PROOF OF INSURANCE (2016) CLOSEDCERTIFICATE OF LIABILITY INSURANCE DATE 12/18/14
Keystone Risk Managers, LLC CERTIFICATE # 4053601 -1
1995 Point Township Drive
Northumberland, PA 17867 4 '05 36
ADDITIONAL NAMED INSURED: INSURERS AFFORDING COVERAGE:
EL SEGUNDO LL INSURER A: LEXINGTON INSURANCE COMPANY
PETER GIANUSSO
351 WHITING ST INSURER B: NATIONAL UNION FIRE INSURANCE
EL SEGUNDO CA 90245 (Non - Liability) COMPANY OF PITTSBURGH, PA
INSURER O; CHARTIS SPECIALTY
INSURANCE COMPANY
,COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
AWL
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
POLICY EXPIRATION
LIMITS
LTR
INSRD
DATE MWDD/YYYY
DATE MM/DD/YYYY
GENERAL LIABILITY
EACH OCCURRENCE' t i, 0000 UW
A
X
X OCCURRENCE
01122 5810
1/01/2015
$ /01 /2016
GENERAL AGGREGATE $2, OOO OOO
X
___
INCL. PARTICIPANTS
.Property Damage Deductible: $250
PRODUCTSEGATE CE PS'.
AccRecATE
_ ._�rA
OV" 0., ('
- L
nP S
10 0001000 0
X
SEXUAL ABUSE
r_G
er_ocneT
AT c
$2,060,000
MEDICAL PAYMENTS
AN Ot4
EACH LOSS
$1,000,000
A
X
DIRECTORS & OFFICERS
17602157
1/01/2015
1 /01 /2016
AGGREGATE
$1,000,000
A X 011408714 1/01/2015 1/0112016
EACH LOSS $35,000
CRIME COVERAGE
Crime Deductible: $250 Property /$1,000 Money
AGGREGATE NONE
�_..
B X SPORTS EXCESS ACCIDENT 1 /O 1 / 2015 1/01/2016
ad. Master Master
of in Mast
Policy Excess
v SS
_ ............._......................................... ............................... _.._........................... ...............................
$10oI000
"X" INDICATES COVERAGE SELECTED FOR ADDITIONAL NAMED INSURED
......... _.._.— .._.... . . � .. ......................... .........................._.W_W
ADDITIONAL INSURED
Who is an insured (SECTION Il) of the General Liability policy is amended to include as an insured the person or organization shown in the schedule, but only with respect to
liability arising out of the above named Little League's maintenance or use of ball fields, or other premises loaned, donated, or rented to that Little League by such person or
organizations and subject to the following additional exclusions:
1. Structural alterations, new construction, maintenance, repair or demolition operations performed by or on behalf of the person or organization
designated in the Schedule unless
performed by the above named Little League and
2. That part of the ball field or other premises not being used by the above named Little League
NAME AND ADDRESS OF PERSON OR ORGANIZATION:
1. CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS, EMPLOYEES,
AGENTS AND CERTIFIED
VOLUNTEERS. 2. EL SEGUNDO UNIFIED SCHOOL DISTRICT #641
INSURED CANCELLATION
SHOULD ANY OF THE AETOVE DESCRIBED POLICIES �YD AGVE gNAMED LITTLE LEAGUE BE CANCELED BEFORE THE
Little League Baseball Risk Purchasi EXPI RATION DATE THERCOF, THE WUIN0 INSURER T °C °fly ITEPt L"WADVE.WILL MAIL 34 DAYS WRITTEN NOT ICE
TO THE DEShGNATED PERSON CDR ORGANIZATION AT THEIR LAS'
�NODDRESSTOUS.
53S U.S. RT; 15 HIGHiCU'A
South Williai sport, PA 17702 -
'RE
AUTHORIZED
POLICY NUMBER: 011225810
B Segundo Little League (405-36-01)
CO 20 26 07 04
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies Insurance provided underthefbil wing:
Cdr, �,Yil#Z43F_1itc�#►1g:7�lq!► --]IP L9191 ?:7_T�3
SCHEDULE
Name Of Additional Insured Person(s) Or Organization(s)
CITY OF EL SEGUNDO
350 Main Street
El Segundo, CA 90245
BLANKET —AS REQUIRED BY WRITTEN CONTRACT
ADDITIONAL INSURED(S) LISTED ON CERTIFICATE OF LIABILITY INSURANCE
WHO IS INSURED (SECTION IQ OF THE GENERAL LIABILITY POLICY IS AMENDED TO INCLUDE AS AN
INSURED THE PERSON OR ORGANIZATION SHOWN IN THE SCHEDULE, BUT ONLY WITH RESPECT TO
LIABILITY ARISING OUT OF THE NAMED LITTLE LEAGUE'S MAINTENANCE OR USE OF BALL FIELDS, OR
OTHER PREMISES LOANED, DONATED OR RENTED TO THAT LITTLE LEAGUE BY SUCH PERSON OR
ORGANIZATIONS AND SUBJECT TO THE FOLLOWING ADDITIONAL EXCLUSIONS:
1. STRUCTURAL ALTERATIONS, NEW CONSTRUCTION, MAINTENANCE, REPAIR OR DEMOLITION
OPERATIONS PERFORMED BY OR ON BEHALF OF THE PERSON OR ORGANIZATION DESIGNATED
IN THE SCHEDULE UNLESS PERFORMED BY THE ABOVE NAMED LTTTLELEAGUEAND
2 THAT PART OFTHE BALL FIELD OR OTHER PREMISES NOT BEING USED BYTHE
ABOVE NAMED LITTLE LEAGUE
Information reauired o corn late this Schedule, if not shown above wifl be shown in the
Declarations.
Workers Corn ensation Insurance
Date:
e cyk name) is a / � r" e
of r ar iaation), and therefore not required to
carry IA+orks compensation by the State of California. (Agency's name) staff are
volunte
Signature
Business Automobile Insurance
Date:
��....
_ �. (Agency's name) is a 4 of organization) do not own or lease a Business
Au obile.
Signature