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PROOF OF INSURANCE (2014) CLOSEDAC�"�' DATE (MMroDrYVrY) e - CERTIFICATE OF LIABILITY INSURANCE 3/15/2013 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 endorsernent(s).. PRODUCER CON A T Melissa Sheker - .,..._..._ ..- ....._� -_ Risk & Insurance Consultants, Inc PHONE (404) 459 -5975 '^. (aa e) as9_s9�6 6400 Powers Ferry ltd., NW -MAIL .,msheker @riskinsuranceco.com Suite 105 INSURER FNSt&RER S gAfFORrIING COVERAGE NAIC q' Atlanta GA 30339 _�....y.._ __ � .. .��«.�..�.�..- �_._._._._._..��.,.,.�..�...._ ...m...._.�..w._.w . Aktassachusetts Bay Ins. .2.306 INSUReo _ _r,_ .s 4184 INSURERSAllmerzca Financial Benefi t In 0 _ Challenger Sports Corp, SoccerPlus Camps Inc ver Insurance Co 2292 INSURER C :I;anO Tetra Brazil Soccer, LLC INSURER D:Technolocry Insurance_ Company 42376 8263 Flint St INSURERE m. Ins I CO n 198 -. 7 ,9 :eCllrit National Lenexa KS 66214 INSURERF: BE Insurance CoEp 39217 COVERAGES CERTIFICATE NUMBER:CL131203963 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. i&TSR TYPE _ C POLICY NUMBER w ..YYC7YY dy4ROdCi7YipY __- LIMITS PE OF INSURANCE GENERAL LlAetlliY EACH OCCURRENCE S 1, 000 000' COMMERCIAL GENERAL LIABILITY ME�O Cl?SP i(Ar yQ, gi l£p^a�a S___� 100,000 0 A _j CLAIMS-MADE � OCCUR ZDA9436702 1/1/2013 '1/1/2019 « PLi?SgONAL a AOV INJURY 5 1, 00K'i _60 GENERAL AGGREGATE $ 2,000,000 GEWL AGGREGATE LIMIT ... LI UC -CO $ 2,000,000, APPLIES PER; PRODUCTS - COFdP /OP AGG 9 POLICY PRO• LOC S .._..._.... X AUTOMOBILE Y LIABILITY ._. BODILY (Per person) AN AUTO on)....Sw_. 000 000 AUTOS SCHEDULED A9394043 1/1J2013 /1/2014 BODILY INJURY Per accident $ AUTOS AUTOS � ( ) NON -OWNED ROPER DAM' HIRBp AUTOS .,_.. AUTOS PIP-Basic m OCCUR EACH OCCURRENCE $ 5f000,000 C . EXCESS LIAR _..... CLAIMS -MADE X UMBRELLA LIAR X ...AGGREGATE ^^.....V. -.w,.. $.....__5,000,000 OED LX I RETENTIONS 0 IUHA9436692 1/1/2013 /1/2014 D ANDPROPOYERS' LABILITY CIJTIVE YON SWC1007292 /1/2023 1/1/2014 CH�ATT3 la �0 OPFICERWEMBEREXCLUDED? N ...N1A 1 000 000... E (Mandate In NH -•'� 03339077 /1/2013 1/1/2014 �EASEEEAEMPLOYE $ mm_ 1 000100ui, rS I E.L. DISEASE ., D If '08 SCRIPTION OF OPERATIONS below , «yA,.,v. 4.. n.m..,- tl mm -.. mm .mmE L. DISEASE - POLICY LIM191T tl,S 1101,100,000 F Participant Accident ABHOO6104 /1/2013 1/1/2014 ArcidentiMedical 25,000 DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES {Attach ACORD 101, Additlonar Remarks Schedule, if more space is required) Mini_Kickers & British Soccer Camp, April 1 - November 25, 2013 It is agreed the certificate holder is named as an additional insured as respects to general liability as required by written contract. Waiver of subrogation in favor of same included on workers compensation. CERTIFICATE HOLDER CANCELLATION w SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MI THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo ACCORDANCE WITH THE POLICY PROVISIONS. Jesse Bobbett 350 Main Street... AUTHORIZED REPRESENTATIVE - El Segundo, CA 90245 Jill Kitchen /SHEKER C i ACORD 25 (2010105) d 1988 -2010 ACORD CORPORATION, All rights reserved. IN EI25ommn"�nt Thn A( f'lPn rinm4 and Innn nr4 rnniotornrl marlre of Ar nPn ZDA 9436702 00 2901935 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY„ AMATEUR SPORTS BROADENING ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SUMMARY OF COVERAGES 1. Additional Insured by Contract, Agreement or Permit Included 2. Additional Insured — Sponsors Included mmmmllo 3. Additional Insured — Subcontractor — Aerobic Instructors, Massage Therapists, and Personal Trainers Included 4. Newly Acquired or Formed Organizations - Covered until end of policy period Included 5. Aggregate Limit per Location Included 6. Alienated Premises Included 7. Bodily Injury Redefined Included 8. Broad Form Property Damage - Borrowed Equipment Included 9. Incidental Malpractice (Employed nurses, EMT's & paramedics) Included 10. Knowledge of Occurrence Included 11. Medical Payments - Increased Limit $ 10,000 12. Non -owned Watercraft 51 feet 13. Personal Injury - Broad Form Included 14. Property Damage Legal Liability (Fire, Lightning, Explosion, $500,000 Smoke or Leakage Damage) 15. Supplementary Payments Increased Limits - Bail Bonds $ 2,500 - Loss of Earnings $ 300 16. Unintentional Failure to Disclose Hazards Included 17. Unintentional Failure to Notify Included 18. Liberalization Clause Included This endorsement amends coverages provided under the Commercial General Liability Coverage Form through new coverages, higher limits and broader coverage grants. .' 1. ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT permit; The following is added to SECTION II — WHO IS b. Premises you own, rent, lease or occupy; or AN INSURED, Paragraph 2.: c. Your maintenance, operation or use of Each of the following is also an insured: equipment leased to you. Any person or organization with whom you This insurance applies on a primary basis if agreed, in writing in a contract, agreement or that is required by the written contract, written permit to provide insurance, that such person or agreement or permit. organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to: a. "Your work" for the additional insured(s) designated in the contract, agreement or Page 1 of 5 421 -1383 10 10 ,a 1,1fes copyrighted material of Insurance Services Office, Inc. 2004 This provision does not apply: d. Unless the written contract or written agreement has been executed or permit has been issued prior to the "bodily injury ", "property damage ", "personal and advertising injury"; 3. e. To any person or organization included as an additional insured by an endorsement issued by us and made part of this Coverage Part; f. To any person or organization included as an additional insured under Paragraph 2. or 3. of this endorsement; g. To any lessor of equipment: (1) After the equipment lease expires; or (2) If the "bodily injury", "property damage ", "personal and advertising injury' arises out of sole negligence of the lessor; h. To any: (1) Owners or other interests from whom land has been leased which takes place after the lease for the land expires; or (2) Managers or lessors of premises if: (a) The "occurrence" takes place after you cease to be a tenant in that premises; or (b) The "bodily injury ", "property damage ", "personal and advertising injury" arises out of structural alterations, new construction or demolition operations performed by or on behalf of the manager or lessor; i. To "bodily injury", "property damage" or "personal and advertising injury' arising out of the rendering of or the failure to render any professional services; or Additional insured coverage will not be provided by this provision if an insured is otherwise excluded in this policy. Additional insured coverage provided by this provision will not be broader than coverage provided to any other insured. All other insuring agreements, exclusions, and conditions of this policy apply. 2. ADDITIONAL INSURED — SPONSORS The following is added to SECTION II — WHO IS AN INSURED, Paragraph 2.: Each of the following is also an insured: Any financial sponsor with whom you agreed in a written contract, agreement or permit to provide insurance, that such person or organization be added as an additional insured on your policy. ZDA 9436702 00 2901935 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 your acts or omissions, or the acts or omissions of those acting on your behalf. ADDITIONAL INSURED — SUBCONTRACTOR — AEROBIC INSTRUCTORS, MASSAGE THERAPISTS, AND PERSONAL TRAINERS SECTION II — WHO IS AN INSURED is amended to add as an additional insured Aerobic Instructors, Massage Therapists, and Personal Trainers, with whom you agreed in a written contract, agreement or permit to provide insurance, that such person or organization be added as an additional insured on your policy. Such person 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 your acts or omissions or the acts or omissions of those acting on your behalf in the performance of your ongoing operations. No Aerobic Instructor, Massage Therapist, or Personal Trainer is an additional insured with respect to any claim arising out of the rendering of or failure to render professional services. 4. NEWLY ACQUIRED OR FORMED ORGANIZATIONS SECTION II — WHO IS AN INSURED, Paragraph 3.a. is replaced by the following: a. Coverage under this provision is afforded only until the end of the policy period. 5. AGGREGATE LIMIT PER LOCATION a. Under SECTION III — LIMITS OF INSURANCE, the General Aggregate Limit applies separately to each of your "locations" owned by or rented to you. b. The following is added to SECTION V — DEFINITIONS: 23. "Location" means premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway, waterway or right -of -way of a railroad. 6. ALIENATED PREMISES Under SECTION I — COVERAGES, COVERAGE A, Paragraph 2. Exclusions, j.