 17, 2011 12:13 PM
To: Will Krouslis
Subject: Fwd: UK International Camp agreement 2011
Jessica
Please see the response from the city regarding the endorsement you sent.
Dave
2/23/2011
Begin forwarded message:
From: "Ramos, Vina" <vramos @elsegundo.org>
Date: February 16, 2011 5:10:13 PM PST
To: "Dave Thomas" <david.thomas@uksocca.com>
Cc: "Bobbett, Jesse" <JBobbett @elsegundo.org>
Subject: RE: UK International Camp agreement 2011
Sorry Dave but the endorsement has to be the same as the attached
sample. The endorsement you sent does not even cover us. Please
forward the sample again. The sample is the only version Risk Manager
will accept. Sometimes, insurance companies require a copy of the
contract to produce the endorsement. they can review your contract,
section 1`2 where it explains the insurance requirements.
Thank you
Vina
From: Dave Thomas [ mailto :david.thomas @uksocca.com]
Sent: Wednesday, February 16, 2011 12:35 PM
To: Ramos, Vina
Subject: Re: UK International Camp agreement 2011
Vina
Please see attached the endorsement that the insurance sent
through.
Dave
This message and any accompanying documents are
intended only for the use
of the individual to whom they are addressed and may
contain information that
is privileged, confidential or protected from
disclosure under applicable law.
If you are not the intended recipient, you are
prohibited from distributing
or copying this communication. If you have received
this e -mail in error,
please notify the sender immediately by reply e -mail
and delete the original
message, attachments and copies.
This email is being sent to you by Bollinger, Inc.
with its headquarters
located at 101 JFK Parkway, Short Hills, NJ, 07078.
Should you wish
to stop receiving email communication from Bollinger
please advise us
by replying to this email with your request, or by
emailing your request
to opt- out @BollingerInsurance.com.
2/23/2011
Page 2 of 2
ATTACHED TO AND FORMING PART OF COMMERCIAL GENERAL LIABILITY
POLICY NUMBER: 8502AH238111 - 8
Markel Insurance Company
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BLANKET ADDITIONAL INSURED ENDORSE ENT
This endorsement modifies insurance provided under the followi
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
THIS ENDORSEMENT WILL ONLY BECOME EFFECTIVE UPON THE ISSUANCE OF A
CERTIFICATE OF INSURANCE ISSUED BY AN AUTHORIZED REPRESENTATIVE FOR THE
COMPANY. THIS CERTIFICATE MUST BE ON FILE WITH THE COMPANY AND THE
INFORMATION REQUIRED TO COMPLETE THIS ENDORSEMENT WILL BE SHOWN IN THE
CERTIFICATE OF INSURANCE APPLICABLE TO THIS ENDORSEMENT.
WHO IS AN INSURED (Section II) is amended to include as an additional insured the person or
organization shown in the Schedule as an insured but only with respect to the following
specified liability:
I. Managers or Lessors of Premises
Liability arising out of the ownership, maintenance or use of that part of the premises
leased to you and shown in the Schedule, subject to the following additional exclusions:
This insurance does not apply to:
1. Any "occurrence" which takes place after you cease to be a tenant in that
premises; and
2. Structural alterations, new construction or demolition operations performed by
or on behalf of the person or organization shown in the Schedule.
II. Grantor of Franchise
Liability as grantor of a franchise to you.
III. Lessors of Leased Equipment
Liability for "bodily injury ", "property damage" or "personal and advertising injury"
caused, in whole of in part, by your maintenance, operation or use of equipment
leased to you by such person(s) or organization (s).
With respect to the insurance afforded to these additional insureds, this insurance
does not apply to any "occurence" which takes place after the equipment lease expires.
All other terms and conditions remain the same.
MGL165 (7/05) Page 1 of 1
Ramos, Vina
From: Dave Thomas [david.thomas @uksocca.com]
Sent: Tuesday, February 22, 2011 8:51 AM
To: Ramos, Vina
Subject: UK International Coaching staff
Vina
All UK International coaches are independent contractors.
Dave
Page 1 of 1
Bacon» a
UK bAwnstkmal tan
The Best Possible Soccer Experience
David Thomas - Regional Director
Tel: 562 - 275 -1786
Office: (888) UK SOCCA
Fax: (866) 288 -4554
david.thomas @ uksocca.com
www.uksocc.a.com
2/22/2011
www. facebo-ok .com /uhinternation.alsoccer
Page 1 of 2
Ramos, Vina
From: Ramos, Vina
Sent: Monday, February 14, 2011 1:37 PM
To: Berger, Karl (Assistant City Attorney)
Subject: RE: Summer camps
Thank you
Vina
From: Karl Berger [ mailto:KBerger @localgovlaw.com]
Sent: Monday, February 14, 2011 12:46 PM
To: Ramos, Vina
Subject: RE: Summer camps
Hi Vina -
Please use the attached form which was updated in 2009. Thanks!
Karl H. Berger
Jenkins & Hogin, LLP
Manhattan Towers
1230 Rosecrans Avenue, Suite 110
Manhattan Beach, CA 90266
Email: kberger @localgovlaw.com
Check out our new wehsitc: www.localgovlaw.com
The information contained in this e-mail message is intended only for the CONFIDENTIAL use of the
designated addressee named above. The information transmitted is subject to the attorney - client
privilege and/or represents confidential attorney work product. If you are not the designated addressee
named above or the authorized agent responsible for delivering it to the designated addressee, you
received this document through inadvertent error and any further review, dissemination, distribution or
copying of this communication by you or anyone else is strictly prohibited. IF YOU RECEIVED THIS
COMMUNICATION IN ERROR, PLEASE NOTIFY US IMMEDIATELY BY TELEPHONING THE
SENDER NAMED ABOVE AT (310) 643 -8448. Thank you.
From: Ramos, Vina [mailto:vramos @elsegundo.org]
Sent: Monday, February 14, 2011 11:11 AM
To: Karl Berger
Subject: Summer camps
Hi Karl,
We are now starting to work on our summer programs, and UK International will be providing soccer camps.
Attached is the agreement that was used in the past. Can you please review and advise if this is still the version
you would like us to use?
Maximum students will be 50 @ $170 = $8,500
2/23/2011