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PROOF OF INSURANCE (2013) CLOSEDNH63759 CERTIFICATE OF LIABILITY INSURANCE DATE 2/11 /20'YYYY' 2/11 /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 poli'cy(les;) 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: Corey Cash Commercial Lines — (800) 990 -7465 PHONE 603 559 1360 FAX 855 529 7684 Wells Fargo Special Risks, Inc. .M core cashC� well fargo.com 230 Commerce Way, Suite 230 — INSURERIS) AFFORDING COVERAGE NAIC # Portsmouth, NH 03801 INSURERA. GreatAmerican Assurance Company 26344 IN.______________ .... l......, ............. _ INSURER B : S INSURED entlnel Insurance COmpany Ltd. 1 1000 g INSURER C , NOVA Cas _ C American Skating Entertainment Centers, LLC ualt Company 42552 4809 E. Thistle Landing Drive .........._ ............. INSURER D S.. �. � ................ . . . . ... --............................ ..............,..,..,.. Suite #100 INSURER ........ -- ,........,. Phoenix, AZ 85044 INSURER F COVERAGES CERTIFICATE NUMBER. 5582100 RFVISIAN NIIMRFR• coo hcln,.. 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. ILTR -.w_. TYPE OF INSURANCE .----- —�.. ....... .�. POLICY EFF POLICY EXP .. ..............� ......... ...... .............---- 1R WVD POLICY NUMBER MM /DD/YYYY MMJq LIMITS A GENERAL LIABILITY PAC3915162 09/01/2012 09/01/201 CH OCCURRENCE "h��I~x��L $ 1,000,000 - X t"i� ftt.'N"tI �S O COMMERCIAL GENERAL LIABILITY IP Era oupsoru REM16ESI $ 300,000 %t I _ _ CLAIMS -MADE OCCUR MED EXP (An one person $ Excluded PERSONAL & ADV INJURY 'A' $ 1,000,000 ....... T...'� GENERAL A GGREGATE n $ None � ........... .................... __..... —.. GEN'L AGGREGATE LIMIT APPLIES PER: ...... PRODUCTS - COMP /OP AGG $ 2,000,000 I'OLtlCY Prtid _ ILOC — _____.�.____........ $ ........, , B AUTOMOBILE LIABILITY 04UECNW6182 11/14/2012 11/14/201 OMBINED SINGLE LIMIT Ea accidenq 1,000,0 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) ____ $ X X NON -OWNED r RO! kRTY OAfvfAGE HIRED AUTOS AUTOS (Par acarlpwrl $ UMBRELLA LIAB x EXC8635351 09/01/2012 09/01/201 URRENCE _ _ 1,000,00 .,...,.... X. EXCESS LIAR CLAIMS -MADE AGGREGATE ....._. ....$, 1,000,000 DED RETENTION $ $ WORKERS COMPENSATION x WC STATU- OTH C AND EMPLOYERS' LIABILITY YIN WFI -WK- 0010091 -2 09/01/2012 09/01/2013 — .TO,RXImtMITS - -... F...P .. ANY PROPRIETOR/PARTNER/EXECUTIVE � OFFICE EXCLUDED? N N / A E L EACH ACCIDENT __ . _ $ 1,000,000 - - --0 (Mandatory in H) in E.L. DISEASE - EA EMPLOYEE', $ 1,OOQ000 yes, d and DESCRIPTION OF OPERATIONS Izelaw E.L, DISEASE -POLICY LIMIT 000,000 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 insureds facility located at: 555 N. Nash Street, El Segundo, CA 90245 For General Liability coverage, 30 Days notice of cancellation given to to the certificate holder in accordance with the policy provisions, except 10 days notice of cancellation given for non - payment of premium. City Of El Segundo Attention: Bob Cummings Director of Recreation & Parks 339 Sheldon St El Segundo, CA 90245 ACORD 25 (2010/05) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE The ACORD name and logo are registered marks of ACORD ©1988 -2010 ACORD CORPORATION. All rights reserved. 0 hi. certrficate replare, certitiratc:W 4823B5D ie ,.d - 91712012} s �(� / �/0�\ // V 00005040 DATE (MM /DD/YYYY) AC"RO6 CERTIFICATE OF LIABILITY INSURANCE 9/7/2012 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 certlflcate 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 CONTACT Core Cash NAME: Y Commercial Lines — 800 990 -7465 v " FAX 8 ( ) i10, 603- 742 - 1616 (ANC No). 