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PROOF OF INSURANCE (2017 - 2017) CLOSEDCERTIFICATE OF LIABILITY INSURANCE u "U5/12J2016rT, THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS. NO RIGHTS UPON THE CERTIFICATE HOLDER. THUS 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 PROD_q_gR AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to ; ertificate holder in lieu of such endorsement(s). JCE R GON T A.GI NAME CS &S/WALLER INSURANCE INC. PN IONI I a $ 2 ANA% No. No)' PO BOX 946580 EMAIL ADDRESS: Maitland, FL 32794 -6580 INSURER(S) AFFORDING COVERAGE NAIC # 1- 877 - 724 -2669 INSURER A: Continental Casualty Company 20443 INSURED INSURER B: National Fire Insurance of Hartford 20478 AMERICAN CHESS INSTITUTE, AMERICAN YOUTH ENRICHMENT INSURER C: PROGRAMS 13415 SE SILVER CIRCLE, INSURER D: - ........ VANCOUVER, WA 98683 INSURER E: INSURER F: COVERAGE'S 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, NOTWITHSTANDINGANY 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. INSR �ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WvVD POLICY NUMBER LIMITS MMIDD/XY MM /DD/YY A /" COMMERCIAL GENERAL LIABILITY Y 4017390864 07/01/16 07/01/17 EACH OCCURRENCE Is 1,000 DAMAGE TO RENTED CLAIMS -MADE OCCUR PRFMISFS (Fa mrarenral 300000 GEN'L AGGREGATE LIMIT APPLIES PER: II F7 PRO- p7" y OTHER: AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS MED EXP (Any one person) $ 1 PERSONAL & ADV INJURY $ 1 GENERAL AGGREGATE $ 2 PRODUCTS - COMP /OP AGG $ 2 COMBINED SINGLE LIMIT (Ea accident)$ BODILY INJURY(Per person) $ .. ...._..�..�......_............ BODILY INJURY(Per accident) $ PROPERTY DAMAGE (Per accident) $ DESCRIPTION OF OPERATIONS .B LOCATIONS P''YEHICLES tAt't"actt Accord 101, A40nional Hemarw's ticnatfule, 11 more space IS required,) City of El Segundo is added as an additional insured as provided in the blanket additional insured endorsement as pertains to work being performed by named insured under contract. Waiver of Subrogation applies. El Camino Creek Elementary School Chess :RTIFICATE HOLDER of El Segundo 350 Main Street El Segundo, CA 90245 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ci Q fiZ)17�ti� + C 1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD UMBRELLA LIAR I OCCUR EACH OCCURRENCE EXCESS LIAR CLAIMS -MADE AGGREGATEmnnn ___ $ ..... DEDI RETENTION $ $ B WORKERS COMPENSATION 6016676150 07/01/16 07/01/17 PER brH X AND EMPLOYERS' LIABILITY WN STATUTE ER ANY PROPRIETOR /PARTNER /EXECUTIVE EACH ACCIDENT $ 1 OFFICER/MEMBER EXCLUDED? N/A _E _L (Mandatory in NH) E.L. DISEASE -n EA EMPLOYEE $ 1 If yes, describe under DESCRIPTION OF OPERATIONS below E . DISEASE - POLICY LIMIT $ 1 .Ww. .. .. .. ....... _ ...... ........ ..... . ............. .._,. .• PER OTH- ,. OTHER STATUTE ER E,L- EACH ACCIDENT '$ E.L. DISEASE - EA EMPLOYEE $ '. EL DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS .B LOCATIONS P''YEHICLES tAt't"actt Accord 101, A40nional Hemarw's ticnatfule, 11 more space IS required,) City of El Segundo is added as an additional insured as provided in the blanket additional insured endorsement as pertains to work being performed by named insured under contract. Waiver of Subrogation applies. El Camino Creek Elementary School Chess :RTIFICATE HOLDER of El Segundo 350 Main Street El Segundo, CA 90245 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ci Q fiZ)17�ti� + C 1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01) ©1988 -2014 ACORD CORPORATION. All rights reserved. Tk— AP`f%Dll ......... .....J I ...................a......a .......I,.. —9 A^f%C2 % C AGENCY POLICY NUMBER '390864 _R ADDITIONAL REMARKS THIS ADDITIONAL REMARK: FORM NUMBER: 25 classes and events FICATE HOLDER of El Segundo 350 Main Street El Segundo, CA 90245 AGENCY CUSTOMER ID: LOC# ADDITIONAL REMARKS SCHEDULE Page 3 Of 3 ... ,.. �,.,..._._..,.,.,_, NAMED INSURED AMERICAN CHESS INSTITUTE, AMERICAN YOUTH ENRICHMENT P NAIC CODE EFFECTIVE DATE FORM TITLE: CERTIFICATE OF LIABILITY CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD co O CO N_ LO O O O C- L O 0 0 0 O O 0 0 O 0 0 CNA Small Business Service Center PO Box 946580 Maitland, FL 32794 -6580 000031 City of El Segundo 350 Main Street El Segundo, CA 90245