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PROOF OF INSURANCE (2014) CLOSED L.A. Ice Ventures, LLC Agreement No. 4690 NH63759 Ate" CERTIFICATE OF LIABILITY INSURANCE DATE/MM/DD/YYYY) 9125/2013 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 NAME, Carey Cash Commercial Lines—(800)990-7465 PHONE 603-559-1360_ _. a 855-529-7684 rely u c.r1. ...WIC''4);.. Wells Fargo Special Risks,Inc. E a L:$S: oorey, Sh(r wellsfar o.cDn1 INSURERIS.. _._...._.. ............._............ — y.ca �. 230 Commerce Way,Suite 230 AFFORDING COVERAGE NAIC# ._. _."- --._....... Portsmouth,NH 03801 INSURER NOVA Casualty Company 42552 INSURED ....________............................ .............-........................................�.�...� .. -.......-..--........-_-...._.. .-�_� INSURER B: American Skating Entertainment Centers,LLC INSURER C':............................................___.._____ ..... ... .._..........................................--------- _ 4809 E.Thistle Landing Drive INSURER D: .. ............ Suite#100 _ INSURER E: Phoenix,AZ 85044 INSURER F: COVERAGES CERTIFICATE NUMBER: 6816487 REVISION NUMBER: See below 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. A S POLICY EFF POLICY EXP .. -...... ........................................................_......... INSR TYPE OF INSURANCE ruso wvn POLICY NUMBER fMMloolWW1 lMMlonlvyYvl LIMITS LTR . .. _. GENERAL LIABILITY A WSI-CL-TBD 09/01/2013 09/01/2014 EACH OCCURRENCE $ 1,000,000 UAKTAWTUAMTUEF COMMERCIAL GENERAL LIABILITY PR'EMNSE. LEa ca¢xaulroncp $ 300,000 .. CLAIMS-MADE [ OCCUR ME D EXP(Any one person) $ Excluded PERSONAL&ADV INJURY $ 1,000,000 .......... .,.....__......_............................................................................. .-.GENERAL AGGREGATE $ None GEN'LAGGFIEGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 O- POLICY _ PR LOC $ A AUTOMOBILE LIABILITY WSI-CL-TBD 09/01/2013 09/01/2014 FOMe1.11NEO SINGLE LIMIT 1,000,oa0 Vde t Is IxANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS X AUTOS leer . 'd at — $ ......_.._..............m......... A UMBRELLA LIAR x OCCUR WSI-XS-TBD 09/01/2013 09/01/2014 _IT _, 1,000,0oo EACH OCCURRENCE $....... .___ X EXCESS LIAB_ CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION$..... ....... ............_................... .. ... ..$... WORKERS COMPENSATION X TOWS OF H- A AND EMPLOYERS'LIABILITY WSI-WK-0010091-3 09/01/2013 09/01/2014 T �.... OFFICER/MEMBER EXCLUDED N N/A $ 1,000,0 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE''.$ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Certificate holder and it's Officers,Officials,employees,Agents&Volunteers are named as Additional Insured for liability coverage solely as respects their interests in the Skating Programs held at the insured's facility located at 555 N.Nash Street,El Segundo,CA 90245 and per attached form AGL1350408. Waiver of Subrogation and Primary coverage also applies on the General Liability policy per this form when required by written contract. CERTIFICATE HOLDER CANCELLATION City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Director of Recreation&Park THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 339 Sheldon St. El Segundo,CA 90245 AUTHORIZED REPRESENTATIVE `w The 4,00o o name and logo are registered marks of ACORD ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) {This certifies!®sspl—eertificsle#6616021 issued on 9!2512013) COMMERCIAL.GENERAL LIABILI TY THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY, GENERAL LIABILITY EXTRA ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM 1. EXTENDED PROPERTY DAMAGE It is agreed that SECTION I—COVERAGE A., paragraph 2. Exclusions a. Expected or Intended is deleted and replaced by the following: a. Extended Property Damage "Bodily Injury" or "Property Damage" expected or intended from the standpoint of the insured. This exclusion does not apply to"bodily injury"or"property damage' resulting from the use of reasonable force to protect persons or property. 2. PROPERTY SOLD OR ABANDONED BY YOU It is agreed that SECTION I — COVERAGE A. paragraph 2. Exclusion j.(2) is deleted and replaced by the fallowing: (2) Premises you sell, give away, or abandon, if the "property damage" arises out of any part of those premises, and occurred from hazards that were known by you or should have reasonably been known by you,at the time the property was transferred or abandoned. 3. NON OWNED WATERCRAFT It is agreed that SECTION I — COVERAGE A. paragraph 2. Exclusion g.(2) is deleted and replaced by the following; (2) A watercraft you do not own that is: (a) Less than 52 feet long; and (b) Not being used to carry persons or property for a charge; This provision"applies to any person,who with your consent, either uses or is responsible for the use of a watercraft. This insurance is excess over any other valid and collectible insurance available to the insured whether primary, excess, or contingent. 