855 - 529 -7684 Wells Fargo Special Risks, Inc. EMAIL core cash wellsfar o.com ADDRESS: Y• @ 9 _. ..... 1 a....... - _..__ 34 Dover Point Road _ INSURERS AFFORDING COVERAGE NAIC # Dover, NH 03820 INSURER A: Great American Assurance Company 26344 _ _ _..._,...- INSURED INSURER B NOVA Casualty Company 42552 American Skating Entertainment Centers, LLC INSURER C . ... ..................__.. 4809 E. Thistle Landing Drive INSURER D: Suite #100 INSURER E Phoenix, AZ 85044 INSURER F r`r1VFRAr.FA rFP"TlFllf'ATF: Nl11 RF:R' 4823850 RFVIRInN Nl1MRFR* qo. hnlnw 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. .. -_ .... .. _, mm... "....._ ".".,. ._, INSIi.......,. ...". IT6oL S POLICY EFF POLICY' ExP POLICY.1„„1, TYPE OF INSURANCE LIMITS LTR. NUMBER MMIpIp/YYYY MM�d DdYYY EACH GENERAL. UAWLITY' OCCURRENCE $ A PAC3915162 09/01/2012 09/01/2013 1.000,000 X... COMMERCIAL GENERAL LIABILITY F'FJJa.'a"1J1°(i tut` to rs�dtrl. $ 300,000 _ CLAIMS-MADE I OCCUR MED EXP (Any , one persons $ mExcluded PERSONAL & AD) INJURY $ 1,000,000 GENERAL AGGREGATE $ None GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 PfLO- LOC AUTOMOBILE LIABILITY ..._ COMBINED SINGI. E UNII r .tE�Asbrcld+PShc) ... " � ........" ...$�.. .... ..... ANYAUTO BODILY INJURY (Per person) _ $ ---------- ALL OWNED SCHEDULED ...............,.... BODILY INJURY (Per accident)'' $ AUTOS NON -OWNED PROPERTY CbA8v4AGIE $ HIRED AUTOS ...... AUTOS $ A UMBRELLA LIAB X OCCUR EXC8635351 09/0112012 09/01/2013 EACH OCCURRENCE $ 1,000,000 X EXCESS LIAB CLAIMS -MADE AGGREGATE $ 1,000,000 RETENTION$ $ WORKERS COMPENSATION X WC STATU 0TH B AND EMPLOYERS' LIABILITY WFI -WK- 0010091 -2 09/01/2012 09/01/2013 "......" TCRY.LIMITS .ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE�� N p OFFICER/MEMBER EXCLUDED? NIA E.L. EACH ACCIDENT $ - - -- 1,000 000 " L. � � k (Mandatory in NH) " " "' "' "" E.L. DISEASE - EA EMPLOYEE $ .,.,...... .. 1000,000 '.1....... _..._ —._. If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE .. .... - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I 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 solely as respects their interests in the Skating Programs held at the insureds facility located at: 555 N. Nash Street, El Segundo, CA 90245 30 Days notice of cancellation given to to the certificate holder in accordance with the policy provisions, except 10 days notice of cancellation given For non - payment of premium. City Of El Segundo Attention: Bob Cummings Director of Recreation & Parks 339 Sheldon St El Segundo, CA 90245 ACORD 25 (2010/05) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE t-/ ,�yy 4 A The ACORD name and logo are registered marks of ACORD @ 1988.2010 ACORD CORPORATION. All rights reserved. %Jn1U11VML rvL11,1 CG 20 26 (Ed. 07 04) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Schedule Name of Additional Insured P rson(s) or Organ! zation(s): CITY OF EL SEGUNDO 339 SHELDON ST EL SEGUNDO CA 90245 IS INCLUDED AS ADDITIONAL INSURED SOLELY AS RESPECTS THEIR INTEREST IN SIGNING PARTICIPANTS UP FOR THE INSURED'S SKATING PROGRAM TO BE HELD AT THE INSURED'S PREMISES LOCATED AT 555 NORTH NASH ST, EL SEGUNDO CA 90245 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. SECTION