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PROOF OF INSURANCE (2012) CLOSEDCQRD 0)' " N��"�"" i Y �w DATE a �M�� A w� �9 f , G 0 /04 /DDJY PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. FOR SERVICE CALL: THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE FRANCIS L. DEAN & ASSOCIATES OF FLORIDA, LLC COVERAGE AFFORDED BY THE POLICIES BELOW. OCALA, FLORIDA 877/671 -3326 COMPANIES AFFORDING COVERAGE www.fdeanfl.com COMPANY RIVERPORT INSURANCE COMPANY A .. _ INSURED SPORTS AND REC. PROVIDERS ASSN. PURCHASING GROUP �...._._ � . ..... ........ COMPANY TriFytt Sports B 1205 N. Red Gum Street, Suite A Anaheim, CA 92805 COMPANY Cert #: AP139806 -00 ........ ....... - °° COMPANY D /ABC1 �� /� �� "�� " " "� THIS IS TO CERTIFY THAT THE POLICIES OF tlNSL)RANCE LISTED BELOW HAVE BEEN ISS JED TO THE UNSURED NAMED VE 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 TERM EXCLUSIONS AND CONDfflO S OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, yu �� CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE MMIDD/YY DATE MM /DD LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ 2,500,000.00 A X COMMERCIAL GENERAL LIABILITY PRODUCTS- COMP /OP AGG $ 2,000,000.00 CLAIMS MADE r occuR FLDA180411 06/13/11 06/13/12 PERSONAL & ADV INJURY $ 1,000,000.00 OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $ 1,000,000,00 INCLUDES ATHLETIC PARTIGPANTS —_... .. _.�.. FIRE DAMAGE ( An one fire) .. $ 3...... .00 MED EXP (Any one person) $ 5,000.00 AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT �ODY $ 1,000,000.00 ALL OWNED AUTOS SCHEDULED AUTOS FLDA180411 06/13/11 06/13/12 e n)URY $ X HIRED AUTOS �.._ BODILY INJURY $ X NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY -EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGG... REGATE $ OTHER THAN UMBRELLA FORM °$ WORKER'S COMPENSATION AND wO sTATU- OTH- EMPLOYERS' LIABILITY ER ��... EL EACH ACCIDENT $ THE PROPRIETOR/ INCL PARTNERS /EXECUTIVE LI IT ...... ........... ........... -.... EL DISEASE - POL CY LIMIT $ OFFICERS ARE: EXCL EL DISEASE- .. EA EMPLOYEE $ OTHER DESCRIPTION OF OPERATIONS /LOCATION'SJYEHICLESISPECIAL ITEMS Certificate Holder is additional insured perform CF2011 attached. Athletic Activities SHOULD ANY OF THE ABOVE DESCRIBED POLICIES B' City of El Segundo, its Officials and Emplo -c CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE c/o City Clerk ISSUING COMPANY WILL MAIL 30 DAYS WRITTEN NOTICE TO 350 Main Street, Room 5 THE CERTIFICATE HOLDER NAMED TO THE LEFT. El Segundo, California 90245 -3813 AUTHORIZED REPRESENTATIVE °> 1.. Dean. C1CFD I�NSt#� COMMERCIAL GENERAL LIABILITY CG 20 11 01 98 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Policyholder /Designation Sports and Recreation Providers Association Purchasing Group/ of Premises TriFytt sports Policy Number FLDA180411 Certificate #AP139806 -00 Name of Person or Organization: City of El Segundo C/O City Clerk 350 Main Street, Room 5 El Segundo, CA. 90245 -3813 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section II — Who Is An Insured is amended to include as an insured person or organization shown in the Schedule but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises leased to you and shown in the Schedule and subject to the following additional exclusions: 1. Structural alteration, new construction or demolition operations performed by or on behalf of the person or organization shown in the Schedule To the extent that any of the additional insureds named herein are liable for occurrences arising out of the named insured's negligent acts or omissions, the insurance afforded to the additional insureds under this endorsement is primary insurance over any other valid or collectible insurance which the additional insureds may have with respect to loss under any of the listed policies. Other insurance of any additional insured applicable to loss is non- contributory and excess over the coverage provided by this endorsement, and the amount of the company's liability under this policy shall not be reduced by the existence of such other insurance. 2. This insurance does not apply to: a. Any occurrence which takes place after you cease to be a tenant in that premises. CG 20 11 01 98 Copyright, Insurance Services Office, Inc., 1997 Page 1 of 1 11 POLICYHOLDER COPY SO P.O. BOX 420807, SAN FRANCISCO,CA 94142 -0807 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 04 -05 -2012 CITY OF EL SEGUNDO SO 350 MAIN ST EL SEGUNDO CA 90245 -3813 GROUP: 000469 POLICY NUMBER: 0004640 -2010 CERTIFICATE ID: 8 CERTIFICATE EXPIRES: 06 -01 -2012/ 06 -01- 2011/06 -01 -2012 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer. We will also give you 10 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement„ term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1901 - TODD, ANDREW - EXCLUDED. EMPLOYER TRIFYTT SPORTS LLC SO 1205 N RED GUM ST STE A ANAHEIM CA 92806 [B14,SD] (REV.: -2010) PRINTED : 04 -05 -2012