4. DAMAGE TO PREMISES RENTED TO YOU a. it is agreed that SECTION I -- COVERAGE A. the last paragraph of 2. Exclusions is deleted and replaced by the following: Exclusions c.through n.does not apply to: (9) darnage by fire, lightning,explosion,smoke or leaks from automatic fire protective systems; and (2) damage caused by a resident;, to premises while rented to you or temporarily occupied by you with the permission of the owner.. b. It is agreed that paragraph 6.oi SECTION III—LIMITS OF INSURANCE is deleted and replaced by the following: 6. Subject to s, above, the Damage to Premises Rented To You Limit is the most We will pay under COVERAGE A for damages because of"property darnage°; a. resulting from fire, lightning, explosion, smoke or leaks from automatic fire protective systems,or any combination thereof; and b. caused by a resident; to premises;rented to you ortemporarily occupied by you with the permission of the owner. AGLO1350408 Includes copyright material from Insurance Services Office, Inc. Page t of 5 COMMERCIAL GENERAL LIASILI T Y S. BROAD NAMED INSURED It is agreed that SECTION II-WHO IS AN INSURED is amended to include the following: Any corporation organized under the laws of the United States of America (including any state thereof, its territories or possessions,or Canada (including any province thereof)will qualify as a Named Insured if there is no similar insurance available to that organization, provided that one or more Famed insureds shown in the Declarations has, at the inception of the policy period, an ownership interest in such organization of more than 50%. &. KNOWLEDGE OF OCCURRENCE,OFFENSE, CLAIM OR SUIT The notification requirements of paragraphs 2.a. and 2.b. of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS apply only when the 'occurrence', offense, claim,or"suit"is known to: a. You, if you are an individual; b. A partner or member if you are a partnership orjoint venture; c. An officer or director if you are an entity other than a partnership, joint venture or limited liability company; d. A member or manager if you are a limited liability company; or e. An insurance manager, risk manager or other"employee"you designate prior to loss to give notice to us. Knowledge of an "occurrence,"offense, claim, or"suit"by your agent; servant or"employee" shall not in and of itself constitute knowledge to you unless an individual described in items 1. - 5. of this provision G. has actual knowledge. 7. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS OR PRIOR OCCURRENCES The following is added to Condition 6. Representations of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: Failure to disclose all hazards or prior`occurrences" or offenses existing as of the inception date of this Coverage Part shall not prejudice the coverage afforded under this Coverage Part, provided such failure to disclose all hazards or prior"occurrences"or offenses is unintentional. 8. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition 8. Transfer of Rights of Recovery Against Others To Us of SECTION IV — COMMERCIAL GENERAL.LIABILITY CONDITIONS is amended by adding the following° We waive any right of recovery we may have against any person or organization when such waiver is required by a written contract that you have agreed to prior to loss. 9. ADDITIONAL.INSUREDS a. LESSOR OF LEASED EQUIPMENT i. SECTION II -WHO IS AN INSURED is amended to include as an additional insured any person or organization from whom you lease equipment when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy.Such person or organization is an insured only with respect to their liability for'bodily injury", `property damage`or`personal and advertising injury' caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person or organization. A person's or organization's status as an additional insured under this endorsement ends when their contract or agreement with you for such leased equipment ends. ii. With respect to the insurance afforded these additional insureds, this insurance does not apply to any"occurrence"which takes place after the equipment lease expires. AGLO1350408 Includes copyright material from Insurance Services Office, inc. Page 2 of 5 COMMERCIAL GENERAL LIABILITY b. MANAGERS OR LESSORS OF PREMISES ii. SECTION Il -WHO IS AN INSURED is amended to include as an additional insured any person or organization from whom you lease premises when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an insured only with respect to liability arising out of your ownership, maintenance or use of that part of the premises leased to you subject to the following additional exclusions: ii. VVdh respect to the insurance afforded these additional insureds,the following additional exclusions apply: This insurance does not apply to: (I) Any"occurrence"which takes place after you cease to be a tenant in that premises, (2) Structural alterations, new construction or demolition operations perormed by or on behalf of such person or organization. c. VENDORS i. SECTION II -WHO IS AN INSURED is amended to include as an additional insured any person or organization (referred to below as vendor) with whom you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy, but only with respect to"bodily injury"or"property damage"arising out of "your products" which are distributed or sold in the regular course of the vendor's business, subject to the following additional exclusions: ii. The insurance afforded the vendor does not apply to: (1) "Bodily injury"or"property damage"for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement.This exclusion does not apply to liability fordamages that the vendor would have in the absence of the contract or agreement; (2) Any express warranty unauthorized by you; (3) Any physical or chemical change in the product made intentionally by the vendor; (4) Repackaging, unless unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; (5) Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; (6) Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; (7) Products