II - WHO IS AN INSURED is amended to include as an Additional Insured the person(s) or organization(s) shown in the Schedule, but 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: A. in the performance of your ongoing operations; or B. in connection with your premises owned by or rented to you. Copyright, ISO Properties, Inc., 2004 CG 20 26 (Ed. 07/04) PRO (Page 1 of 1) 00005040 A O 9/6 /2 CERTIFICATE OF LIABILITY INSURANCE DATE D/YYYY) 9/6/2012 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 endorsements . PRODUCER CONTACT NAME: x Core Cash Commercial Commerciial Lines – ( 800 ) 990 -7465 ,. i c — PHONE 603-742-1616 855-5 Wells Fargo S pecial Risks, Inc. coreY f ash wellsfcr g cD1T Aa 1 F ....... ... _.. -- 34 Dover Point Road - -C Dover, NH 03820 INSURER A : Great American Assurance Company 26344 INSURED ...... � ..... ... ............... .... ......... .. ............ .... .... .....- ......... ...... ....... ... ..INSURER B..... NOVA Casualty Company .... ..... ........... ..,.,._..,.� 42552 American Skating Entertainment Centers, LLC - - -- .............m� INSURER C ,. ,,,,,,, „ ... .... ......... .... 4809 E. Thistle Landing Drive INSURERD — ........ —....------ ........................ _.... Suite #100 INSURER E t Phoenix, AZ 85044 F COVERAGES CERTIFICATE NUMBER' 4821270 REVISION NUMBER' Ann holnw 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. - -.._ POLICY EFF POLICY E,'r -,IP ---- - -- ---- -...,,,.,- ... _ ....._____. ....,. ILTR ...,_ . AbbL'SUBA ............. ................ .....---- -- TYPE OF INSURANCE POLICY NUMBER MMfODNYYY MMIDDdYYYY ''. LIMITS A GENERAL LIABILITY X PAC3915162 09/01/2011 09/01/2012 EACH OCCURRENCE ................ $ 0 .. .. WW0 1,E,0x0C0Iu,0d0e X.. COMMERCIAL GENERAL Ab OO -MADE „ OCCUR MED EXP nyoCLAIMS ne rson� $ d, ., PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE ''$ None _ GE N L AGGREGATE LIMIT APPLIES PE R: P A-G. PRODUCTS - CO--M- P $ 2,. 000,000 —' POLICY 0 0 LOC --/O— -..G _ .. $ AUTOMOBILE AU ,. _._.. LIABILITY COMBINED SINGLE, UM1T' ,..t;EN acrlclmulk }.... ...,...... ..'A ...... ... ........... ANY AUTO BODILY INJURY (Per person) '.. $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ ...........� AUTOS AUTOS .........., NON -OWNED PROPER[YDAMAG $ HIRED AUTOS AUTOS A UMBRELLA LIAB X OCCUR "'J EXC8635351 09/01/2011 09/01/2012 EACH OCCURRENCE .._ ......... ......... $ 1,000000 _0, .. X. EXCESS LIAB CLAIMS-MADE E __ .... A GGREGATE $ 1,000,000 -...' $ DE F RETENTION $ WORKERS COMPENSATION X WC STATU- OTH- B AND EMPLOYERS' LIABILITY YEN WFI -WK- 0010091 -1 09/01/2011 09/01/2012 T RYL6tY - F-l3. E.L. EACH ACCIDENT $ 1,000,000 ANY PROPRIETOR/PARTNEWEXECUTIVE� OFFICER/MEMBER EXCLUDED? N N/A - -- - - - - - -- - - - -- (Mandatory in NH) °""°'°" E.L. DISEASE - EA EMPLOYE $ 1,000,000 If yes, describe under 111-1 ..E.L. •.$ .................. „...........,1,000,000.. DESCRIPTION OF OPERATIONS below 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 solely as respects their interests in the Skating Programs held at the insureds facility located at: 555 N. Nash Street, El Segundo, CA 90245 30 Days notice of cancellation given to to the certificate holder in accordance with the policy provisions, except 10 days notice of cancellation given for non - payment of premium. CERTIFICATE HOLDER CANCELLATION City