Loading...
PROOF OF INSURANCE (2018) CLOSED '`�"' CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) lam,. 1 7/26/2017 THIS CERTIFICATE IS 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 policyll 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 CONTANAME: Karol Judkins Kapnick PHONE Adrian Ml 49221C7 01 up C-MAIL ka of judkns@kapnick corm: FAX, " I ); 517-263-6658 INSURERS)AFFORDING,COVERAGE NAIC# INSURERA:The Hanover Insurance Company 22292 INSURED ISAASPO-01 INSURER B: Isaac Sports Group, LLC INSURERC: Stu Isaac 3419 Wagner Woods Court IysuEF D Ann Arbor MI 48013 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 543950464 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. IUBR POLICY iEFF POLICY EXP LS TYPE OF INSURANCE IAINSD DDL SWVD POLICY NUMBER (MMIDDrYYYY)_)(MWDDIYYYYI( LIMITS A COMMERCIAL GENE X OCCUR „D MAOET kLr4lkD $1,000,000 X UU RAL LIABILITY Y OHHA407981 8/28/2017 8/28/2018 CLAIMS-MADE w,rrc�s) $300,000 EX,P(Agy $5,000 MED one person) PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO,. X ^I POLICY JE'CI LOC PRODUCTS-COMP/OP AGG $2,000,000 II OTHER: $ A AUTOMOBILE LIABILITY COMBINED SIN(SO E LIMI f QHHA407981 8/28/2017 8/28/2018 (E awatrirdnrll) $1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY AUTOS (Peraccident)�$ X HIRED AUTOS X NON-OWNED PROPL`R"I'YDA,MAGI" T$ AUTOS (Pw atc,don),) $ U UMBRELLA LIAB I OCCUR EACH OCCURRENCE $ EXCESS LIA RFTENTION$ CLAIMS-MADE AGGREGATE I$ DEC) �,$ A WORKERS COMPENSATION WHHA407573 8/28/2017 8/28/2018 PER OTH- AND EMPLOYERS'LIABILITY YIN Y X I STATUTE ER ( ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E L EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED (Mandatory in NH) EL DISEASE-EA EMPLOYEE: $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $500,000 A Professional Liab OHHA407981 8/28/2017 8/28/2018 Limit 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder is listed as additional insured with respects to general liability.A waiver of subrogation applies in favor of the certificate holder in regards to workers compensation CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of EI Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. EI Segundo,CA 90245 AUTt•$ORIZED REP/1RESENTATIVE / I � ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Citizens Insurance.. A eomparry aJTise Huruhxr Inturmko Gnruq OHHA407981 0301480 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Name of Person or Organization: jI CITY OF EL SEGUNDO, 350 MAIN ST. EL SEGUNDO, CA 90245 V ............... ............ (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) For the purpose of coverage provided by this B. The following is added to SECTION II - endorsement, the following changes are made to LIABILITY, D. Liability and Medical Expenses SECTION II - LIABILITY: Limits of Insurance. A. The following is added to SECTION II - If coverage provided to the additional insured is LIABILITY, C.Who is an Insured: required by a contract or agreement, the most Any person or organization shown in the we will pay on behalf of the additional insured is Schedule above is also an additional insured, the amount of insurance: but only with respect to liability for "bodily a. Required by the contract or agreement; or injury", "property damage" or "personal and b. Available under the applicable Limits of advertising injury" caused, in whole or in part, Insurance shown in the Declarations; by your acts or omissions or the acts or omissions of those acting on your behalf in the whichever is less. performance of your ongoing operations or in This endorsement shall not increase the connection with your premises owned by or applicable Limits of Insurance shown in the rented to you. Declarations. However: a. The insurance afforded to such additional insured only applies to the extent permitted by law; and b. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. ALL OTHER TERMS, CONDITIONS, AND EXCLUSIONS REMAIN UNCHANGED. 391-1941 08 16 Includes copyrighted material of Insurance Services Offices, Inc., with its permission, Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Name Of Person Or Organization Location And Description Of Completed Operations CITY OF EL SEGUNDO 350 MAIN ST. EL SEGUNDO, CA 90245 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) For the purpose of coverage provided by this agreement, the insurance afforded to such endorsement, the following changes are made to additional insured will not be broader than SECTION II -LIABILITY: that which you are required by the contract A. The following is added to SECTION II - or agreement to provide for such additional LIABILITY, C.Who Is An Insured: insured. Any person or organization shown in the B. The following is added to SECTION II - Schedule above is also an additional insured, LIABILITY D. ce: iry And Medical Expenses Limits Of Insurance: but only with respect to liability for "bodily injury" or "property damage" caused, in whole If coverage provided to the additional insured is or in part, by "your work" at the location required by a contract or agreement, the most designated and described in the Schedule we will pay on behalf of the additional insured is above, performed for that additional insured and the amount of insurance: included in the "products-completed operations 1. Required by the contract or agreement; or hazard". 2. Available under the applicable Limits of However: Insurance shown in the Declarations; 1. The insurance afforded to such additional whichever is less. insured only applies to the extent permitted This endorsement shall not increase the by law; and applicable Limits of Insurance shown in the 2. If coverage provided to the additional Declarations. insured is required by a contract or ALL OTHER TERMS, CONDITIONS AND EXCLUSIONS REMAIN UNCHANGED. 391-1602 08 16 Includes copyrighted maled2l of Insurance Services Office, Inc ,with its permission. Page 1 of 1 Citizens Insurance.. A company of The 14,mo"lwumuce Group WHH4407573 0301480 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule CITY OF EL SEGUNDO 350 MAIN ST EL SEGUNDO CA 90245 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. Endorsement No. Insured Premium Insurance Company Countersigned by .......................... C 00 03 13 (Ed. 4-84) Copyright 1983 National Council on Compensation Insurance.