which, after distribution or sale by you, have been labeled or relabeled or used as a container,part or ingredient of any other thing or substance by or for the vendor;or. (8) "Bodily injury" or"property damage" arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on.its behalf. However, this exclusion does not apply to: (a) The exceptions contained in Sub-paragraphs 4.or 6.;or (b) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. iii. This insurance does not apply to any insured person or organization,from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. AGLO1350408 Includes copyright material from Insurance Services Office, Inc. Page 3 of 5 COMMERCIAL GENERAL LIABILITY d. OWNERS, LESSEES OR CONTRACTORS I. SECTION 11—WHO IS AN INSURED is amended to include as an additional insured any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability for"bodily injury", "property damage" or"personal and advertising injury"caused, in whole or in part", by: (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured. A person's or organization's status as an insured under this endorsement ends when your operations for that insured are completed. ii. With respect to the insurance afforded these additional insureds, the following additional exclusion applies: This insurance does not apply to: (1) "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: (a) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports,surveys,field orders,change orders or drawings and specifications; and (b) Supervisory,inspection, architectural or engineering activities, (2) Bodily injury'or"property damage'occurring after: (a) All work, including materials, parts or equipment furnished in connection with such work, on the project(other than service, maintenance or repairs)to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or (b) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. e. ADDITIONAL INSUREDS—BY CONTRACT,AGREEMENT OR PERMIT SECTION 11—WHO IS AN INSURED is amended to include as an additional insured: (1) Any person or organization is an insured with whom you are required to add as an additional insured to this policy by a written contract,written agreement, or permit that is: (a) currently in effect or becoming effective during the term of this policy; and (b) executed prior to the"bodily injury',"property damage", "personal and advertising injury. (2) This insurance provided to the additional insured by this endorsement applies as follows: (a) That person or organization is only an additional insured with respect to liability caused by your negligent acts or omissions at or from: (1) Premises you own, rent, lease or occupy, or (2) Your ongoing operations performed for the additional insured at the job indicated by written contract or written agreement. (b) The limits of insurance applicable to the additional insured are those specified in the written contract or written agreement or in the Declarations of this policy whichever is less. These limits of insurance are inclusive of and not in addition to the limits of insurance shown in the Declarations. AGL01350408 Includes copyright material from insurance Services Office, Inc. Page 4 of 5 COMMERCIAL GENERAL LIABILITY (3) With respect to the insurance afforded these additional insureds, the following additional exclusions apply: (a) This insurance does not apply to'bodily injury" or'property damage"occurring after. (1) all work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed; or (2) that portion of`your work"out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations on or at the same project. (b) This insurance does not apply to 'bodily injury', `property damage", "personal and advertising injury' caused by the rendering of orfallure to render any professional services. (4) Regardless of whether other insurance is available to an additional insured on a primary basis, this insurance will be primary and noncontributory if a written contract between you and the additional insured specifically requires that this insurance be primary. 10. EXTENDED DEFINITION OF"BODILY INJURY" The definition of'bodily injury"in SECTION V—DEFINITIONS paragraph 3,is replaced by the following: 'Bodily injury' means bodily injury, sickness or disease sustained by a person, including mental anguish or death resulting from any of these at any time. 11. EXTENDED DEFINITION OF"PERSONAL AND ADVERTISING INJURY" The definition of"personal and advertising injury'in SECTION V—DEFINITIONS paragraph 14. is amended to include the additional offense of abuse of process. AGI.01350408 Includes copyright material from Insurance Services Office, Inc. Page 5 of 5 WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT— CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy.We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to e extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be_2_% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization�`° Job Description Blanket per contra ( „4 Skating programs offered by the named insured, Ice Rink Management This endorsement changes the policy to which it is attached effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 09/01/2013 Policy No. WSI-WK-0010022-3 Endorsement No. 001 Insured AMERICAN SKATING ENTERTAINMENT CENTERS,LLC;See Extended Named Premium$ Insured Endt Insurance Company Countersigned by NOVA CASUALTY COMPANY WC 04 03 06 (Ed.4-84)