PROOF OF INSURANCE (2016) CLOSED(Mmfooryyyy)
CERTIFICATE OF LIABILITY IN�SURANCE 01412312015
THIS CERTIFICATE IS ISSUED ASA 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 ACORTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT. If the certificate holder is an ADDITIONAL INSURED, the policyties) must be endorsed, it 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
BOLLINGER. Inc.
101 J PIK PARKWAY
SHORT HILLS. NJ 07078
PHONE: 1-800-446-5311 FAX: 973-921-2870
I FAX
jAr— No_ Fits: 800-AA6 -53111 (AOC. Nm): 973-921-2876
e-VAL
ADOWSS:
011988-2010ACOROCORPORATION. Ail right remrvtd,
ACORD 25 (2010+03) The ACORD namt and lac oirt reglstwv4 maft of ACORD
INKMER A: Mark*[ Insurance' ompany
INSURED
INSU11MRS:
Amateur Softball Association and Members of the ASA SoCal
Indiv Reg Program
IN SURER C:
Phil Gutierrez
IN UPER D:
PO Box 5028
IN SUNME:
Oceanside, CA 92052
=ww-m-
COVERAGES CERTIFICATE NUMBER:
REVISION NUMBER.,
THIS 18 TO CERTIFY THAT THE POLICIES Or INSURANCE LISTED BELOW HAVE SEEN t5SUEDTOTHE
INSURED NAVEDASOVE FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREO'ENT, TERM OR CONDITION OF ANY C014TRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED
OR NMY PERTAIN, THE INSURANCE AFFORDED BY THE POLICtE DESCRIBED HEREIN IS SUBJECT TO ALL THE TERVE, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ihillet
LTR
TYPE OF INSURANCE
ADIX
RISR
SUIIw
v"
� POLICY NUMBER
POMYE" PoLocyew
222= fum"YYYYY)
LIMITS
GENERAL LIABILITY
X
EACH OCCLNURENICE
52,000,000
A
X COMMERCIAL GENERAL LIABILITY
DMOZE TO RENTED
$300.000
3602AH230069-14
Pft0f',VS, ff:! COMETWCO)
FOCCUR
x-]
jx�
WD EXP
$10,000,
Participants Liab
"Non-participants 0"Iy
PERSON& S ACV WON
$2,000,000
GVZAAL AGGAZWE
55,000,000
GeN'L AGGREGATE LIUr APPLIES PEk
$2.000,000
7
POLICY
PRO
FJECT
2
L oc
S
AUTOMOBILE
LIABILITY
as
ANY AUTO
OWLY WURY T—w 2---
S
ALL OWNED
SCHEDULED
SWEY KA)RY (Pw!p�en
$
AUTOS
AUTOS
HIRFDAUTCS
NO11WNED
PROPERLY DAMAGE
AUTOS
UMBRELLA LIAR
"OCCUR
EACH OCCURRENCE
EXCESS LIAB
CLAWS-
AGGA3,7ATZ
DACE
is
DIED
7]
FqETP-N-riON $
WORKERS COMPENSATION
s
AND EMPLOYERS' LIABILITY
ANY pRoppmToFLPPAr.�nmr,�,,rAit Y/N
CFT0CVL%4DANR!XCLUCW'
❑
N/A
EL M 4 ACCVtXr
$
(Mandatory in NH)
EL 0tW-*W-l5AZA4PLOYEE
EL
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OTHER
VL2010
A
Accident Medical
4102AR220317-13
fo ]� �: WO,000
Full Access
E-1-'%'#* Ekods vwiod wfible Appli",
DE SC
RI PPON OF OPERATION 5 1 LOCAVONS I VEH I C
LE 3 lAttach ACORD 101, Additional
Rem#rks lohvd u le, II more spooe is riquirvAl
COVERAGE UNDER THIS POLICY SHALL APPLY TO LIABILITY OF THE INSURED ARISING
OUT OF THE ADMINISTRATION, PLAY OR PRACTICE OF AMATEUR SOFTBALUBASEBALL,
BUT ONLY FOR INCIDENTS INVOLVING BODILY INJURY, PERSONAL INJURY OR PROPERTY DAMAGE. CERTIFICATE HOLDER IS NAMED AS AN ADDITIONAL INSURED, THIS
ERTIFICATE IS I S SUEO 014 BEHALF OR El Lgjluodo Girls Softball
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
The City of El Segundo, ifs officers, officials, employees, agents and
ACCORDANCE WTH THE POLICY PROVISIONS.
volunteers
k4ej4�0�
El Segundo, CA 90245
AUTHORIZED REPRESENTATIVE
011988-2010ACOROCORPORATION. Ail right remrvtd,
ACORD 25 (2010+03) The ACORD namt and lac oirt reglstwv4 maft of ACORD
ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION FOR
AMATEUR SOFTBALL ASSOCIATION OF AMERICA ACTIVITIES
This endorsement modifies insurance provided under the following:
COMORCIAL GENERAL LL%B]LrrY COVERAGE FORM
With respect to coverage provided by this ertdorsement� the provisions of the Coverage Form apply unless modified by the endorsement.
,N=* of Insx9d
Asnateur 3*6411 Association and M=bairs of the AS A SoCA Indiv lie j Pforran,
The City of El Segundo, it's officers, officials, emp$oym, ants and votuntw%,
Policy X=bw Policy vftl od Eacllormvm Efficti%v Dow
36�02AH230069-14 1 1412015 - 1/112016 As Shown on ft owhod cwd,tStt of
1 ssUO6 By AvxhaiZ14 Pw,"*nwN,0
NLARKIL INSMAiNCY COSIPMNY
71* 00ye irdxrradct is rNwred mly %Un dsistndomwmt Isprepaw der thtpolic). ts isswd,
SCHEDULE
Name of Person or Organization:
As Show on the Attached Certificate offissurance
A. The following is added to Section U-NNIHOISAN'TNSURED:
The person or organization shown in the above SCHEDULE but only NAith respect to liability arising, out of the organization,
promotion, administration and conduct of amateur softball activities, including games, practices, tournaments, and fund-raising
activities, under the rules of the Amateur Softball Association of America, provided:.
a, That if the person or organization is designated as a Tram the person or organization so designated shall be deemed to
include team members, managers, coaches, assistants, batboys, registered scorekeepem, sponsors, any other individual
participating in the official functions of the team, and if so indicated, a Field Owner, but only forliability arising out of the
designated Team's amateur softball activities covered under this policy;
b. That if the person or organization is designated as a League, the interest of the League shall not be included unless all teams
in the League purchase this insurance, Vk`hen the interest of the League is so included, the person or organization designated
as a League shall be deemed to include all teams in the league and team members, managers coaches, assistants, batboys.
registered scorekeepers, sponsots, any other individual participating in the official functions ofthe League or of any such
teams, and if so indicated, a Field Owner, but only for Lability arising out of the designated League's amateur softball
activities covered under this policy:
All other terms and conditions of this policy remain unchanged.
POLICY NUMBER: 3602AH230069 -14
COMMERCIAL GENERAL LIABILITY
POLICY DATES: 1/1/2015 - 1/1/2016 CG 20 110196
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE REMIT CAREFULLY.
ADDITIONAL INSUR E D - MANAGERS OR LESSORS OF
PREMISES
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
1. Designation of Premises (Part Leased to You): Softball Facility
2. Name of Person or Organization (Additional Insured):
City of El Segundo
3. Additional Premium: ATL
(If no entry appears alcove, the inf:brrnalion required to complete this endorsement will be shown in the
Declarations as applicable to this endorsement.)
WHO IS AN [NSLIRLD (Section ll is amended to include as ati insured the person om• organization
shown in the Schedule but only wit °cspect to .liability ansin I out of the ownership, maintenance or use
of that pa of the p� raises lea cdto you and shown i.n the Sc cdule and sul sect to the Ia llaawing adcli-
tional Exclusions:
This insurance does not apply to:
1. Any 'occurrence" which takes place after you cease to be a tenant in that premises.
2. Structural alterations, new construction or demolition operations performed by or on behalf of the
person or organization shown in the Schedule.
City of El Segundo, its officers, officials, employees, agents and volunteers.
This endorsement is issued on behalf of El Segundo Girls Softball.
CG 20110196 Copyright, Insurance Services Office, Inc., 1994
Page 1 of 1
Workers Compensation Insurance
Date:
Agency's name) is a hivi —vvd-' J (type of organization), and therefore not required to
carry Workers Compensation by the State of California. (Agency's name) staff are
volunteers.
Signature VP/'P(cIkI-eK Ajc�,4
Business Automobile Insurance
Date:
ej (A � 0
qtPLLw4 (Agency's name) is a -6�) �ro (type of organization) do not own or lease a Business
Automobile.
Signature