PROOF OF INSURANCE (2016) CLOSED",,,r""> r? DATE (MMMD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE aMMIIn4k.
THIS CERTIFICATE 13 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(lee) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terns 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 endorsamentts).
PRODUCER
AHBT Inc.
1144 Walnut Hill Lane, 16th FI
)alias TX 75231
INSURED INSURER B:
Los Angeles Area Council #33 INSURER C.,
Boy Scouts of America
2333 Scout Way
Los Angetes CA 90026 weuRER E :
INSURER F:
COVERAGES CERTIFICATE NUMBER: 540992512 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 POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INOR ", POL EPP Y Elcp
TYPE OF INSURANCE POLICY NUMBER LIMITS
GENERAL UABIUTY MVYZY303431 Ylr2015 112010 EACH OCCURRENCE $1.000.000
X COMMERCIAL GENERAL LIABILRY 3F3 r6s erasronmr S
j� _W oa
CLAIMSwMADEl j OCCUR. MED EXP IAnr me oerlae S
PERSONAL &ADV INJURY S
W ORAL ATE $
OF K`LAGGMGATE LIMITN'T'LNESPER: PRODUCTS — COMP/OP AGG i
POUCY PRO LOC S
AUTOMOBILE LIABILITY s
a ,
ANY AUTO BODILY INJURY (Per Ww o $
ALL
AUTOS OYMED AUTOS D BODILY INJURY (Per accident) $
�Og� ., DAMAGE
HIRED AUTOS
S
UMBRELLA UAB OCCUR EACH OCCURRENCE S
EXCESS UAB CLAIMS -MADE AGGREGATE S
_DED RETENTION S .- ... S
WORKERS COMPENSATION T
AND EMPLOYERS' LIABILITY YIN Tnwv � IWTC -ER
ANY PROPRIET'OWARTNERrF'XECUTNE I N/A EL EACH ACCIDENT S
OFFICERWEMBER EXCL0.IIIECI?
I'm (MandslcelL 014 E.L. DISEASE - EAEMPLO _ S
OINP1I PEIIAT EL DISEASE - POLICY LIMIT f
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AWeh ACORD 101, AddNlonr Ramwits Schedule, N more specs Is required)
'The City of El Segundo, its officers, officials, employees, agents, and volunteers are named as an ad'ditlonal insured by virtue of a written or
oral contract or the Issuanceie Istence of a permit or certificate of Insurance but ON y with respect to operations b or on behalf of the
Insured, or to or of, or facilities used by the Insured and then only for the limits of liabilfly specified In such Contract for the event
specified herein.
Daniel Chavez Eagle Scout roject - Cam Eucalyptus beautification project - on each weekend between June 27, 2015 - August 15, 2015.
This certificate verifies that coop 762 anrN registered RSA volunteers have primary Coverage.
June 18, 2015
Los Angeles Area Councils
Boys Scouts of America
2333 Scout Way
Los Angeles, CA 90026
City of El Segundo
Recreation and Parks Department
350 Main Street
El Segundo, CA 90245
To Whom It May Concern:
Re: Request for Endorsement to BSA's General Liability Insurance Policy
Policy Term: 03/01115 - 03101116
The request for an endorsement to the General Liability policy for Boy Scouts of
America and /or its Local Council has been denied. Per the Insured's guidelines, we do
not usually request or issue an endorsement to the policy for unit activities unless the
need involves ten or more units.
The Certificate of Insurance previously provided accurately reflects the coverage
provided.
Regards,
MCQUEARY HENRY BOWLES TROY, LLP
,bane E. Passino
Jane E. Passino, CPCU, CIC, CRM
Senior Account Manager
Assistant Vice President