(2) is replaced by the following: 421 -1383 10 10 Includes copyrighted material of Insurance Services Office, Inc. 2004 Page 2 of 5 7 8 (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. BODILY INJURY REDEFINED Under SECTION V — DEFINITIONS, Paragraph 3. "bodily injury" is replaced by the following: 3. "Bodily injury" means bodily injury, disability, sickness or disease sustained by a person, including death resulting from any of these at any time. "Bodily injury" includes mental anguish or other mental injury resulting from "bodily injury ". BROAD FORM PROPERTY DAMAGE — BORROWED EQUIPMENT a. Under SECTION I — COVERAGES, COVERAGE A, Paragraph 2. Exclusions, item j. is amended as follows: Paragraph (4) does not apply to "property damage" to borrowed equipment arising out of your operations or while at your location. b. The insurance afforded under this provision is excess over any other valid and collectible property insurance (including deductible) available to the insured whether primary, excess, contingent or on any other basis. INCIDENTAL MALPRACTICE Employed Nurses, EMT's and Paramedics Under SECTION II — WHO IS AN INSURED, Paragraph 2.a.(1)(d) does not apply to a nurse, emergency medical technician or paramedic employed by you if you are not engaged in the business or occupation of providing medical, paramedical, surgical, dental, x -ray or nursing services. 10. KNOWLEDGE OF OCCURRENCE Under SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim or Suit, Paragraph e. is added as follows: e. Notice of an "occurrence ", offense, claim or "suit" will be considered knowledge of the insured if reported to an individual named insured, partner, "executive officer" or an "employee" designated by you to give us such a notice. 11. MEDICAL PAYMENTS — INCREASED LIMITS a. Under SECTION I — COVERAGES, COVERAGE C, Paragraph a.(2) is replaced by the following: ZDA 9436702 00 2901935 (2) The expenses are incurred and reported to us within three years of the date of the accident; and b. Under SECTION III — LIMITS OF INSURANCE, Paragraph 7. is replaced by the following: 7. Subject to 5. above, the higher of: a. $10,000; or b. The amount shown in the Declarations for Medical Expense Limit is the most we will pay under COVERAGE C for all medical expenses because of "bodily injury" sustained by one person. (3) This coverage does not apply if COVERAGE C — MEDICAL PAYMENTS is excluded either by the provisions of the Coverage Form or by endorsement. 12. NON -OWNED WATERCRAFT Under SECTION I — COVERAGES, COVERAGE A, Paragraph 2. Exclusions, g.(2) is replaced by the following: (2) A watercraft you do not own that is: (a) Less than 51 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. 13. PERSONAL INJURY — BROAD FORM a. Under SECTION I — COVERAGES, COVERAGE B, Paragraph 2.e. is deleted in its entirety. b. Under SECTION V — DEFINITIONS, definition 14. "Personal and advertising injury": (1) Paragraph b. is replaced by the following: b. Malicious prosecution or abuse of process; (2) Paragraph d. is replaced by the following: d. Oral or written publication, in any manner, or televised or videotaped publication of material that slanders or libels a person or organization or disparages a person's or 421 -1383 10 10 Includes copyrighted material of Insurance Services Office, Inc. 2004 Page 3 of 5 organization's goods, products or services; (3) Paragraph e. is replaced by the following: e. Oral or written publication, in any manner, or televised or videotaped publication of material that violates a person's right of privacy; (4) Paragraph h. is added as follows: h. Discrimination (unless insurance thereof is prohibited by law) that results in injury to the feelings or reputation of a natural person, but only if such discrimination is: (1) Not done intentionally by or at the direction of: (a) The insured; (b) Any officer of the corporation, director, stockholder, partner or member of the insured; and (ii) Not directly or indirectly related to an "employee ", nor to the employment, prospective employment or termination of any person or persons by an insured. c. This coverage does not apply if COVERAGE B — PERSONAL AND ADVERTISING INJURY is excluded either by the provisions of the Coverage Form or by endorsement. 