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PROOF OF INSURANCE (2015) CLOSEDO'E') "'FL.0 DATE (MMIDDNYYY) , CERTIFICATE OF LIABILITY INSURANCE 11/26/2014 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(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 NAME cr Frazier Insurance Agency, Inc. Frazier Insurance Agency, Inc. f JC N P.O Box 1250 E MAIL Midlothian, VA 23113 -1250 ADL INSURER A INSURE D ---- -- Sports & Recreation Providers Assn Risk Management Inc INSURERS, INSURERC South Bay Youth Sports 531 Main Street, #321 INSURERD: El Segundo, CA 90245 INSURERE: INSURERF (804) 754 -7610 FAX . Nol (804) 754 -7613 to alter @frazled nsu rant e.cont INSURER(S) AFFORDING COVERAGE NAIC # United States Fire Insurance Company 21113 COVERAGES CERTIFICATE NUMBER; 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 POt.IC, ES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. X11 TYPE OF INSURANCE DUD` iSUel't. POLICY NUMBER PODL'YEFF POLICY vYY LIMITS f R INSR IhND tMMJOD%YYY'Y} IMM+DDfM'Y7 GENERAL LIABILITY GENERAL AGGREGATE $ 2,000,000.00' X COMMERCIAL GENERAL LIABRITY PfWbUCTS - COMPIOP AGG $ 2,000,000.00 CLAIMS-MADE OCCUR ITm '�ER:SONAL &ADV INJURY SRPGP- 101 -0414 12/01/2014 12101/201 $ 1r00tb. pp.04 A 12:01 AM I EACH OCCURRENCE $ 1,,Ot0,00.00 - -..- K INCLUDES ATHLETIC PARTICIPANTS FIRE DAMAGE (Arty one fire) $ 00,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: MED EXP (Any one person! E R noo on X POLICY x E LOO $ COMBINEOWNGLF ''LIMIT AUTOMOBILE LIABILITY Ea acrxle i a ANY AUTO BODILY INJURY (Per person) $ ALLOWNED sCHEDUI.ED BODILY INJURY (Per acadent) S AUTOS AUTOS HIREDAUTO W`4r",'AN86 PROPERTYDAMAGE AkdTOF IPeracotleMl $ UM13RELLALIAB --U- EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ .............._......... I OED RETENTION 5 $.- $ DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (Atterh ACORD 101. Additional Remarks Scheduia, If more Space is requiled) POLICY DEDUCTIBLE, SO 00 PER EACH BODILY INJURY OR PROPERTY DAMAGE CLAIM Certificate Holder is An Additional Insured, But Only As Respects The Operations Of The Named Insured. CERTIFICATE HOLDER CANCELLATION City of El Segundo 350 Main Street El Segundo, CA 9 $ 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 John W. hazier ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) Tha ai,,op 1 name nnri tnnn Ora r=niatarari mnrkc of G( OPn COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED — DESIGNATED PERSON • 0 2, .r, lr: • . Insured: South Bay Youth Sports Policy Number: SRPGP- 101 -0414 This endorsement modifies insurance provided under the following: COMMERCIAL_ GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) City of El Segundo 350 Main Street El Segundo, CA 90245 Information required to complete this Schedule, if not shown above will be shown in the Declarations. Section 11 - WHO IS AN INSURED is amended to include as an 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 of the acts or omissio f. ose acting on your behalf: A. In the performance of yo r ongoing operation . or B. In connection with your remises ow by or rented to you. ~' CG 20 26 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 13 SoUT" BAS 0 r4 OTH evil 531 Main Street, 4#321, El Segundo, CA 90245 www sotitlib yyquths,pos -t .oi° To Whom It May Concern: CERTIFICATION OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE This letter has been written to inform you that South Bay Youth Sports does not carry Workers Compensation Insurance by State of California as we do not have any employees. All workers for our agency are either volunteers or consultants. Business Automobile Insurance South Bay Youth Sports do not own or lease a Business Automobile, Date: 2/25/15 Licensee: