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PROOF OF INSURANCE (2018 - 2018) CLOSED A,C CERTIFICATE OF LIABILITY INSURANCE DATE(MM10°nrrT) 09/10/17 I 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 policy(ies) 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 endorsement(s). PRODUCER C NTACT NAME'.; 9 Agency �A/C ra NOI:r 800-991-... Sterlin A enc Insurance Services P E,,, 800 991-2002 2024 .... EMAIL wsterllrti P.O. Box 12439 ADDRESS q@sterllrig com Marina Del Rey, CA 90295 INSURE ),AFFORDING COVERAGE NAICY INSURER A:Scottsdale Company II, -_... ...._. ....._. ......... INSURED INSURER 8: Ser iu Boerica g INSURER C 9 Y, INSURER D: DBA:Jaguar Tennis Academy, LLC INSURER E: INSURER F. ..,......... COVERAGES 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 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 INS MY CE POLICY LAR X„,. TYPEOFGENERAL NERALNLIABILITY A�S n CPS2O51988 NUMBER rM9/11/1 7 I IM9 oD/YVYPn,.^D��q��C������� LIMITS ....2,000,000 COMMERCIAL GE p ..... ..- .._,_.„.. CLAIMS•MADE �q X OCCUR MCf,,,,,,,,$ES,(is�awcc_u�reer,pw), �,5,,, 100,000 111 P.... ...? - _ PERSONAL d ADV INJURY I$ 1,000,0 D EXP An onr• er�on S 5 OOO GEN'L,AGGREGATE LIMIT APPLIES PER I? OO GENERAL AGGREGATE I$ 1,000,000 Yw � W . P PRO- JECT LOC _ $ 1 POLICY PRODUCTS-COMP/OP AGG _ „OO'O,OOO �......_,.......,_..._..J.... OTHr R, $ AUTOMOBILE LIABILITY COMBINED SINGLE L0@ CT dlm�,4"400), w S ... ... _................... ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED ., accident �s --. AUTOS ONLY AUTOS HIRED OS ONLY ....,,,d NON-AUTOWNED ONLY .obFtote CNAMAG.+E.. ) $UMBRELLA ,..�.�.�.� ,S EACH I._. AB EXCESS ABCLAIMS-MAD.... OCCUR .E. AGGREGATER9t:Nt t':.. -E.� ... DEO I RETENTION S I 1 ,..,_�..................... WORKERS COMPENSATION p f'Eft-OTHIT ITITITm AND EMPLOYERS'LIABILITY YIN �ANYPROPRIETOR/PARTNER/EXECUTIVE DISEASE ,S OFFICER/MEMBEREXCLUDED? N I A E L E EJ i (Myyandatory In NH) _........ N ......... .E 'S ._.......... It describe er DESCR PTION OF OPERATIONS below E L.DISEASE-POLICY LIIMITE,$m 1 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If mon space Is required) CERTIFPCA'TE MOLDER CA'NCELLAT'ION The City of EI Segundo, its officers, SHOULD ANY OF Til' 'OV'E DESCRIBED POLICIES BE CANCELLED BEFORE officlals,em Io ees, agents, and volunteers THE EXPIRATION ATE THEREOF, NOTICE WILL BE DELIVERED IN P Y g ACC 'RD NCE W H THE POLICY PR as Additional Insured 401 Sheldon Avenue AIT DRF. ENTA1°VE EI Segundo, CA 90245 / ©1988-2015 ACORI CORPORATIOP All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: CPS2051988 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS,S, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Location And Description Of Completed Opera- Or Organization(s); tions City of EI Segundo, its officers, officials, employees, Recreation Park agents and volunteers 401 Sheldon St EI Segundo, CA. 90245 ._..._. .........__....................................... Information required to cooiplete this Schedule, if not shown above, will be shown in the Declarations. j Section II—Who Is An Insured is amended t include as an additional insured the person(s) or organiza- tion(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 desig- nated and described in the schedule of this endorse- ment performed for that additional insured and included in the"products-completed operations hazard". CG 20 37 07 04 ©ISO Properties, Inc., 2004 Page 1 of 1 p Callifoltnia Evidence of 11 ialbillity Insurance Evidence of Insurance IGIO'Elco, 9011100 calm Here are your Evidence of Liability Insurance GI:::.:ICO GENEWd-INSURANCE COMPANY PO BOX 509090 SAN DIEGO,CA 92150-9090 Cards. One card must be carried in the proper NAIC Code: 35882 insured vehicle. Proof of insurance is required to register or renew the registration of your Policy Number E.-Ifective Da:teL Expiration Date vehicle. A law enforcement officer can ask you .4277475929 02-13-18 08 13••18 to prove that you have liability insurance meeting Year IIMalke Model Vehicle ID INo the basic requirements of California law. 2002 l:.::.XCIRSN L TI) 1l:::]MNU-42l::72EB78833 A violation of these requirements can result in a fine Insured:: of up to: VIIRGIINIJA IkVRVCIL..IIV IN I:::: $1 000 for the first time Sl:..:1RGIU BOIERICA $2,000 for additional times 906 F IIMPl:..:.lR1A11 AVE Also, a judge can have your vehicle impounded. False proof of insurance may result in a fine up to E.11 Si::.::GUNl)0, CA 902-45 2519 $750 and 30 days in prison. 11k,r,lifill rium roiuirorwx is of w--,tiorin wnv, & I cEx,o,ol IIIUCLW-m 1 ILI Due to space limitations on the ID card, only the Volude C,Ido,IT'I;HITIUM I Iabilh I I mim prGsmbod bV hw Named Insured and the Co-insured are listed For a full list of drivers covered under this policy, please reference the Drivers section of your Declarations Page,which is included with your insurance packet. If you would like additional ID cards you can go online to geico.com or call us at 1-800-841-3000. What to do at the time of an accident. • Do not admit fault. • Do not reveal the limits of your liability coverage to anyone. • Exchange contact information;get year, make, model, plate number, insurance carrier and policy number of all involved. Also, identify witnesses and collect contact information. • Contact the police or 911 if applicable. • Contact GEICO by calling 1-800-841-3000 or visit gelco.com to report the accident. U-4-CA(11-09) CITY OF EL SEGUNDO WORKERS' COMPENSATION DECLARATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SUBJECTS AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN LABOR CODE § 3706, INTEREST, AND ATTORNEY'S FEES. I affirm under penalty of perjury under the laws of California one of the following declarations: (_) I have and will maintain a certificate of consent of self-insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Labor Code§3700 for the performance of the work set forth the agreement with the City of EI Segundo. Policy No. (�I have and will maintain workers'compensation insurance as required by Labor Code§3700 for the performance of the work for which the agreement with the City of EI Segundo is executed. My workers' compensation insurance carrier and policy number are: Carrier Policy Number Expiration Date Name of Agent Phone# (_X_) I certify that, in the performance of the work set forth in the agreement with the City of EI Segundo, I will not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Labor Code § 3700 1 must immediately comply with those provisions or the agreement will automatically become void. Signature of Applicant Date May 7, 2018 Agreement for-,l k )i V. 7� �)II 0 Dated: Reviewed bw, y 1