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PROOF OF INSURANCE (2004) CLOSEDDATE (MMIDDIYYYY) A ;O . CERTIFICATE OF LIABILITY INSURANCE 08/11/2004 PRODUCER (805) 520 -8410 FAX (805) 526 -4659 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION HAYES COMPANY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 0 BOX 1988 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 2315 N KUEHNER DR #107 INSURERS AFFORDING COVERAGE NAIC # SIMI VALLEY, CA 93062 INSURED West Coast Baseball School Inc INSURER A: Burlington Insurance Company Dba: Baseball Expansion, Tournament Batting INSURER B: Cages, Total Baseball INSURER C: — 28914 Roadside Drive #1D INSURER D: Agoura Hills, CA 91301 INSURER E: rnVFRA[;FS , — r,.. D=Dlnn INnlnaTFn- NOTWITHSTANDING THE ANY MAY POLICIES. IN- POLICIES REQUIREMENT, PERTAIN, OF INSURANCE LISTED BELOW TERM OR CONDITION THE INSURANCE AFFORDED AGGREGATE LIMITS SHOWN MAY HAVE BEEN IJ,Utu I U 1 nr 11NQ OF ANY CONTRACTOR OTHER DOCUMENT BY THE POLICIES DESCRIBED HEREIN HAVE BEEN REDUCED BY PAID POLICY NUMBER r ram ,. ,.,� - •. WITH RESPECT IS SUBJECT CLAIMS. POLICY EFFECTIVE POLICY - • - - TO WHICH TO ALL THE TERMS, EXPIRATION THIS CERTIFICATE MAYBE EXCLUSIONS AND CONDITIONS LIMITS ISSUED UK OF SUCH SR DD' TYPE OF INSURANCE GENERAL LIABILITY 1608000292 10/0312003 10/03/2004 EACH OCCURRENCE 00 $ 1'000,0 $ 100 Qnn DAMAGE TO RENTED PREMISES (Fa occil enre) X COMMERCIAL GENERAL LIABILITY X CLAIMS MADE ❑ OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 A X GENERAL AGGREGATE $ 1,000,000 PRODUCTS - COMP /OPAGG $ GEN'L AGGREGATE LIMIT APPLIES PER: _Included PRO- LOC POLICY JECT COMBINED SINGLE LIMIT (Ea accident) $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (Per accident) $ NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ AUTO ONLY - EA ACCIDENT $ GARAGE LIABILITY ANY AUTO EA ACC OTHER THAN __.. AUTO ONLY. AGG $ $ EACH OCCURRENCE $ EXCESSIUMBRELLA LIABILITY OCCUR CLAIMS MADE AGGREGATE $ $ $ RETENTION $ WC STATU- OTH- _—FIDEDUCTIBLE WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, descdbe under E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE - -_ -_ -- E.L. DISEASE - POLICY LIMIT $ - _ $ SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Revised certificate 09/02/04 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT Additional Insured: BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY City Of El Segundo OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. 350 Main Street AUTH REPRESENTATIVE Q E1 Segundo, CA 90245 -3895 aJ,(1 /J © ACORD CORPORATION 1981 ACORD 25 (2001/08) DATE (MMIDDIYYYY) AVC a CERTIFICATE OF LIABILITY INSURANCE 06/19/2003 r FAX (805) 526 PRODUCER } 520 -8410 -4659 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION C ' ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HAYES COc' '1Y HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P 0 BOX 3 2315 N I NER DR #107 INSURERS AFFORDING COVERAGE NAIC# SIMI VA'_ CA 93062 _ - -- INSURERA. Burlington Insurance Company. INSURED We... oast Baseball School Inc INSURERB Ba 11 Expansion & Tournament —_ -- - 28< INSURER C. Roadside Drive #1D -- INSURER D: Ac, Hills, CA 91301 INSURER E IN( it i WOF EMPt, OFF1 If yes SPEC: OTHI 'ro DESCRIPTI( CERTIF" PERIOD INDICATED. NOTWITHa I AN rNTSTEI I t OR CONDITION OF ANY CO TRACT OR OTHER DOS UMENTAWITH RESPECT OTO THE WH COHL HIS CERTIFICATE MAY BE ISSUED OR D HE INSU ,1 fJCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH EGATE Lln',H S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. — LIMITS — -- -- POLICY EFFECTIVE POLICY EXPIRATION 'YPE OF RdSURANCE POLICY NUMBER IDDIYY) DATF rM� MIOD /VVIOD )_. -EACH OCCURRENCE $ 1,000,01 1608000086 10/03/2002 10/03/2003 - LIABILITY DAMAGE TO RENTED $ 10010 '.1ERCIAI- •!711 -.RAL LIABILITY _' T'FMI4F5IF_a mm�rNnc _ NIED EXP (Any one person) $ CLAIMS r.lA1 -. OCCUR L,___ — L-1 PERSONAL & ADV INJURY $ 1,00 0 RATIONS I LOCATIONS /VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS 'ALDER. L Adchitonal 7.!i '.Ired: Cc +y of E1 Segundo 350 Min SLi ee,c E I Seg'-Indo, u,. 90245 ACORD 108) ✓ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE B33UING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILUI7E TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZ PLPRESENTATIVE CORPORATION 1988 GENERALAGGREGATE $ 19000,000 - - -._ PRODUCTS - COMP /OP AGG $ 1,000,000 _ ;REGATE L11A I APPLIES PER: Pf:O LOC Y I J6CT - - -- COMBINED SINGLE LIMIT $ 41LE LIABILITY (Ea accident) ',UTO HODILY INJURY $ WNLD !.'