Of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attention: Bob Cummings THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Director of Recreation & Parks 339 Sheldon St AUTHORIZED REPRESENTATIVE El Segundo, CA 90245 (,r,,,-/�j,�„` The ACORD name and logo are registered marks of ACORD © 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 00005040 CERTIFICATE OF LIABILITY INSURANCE UATE,MM / ° °/YYYY) 10126/2011 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 ICONTACT Corey Cash tA/ � . ore cas. Commercial Lines - 800 990 -7465 PHONE _ _ - 1, rA 855-529-7684 5— ( ) �� �cllz (AIC N�) _ Wells Fargo Special Risks, Inc. E-MAIL h wellsfar o.com app)rs, y• @ 9 34 Dover Point Road (S)AF FOk)DjW OVERA NAIC # Dover, NH 03820 INSURERA: Great American Assurance Company 26344 ....._. INSURED � � �.. ....... ........................ ... ER B . INSURER NOVA Casualty Company -INSU RER . c ... .. - - -- - - American Skating Entertainment Centers, LLC ER 4809 E. Thistle Landing Drive wsuR ERD[ Suite #100 INSURER E : . -- ............ ............. — ---------------- ......... ...... . .. Phoenix, AZ 85044 INSURER F COVERAGES CERTIFICATE NUMBER: 3434130 REVISION NUMRFR! caa holi %i x 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. tNSR Aff � °06A POLICY EFF I�OLtCY E fP ........... - - - -- TYPE OF INSURANCE LTR POLICY NUMBER MM /DD /YYYY MMMOIYYYY LIMITS GENERAL LIABILITY X PAC3915162 09/01/2011 09/01/2012 1'A ..--_3._._0.0. P $ COMMERCIAL GENERAL L IABILITY 0. 00 CLAIMS- MADE X OCCUR „ MED EXP (An y. one erson $ Excluded ........ V INJURY ..PERSONAL & AD........... $ - 1,000,000 GENERALAGGREGATE ... $ None GEN'L AGGREGATE TE LIMIT APPLIES PER: PRODUCTS - CO.... MP /OP AGG $ 2,000,000 PRO- POLICY' LOC $ -.. AUTOMOBILE LIABILITY COMBINED MINED SINGLE LIMIT -. -,. (_ .. � 00: .. ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ .. NON -OWNED f''ERI"YUi AM ..... $ ---.... ---- HIRED AUTOS AUTOS 4Per acr,.;(Gi�tpat), ,, ... .. -- $ A x OCCUR EXC8635351 09/01/2011 09/0112012 EACH OCCURRENCE $ 1 000,000 - x EXCESS LIAB. ..................' MS MADE — OLL.. -11, .. AGGREGATE .......... ....,,�„ 1 $ .M,.,..,. 1,000 000 --- _ DED RETENTION $ $ WORKERS COMPENSATION X WC STATU OTH- B AND EMPLOYERS' LIABILITY WFI -WK- 0010091 -1 09/01/2011 09/01/2012 TDRY.dMITS Rf y/N ANY PROPRIETOR/PARTNER/EXECUTIVE� . ......... E L.. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A ------------------ L_- __a.....,, (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ 1,000,000 DESCRIPTION OF OPERATIONS below E L. DISEASE -POLICY LIMIT $ 1,000 000 DESCRIPTION OF OPERATIONS I 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 solely as respects their interests in the Skating Programs held at the insureds facility located at: 555 N. Nash Street, El Segundo, CA 90245 30 Days notice of cancellation given to to the certificate holder in accordance with the policy provisions, except 10 days notice of cancellation given for non- payment of premium. CERTIFICATE CANCELLATION City Of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attention: Bob Cummings THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Director of Recreation & Parks 339 Sheldon St AUTHORIZED REPRESENTATIVE 10 Id El Segundo, CA 90245 The ACORD name and logo are registered marks of ACORD @ 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 011 ,.. [1 .Y. I, j a 1,1w •�I I ,k# 141 ! yy[, rIU4 AIH