Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
PROOF OF INSURANCE (2016) CLOSED
CERTIFICATE OF LIABILITY INSURANCE �� /21 /lte� �r �f'[IiJrra 1 /21!2015 5 HTS 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 pollcy(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 endoriluam entfsl. PRODUCER K &K Insurance Group, Inc 1712 Magnavox Way CONTACT NAME- Cheryl! Pettibone PHONE INC, No. Ead)', 441 FAX 800-441-3994 (Arc, P.O. Box 2338 ADDRESS: Cheryi.Pefflbonqpandidnaurance.com Fort Wayne, IN 46801 INSURERI'S) AFFORDING COVERAGE NAIC # INSURED INSURER A: Nationwide Life Insurance Co. El Segundo Babe Ruth League INSURER B: Nationwide Mutual Insurance Co. 750 Sierra Street INSURER C: El Segundo, CA, 90245 INSURER D: %.VV rA"r_0 CERTIFICATE NUMBER. REVISION NUMBER: INDICATED. NOTWITHSTANDING ANIY IETM 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. TYPE OF INSURANCE INSR wV0 MMlDDdyYYY MMFODrY YY LIMITS LTR POLICY NUMBER GENERAL LIABILITY EACH OCCURRENCE $2 I100,t1 B X COMMERCIAL GENERAL LIABILITY 1 11 TOWENTE15 CLAIMS MADE x OCCUR Ee PReMISES occurrEc, $ 300,000 X 02/01/2016 MEO' EXP (Any one 11p, arson) $ 5,000 RPG- 266488 -00 02101/2015 12:01 AM PERSONAL &ADV INJURY $2,000,000 GENERAL AGGREGATE $5,000,000 GEN'LPAGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $2,0'00,000 --]POLICY PROJECT LOC PARTICIPANT LEGAL LIABILITY $2,,000,0100 AUTOMOBILE LIABILITY Ea Auzdderll $1,000,00 ANY AUTO BODILY IN JURY Pe Per rsa n ( ) ALL OWNED AUTOS BODILY INJURY (door aooddsult) B SCHEDULED AUTOS 02/01/2015 02/01/2016 — RPG- 266488 -00 12:01AM 12:01 AM Pau acddant X HIRED AUTOS — X NON - OWNEDAUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAR CLAIMS -MADE AGGREGATE DEDUCTIBLE �- RETENTION WORKERS COMPEN ATION Y P EMPLOYERS, LI BUTY NER/ YIN I OItY LdMNl S OTHER EXEC UTIVE OFF iCERWCMSER NIA E1 EACH ACCIDENT EXCLUDED? Mandatory In NN) E.L. DISEASE— EA EMPLOYEE �f yyes, describe undo DESCRIPTION OF OPERATIONS below E.L. DISEASE— POLICY LIMIT PARTICIPANT ACCIDENT A 02/01f2015 12:01 02/01/2016 ADSO 1U,000 SPP- 266489 -00 12:o,AM 12:01 AM PRIMARY MEDICAL $ 250,000 DESCRIPTION OF OPERATIONS ,I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED, BUT SOLELY WITH RESPECTTO THE OPERATIONS OF THE NAMED INSURED. RE: Owner, manager or lessor of the premises where you conduct practices or games SEXUAL ABUSEIMOLESTATION: $1,000,000 PER OCCURRENCE 1$2,000,000 AGGREGATE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Mein Street AUTHORIZED REPRESENTATIVE' El Segundo, CA 90245 ACORD 25 (2009/09) ©1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: RPG- 266488 -00 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL_ GENERAL LIABILITY COVERAGE PART SCHEDULE � Name Of Additional Insured Personisl Or Oroanizationtsi qffy of El Segundo 350 Main Street El Segundo, CA 90245 uth League Information required to complete this Schedule, if not shown above. will be shown in the Declarations_ Section II — Who Is An Insured is amended to in- clude as an additional insured the person(s) or organi- zation(s) shown in the Schedule„ but only with respect to Iiabi ty for �I� n ur ° "p �epN or "personal and advertising iniu °' caused, in whole r in part, by your acts or omissions or the acts or lions of those acting on your behatf: A. In performance of ur WgAg operations r H. In connection Frith your pr�ernises owed by mnted to u_ CG 20 26 07 04 0 ISO Properties, line.. 2GO4 :Page 1 of I Shawn Green, 3/9/15 El \±funk# Babe Ruth is an all-volunteer organization an therefore not req uire to carry Workers Compensation ?»k* State #\ California. El Segundo Babe Ruth's are volunteers. f$ i #W