.I Ce iPer person) DULED it BODILY INJURY $ AU I �- (Per accident) JWDJ( PROPERTY DAMAGE $ -_ Per accident) T ; \UTO ONLY - EA ACCIDENT $ _IABILII 01-HER THAN ---- __._ -- I EA ACC $ ,UTO AUTO ONLY: AGG $ _ — L -ACH OCCURRENCE $ ,rdBRELI •A L!A iILITY I AGGREGATE $ R ;LAIMS MADE $ I CTIHG $ NTION - -� -- WC STATU- OTH- PRY Ll i°ENSATION AND L. EACH ACCIDENT $ ABILITY R /PF.n • •" •:.CU T:VE E.L. DISEASE - EA EMPLOYE _$ – 1R EXC1.'JDLD' G.L. DISEASE - POLICY LIMIT $ der -IONS b�'��a- _ 1608000086 10/03/2002 10/03/2003 " Loc #3 $25000, Loc #4 $100000 Special Form RATIONS I LOCATIONS /VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS 'ALDER. L Adchitonal 7.!i '.Ired: Cc +y of E1 Segundo 350 Min SLi ee,c E I Seg'-Indo, u,. 90245 ACORD 108) ✓ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE B33UING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILUI7E TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZ PLPRESENTATIVE CORPORATION 1988 AUG, 13, 2003 10;27AM N0, 0011 P. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (TENDER OF ANY LOSS TO OTHER AVAILABLE INSURANCE, AND EXCLUSION OF EMPLOYEE INJURY) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM This endorsement changes the policy effective on the inception date of the policy unless another date is indicated Endorsement Effective Attached to and forming a part of Policy (Standard Number mm dd I yy 1605000086 06/19/20 he above information is reaulred only when this ei orsemer4 is issued sub+ SCHEDULE Name of Person or Organization: CITY OF EL SEGUNDO 350 MAIN STREET EL SEGUNDO, CA 90245 This endorsement is provided in consideration of an additional premium. 12:01 1 A.M. to Premium. Exposure: Only the person or organization named Who is An Insured (Section 11) Is amended to Include as an Insured the person or organization shown in the SCHEDULE, but only with respect to liability arising out of your ongoing operations performed for that insured, including acts or omissions of the Additional Insured in connection with the general supervision of such operations. Except as provided above, this insurance does not apply to any "bodily injury," "property damage" or "personal and advertising injury" arising out of or resulting from the neglect or negligence of the Additional Insured described in this endorsement. If other valid and collectible insurance is available to the person or organization shown in the SCHEDULE for a loss we cover under Coverage A or B of the Coverage Form to which this endorsement attaches, then the person or organization shown must also, as a condition for coverage hereunder, tender any loss to each such other insurance. This insurance does not apply to any "bodily Injury" to. a. An "employee" of any insured, or a person hired to do work for or on behalf of any insured or a BG-G370 0101 Endorsement Number It Date Classification Code: 49850 tenant of any Insured, that arises out of and in the course of: (1) Employment by any insured; or (2) Performing duties related to the conduct of any Insured's business; or b. The spouse, child, parent, brother or sister of that "employee" as a consequence of Paragraph a. above. This exclusion applies: a. Whether an insured may be liable as an employer or in any other capacity; and b, To any obligation to share damages with or repay someone else who must pay damages because of the injury. These provisions and exclusions apply In addition to those contained in the Coverage Form. All of the provisions and exclusions of the policy that apply to LIABILITY COVERAGES also apply to this endorsement. AUG, 13.2003 10 ; 27AM N0. 0011 P. 1 0 IF61"Onies POLICY NUMBER; 160B000086 ENDORSEMENT #; 004 NAMED INSURED: WEST COAST BASEBALL SCHOOL,INC. BASEBALL EXPANSION INSURANCE COMPANY: The Burlington Insurance Company EFFECTIVE DATE: 06/19/2003 PRODUCER: EXCESS & SURPLUS LINES INSURANCE BROKERS,INC. THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. GENERAL CHANGE ENDORSEMENT This endorsement modifies insurance provided under the following: Commercial General Liability Policy ADDING ADDITIONAL INSURED PER THE ATTACHED FORM BG -C -370. ADDITIONAL PREMIUM $ 100.00 ( FULLY EARNED) STATE TAX $ 3.00 STAMPING FEE $ .13 TOTAL A/P $ 103 -13 AUTHORIZED�TURE Premium for this Change Endorsement: $ g Tax, if applicable .00 ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. IFG-1 -0151 1100 Issue Date: 07/10/2003 West Coast Baseball School ' "Home of Future Prospects" August 7, 2003 Mr. Richard Hogate Office of The City Clerk 350 Main St. El Segundo, Ca 90245 -3895 Dear Mr. Hogate I am writing this letter to state that West Coast Baseball School is a LLC partnership. Our instructors are independent contractors, thus they are not subject to workman's compensation. If you have any questions, please feel free to call me at (310)322 -3955. Sincerely, James Lewis West Coast Baseball AGOURA HILLS • SHERMAN OAKS • WOODLAND HILLS • NORTH HILLS BURBANK • GRANADA HILLS • SANTA CLARITA • SIMI VALLEY • EL SEGUNDO 28914 ROADSIDE DR., #4 • AGOURA HILLS, CA 91301 • (818) 865 -8825 • FAX (818) 865 -8647 www.westcoastbasebaflschool.com