14. PROPERTY DAMAGE LEGAL LIABILITY (Fire, Lightning, Explosion, Smoke or Leakage from Fire Protective Systems Damage) a. The word fire is changed to fire, lightning, explosion, smoke and leakage from fire protective systems where it appears in the Limits of Insurance section of the Declarations for the Commercial General Liability Coverage Form. b. Under SECTION I — COVERAGES, COVERAGE A, the last paragraph (after the exclusions) is replaced by the following: Exclusions c. through n. do not apply to damage by fire, lightning, explosion, smoke or leakage from fire protective systems to premises while rented to you or temporarily occupied by you with the permission of the owner. A separate limit of insurance applies to this coverage as described in SECTION III — LIMITS OF INSURANCE. This limit will apply to all damage proximately caused by the same event, whether such damage results from fire, lightning, explosion, smoke or leakage from fire protective systems or any combination of the five. ZDA 9436702 00 2901935 c. Under SECTION III — LIMITS OF INSURANCE, Paragraph 6. is replaced by the following: 6. Subject to 5. above, the higher of: a. $500,000; or b. The Fire, Lightning, Explosion, Smoke or Leakage From Fire Protective Systems Damage Limit shown in the Declarations, is the most we will pay under COVERAGE A for damages because of "property damage" from fire, lightning, explosion, smoke and leakage from fire protective systems to premises, while rented to you or temporarily occupied by you with permission of the owner. d. Under SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, Condition 4. Other Insurance, paragraph b.(2) is replaced by the following: b. (2) That is fire, lightning, explosion, smoke or leakage from fire protective systems insurance for premises rented to you or temporarily occupied by you with permission of the owner; or e. Under SECTION V — DEFINITIONS, definition 9. "Insured contract ", Paragraph a. is replaced by the following: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion, smoke or leakage from fire protective systems to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract ". f. This coverage does not apply if Fire Damage Legal Liability of COVERAGE A is excluded either by the provisions of the Coverage Part or by endorsement. 421 -1383 10 10 Includes copyrighted material of Insurance Services Office, Inc. 2004 Page 4 of 5 ZDA 9436702 00 2901935 15. SUPPLEMENTARY PAYMENTS INCREASED 18. UNINTENTIONAL FAILURE TO NOTIFY LIMITS Under SUPPLEMENTARY PAYMENTS COVERAGES A AND B, Paragraphs 1.b. and 1.d. are replaced by the following: 1.b. Up to $2500 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. 1.d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit ", including actual loss of earnings up to $300 a day because of time off from work. 17. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS Under SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, Condition 6. Representations, Paragraph d. is added as follows: d. We will not disclaim coverage under this Coverage Form if you fail to disclose all hazards existing as of the inception date of the policy provided such failure is not intentional. Under SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, Condition 2. Duties In The Event Of Occurrence, Offense, Claim or Suit, Paragraph f. is added as follows: f. Your rights afforded under this policy shall not be prejudiced if you fail to give us notice of an "occurrence ", offense, claim or "suit ", solely due to your reasonable and documented belief that the "bodily injury' or "property damage" is not covered under this policy. 19. LIBERALIZATION CLAUSE Under SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, the following condition is added: Liberalization Clause If we adopt any revision that would broaden the coverage under this Coverage Form without additional premium, within 45 days prior to or during the policy period, the broadened coverage will immediately apply to this Coverage Form. Page 5 of 5 421 -1383 10 10 Includes copyrighted material of Insurance Services Office, Inc. 2004 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 the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Any person or organization as required by written contract _ tJ This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. Endorsement Effective 1/1/2013 Policy No. TWC3339077 Endorsement No. WC 00 0313 Insured Challenger Sports Corp . Premiurn $ Insurance Company Technology Insurance Company Countersigned by 01983 National Council on Compensation Insurance.