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PROOF OF INSURANCE (2018 - 2018) CLOSED'"" DATE (MMIDDIYYYY) ° CERTIFICATE OF LIABILITY INSURANCE 5/3/2017 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: III the certificate holder Is an ADDITIONAL INSURED, the policy(los) 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 CONTACTCraig' Wind DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF EL SEGUNDO THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. EL SEGUNDO, CA 90245 AUTHORIZED REPRESENTATIVE Patrick O'Connor/CW ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401) NAME:. NFP PHONE (317)808-7272 PAX 1327)972.7142 (AIG, No, cxt)• J AIC, No)._ _ 8900 Keystone CrossingE-MAIL ADDRESS craig.wind@nfp.com Suite 300 INSUREMS)AFFORDING COVERAGE NAIC# Indianapolis IN 46240 INSURERA:IJni:ted States Fire Insurance 21113 INSURED INSURER B: Southern California Masters Swimming Club aka INSURER C,: Swim.Net DBA Culver City Swim Club and SCAQ Kids INiSURER0 - 5714 Tellefson Road INSURERS: Culver City CA 900230 INSURERF. COVERAGES CERTIFICATE NUMBER:Master 17/18 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, INSR ADDI.'S49 R .:.. POLICY EFF POLICY EXP ..... .._.. _..... ........ _ .. LTR TYPE OF INSURANCE POLICY NUMBER (Mgm) MMiDt3 YY LIMITS X ' COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000 DAMAGE 1`3 RLNFC 7 A CLAIMS -MADE OCCUR 300, 000 PREMISES.(8 a occom',Ince) � X USP239729 5/18/2017 5/18/2018 MEDEXP(AtiVonepwson) '.5 5,000 PERSONAL &ADV INJURY S 1,000,000 "AGGREGATE GENT AGGREGATE LIMIT APPLIES PER: GENERAL S" 2,000,000 PRO- X POLICY' PRO LOC JECT " .. "PRODUCTS-COMP/OPAGG S 2,000,000 .... ...... ......... ....... OTHER: $ AUTOMOBILE LIABILITY G Mi IN a'SnI.E 1.IM6'6" S ((a acc�glenti)4 ANY AUTO BODILY INJURY (Per person) a" ALL OWNED SCHEDULED BODILY INJURY (Per "accident) S AUTOS ,,. AUTOS _ NON -OWNED _... PI1{)FEIR'IY DAMAGE S __.. HIRED AUTOS .._... ... AUTOS ,(Per accOent) ...._ S UMBRELLA LIAB .00CUR " EACH OCCURRENCE S EXCESS LIAB CLAIMS -MADE AGGREGATE S DED I RETENTION S WORKERS COMPENSATIONAND EMPLOYERS' LIABILITY YIN ...... STATUTE ..__ER ......._ ANY PROPRIETOR/PARTNER/EXECUTIVE """' EL EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) ---- EL DISEASE DISEASE - EA EMPLOYEE S If yes, describe under DESCRIPTION OF OPERATIONS below EL DISEASE -POLICY LIMIT S A PARTICIPANT ACCIDENT ''. US519407 5/18/2017 5/18/2018 EXCESS MEDICAL $10,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF EL SEGUNDO THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. EL SEGUNDO, CA 90245 AUTHORIZED REPRESENTATIVE Patrick O'Connor/CW ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401) COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - O HERS, L S ES O CONTRACTORS - COMPLETED OPERATIONS Policy Number: SRPGP-101-0716/USP239729 Insured: Southern California Masters Swimming Club aka Swim.Net This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Or Organization(s): Location and Description of Com leted O era Name of Additional Insured Person(s) _�P A tions City of EI Segundo 350 Main Street EI Segundo, CA 90245 Information required to complete this Schedule, if not shown above will be shown in the Declarations Section II - 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" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". CG 20 37 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 13 ' = CERTIFICATE OF LIABILITY INSURANCE DATE(MWOD"YYY) 0311312018 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 i0 an ADDITIONAL INSURED„ the policy(les) must have ADDITIONAL INSURED provisions or 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 ondorsemont(s). PRODUCER NAME. LisaAnderson Shaw Moses Mendenhall & Associates Ins. Agency PHONE AIC (626) 799-7813 626 799-8764 .. APC NoY: License #DD94511 ADDRESS'. �'NExto : () Ilisa@smmainsurence.com w_ 625 Fair Oaks, Suite 158 INSURERS) AFFORDING COVERAGE NAIC A South Pasadena CA 91030 INSURERA, State Compensation Ins Fund INSURED INSURER B : Southern California Aquatics Swim Club INSURERC: 3646 Barry Avenue INSURER D : INSURER E: Los Angeles CA 90066 INSURER F: COVERAGES CERTIFICATE NUMBER: 2017 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. TOW AWL �WUK POLICY—VWd7TW— LTR TYPE OF INSURANCE INSp WVD POLICY NUMBER MMRDOJYY'"p"'y mmmp °YYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ iS F1T01 " "" CLAIMS -MADE DOCCUR PR MI $.Fa $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'LAGGR�EGATELIMIT APPLIES PER: GENERAL AGGREGATE b POLICY E] PRO, JECT` LOC ❑ PRODUCTS - COMPlOP AGG S OTHER: $ PAUTOMOBILE LIABII ITY COH U.?INGLE L I S... Eaaa�rddont. ANYAUTO BODILY INJURY (Per person) Sm OWNED SCHEDULED accidentBODILY INJURY (Per -$... AUTOS ONLY AUTOS ) HIRED NON -OWNED AUTOS ONLY AUTOS ONLY POT anent AMA $ 5 UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED RETENTION S 3 WORKERS COMPENSATION PER OTH- AND EMPLOYERS' UABILITY E.L.STATUTE ER ANY PROPRIETOR MAR'STNER16XFC�UT1VIE YIN � EACH ACCIDENT S 1,000.000 OFFICERIMPMSER JMftn4atwy1nNHl, EXCL;,DDEOY 0611 812 01 6 E.L. DISEASE EAE 1,000000� (Hander Rrr H NIA 9135796 06/18/2017 EMPLOYEE 5 it cribe DESCIMPTIONOFOPE .RAI IONS Wow ^El.DISEASE- POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additlonal Remarks Schedule, maybe attached If more space Is required) Waiver of Subrogation Included CERTIFICATE HOLDER ClAt,Iurl°I I ATIAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of EI Segundo ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Vina Ramos 350 Main Street AUTHORIZED REPRESENTATIVE .m m-. P... •�.. EI Segundo CA 90245 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 26 (2016/03) The ACORD name and logo are registered marks of ACORD ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION 9135796-17 RENEWAL SC 8-74-63-10 PAGE 1 HOME OFFICE SAN FRANCISCO EFFECTIVE FEBRUARY 1, 2018 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING JUNE 18, 2018 AT 12.01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME SOUTHERN CALIFORNIA AQUATICS SWI 3646 BARRY AVE LOS ANGELES, CA 90066 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, THE CITY OF EL SEGUNDO WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, SOUTHERN CALIFORNIA AQUATICS SWI IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER. IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH EMPLOYEES SHALL BE INCREASED BY 03%. NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: FEBRUARY 5, 2018 2570 P Alii}IORI2ED REPRESE99 DDT 4'VE PRESIDENT AND CEO SCIF FORM 10217 IREV.7-20141 OLD DP 217