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PROOF OF INSURANCE (2019) CLOSED DATE(MM/DD/YYYY) A^'�''�'"�"�'�"� CERTIFICATE OF LIABILITY INSURANCE 9/7/2018 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 CONTACT NAME: » rt)r (877)653-2405 FAX -" PHONE II 8P'/ 737-8498 INC,N. I IAiG,Nap; ( � .., KAPNICK&COMPANY,INC, A MDRIESS: Certificale@"-Nanover.com 333 ADRIAN USTRIAL DR MI 49221 Hanover tins R(S)AFFORDING COVERAGE. NAIC 0 INSURER A: insurance Co 22292 INSURED INSURER„B„ .,... INSURER C f ISAAC SPORTS GROUP LLC INSURER D: 3419 WAGNER WOODS CT INSURER E L ,. ANN ARBOR MI 48103 INSURERF; 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 INSE .. ,, ,,,, �AbtYCgUeR POLICY EFF POLICY EXP TYPE LTR / ;INSE3II D POLICYNUMBER IMMIDDIYYYYI (MMIDDIYYYYI LIMITS V COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE70 RENTED ) CLAIMS-MADE �OCCUR PREMISES Fa mourfence $ 300,000 MED EXP(Any one person) s 5,000 A Y N OHH A40798104 08/28/2018 08/28/2019 PERSONAL&ADV INJURY $ 1,000,000 GEN L AGGREGATE LIMIT APPLIES GENERAL AGGREGATE $ 21000,000 r'RC�° LOC POLICY JEO1( [VI PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER' $ AUTOMOBILE LIABILITY COMWNED'SINGLF UMI7 $ 1,000,000 (Eat axcmdenl) ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED Y N OHH A407981 04 08/28/2018 08/28/2019 BODILY INJURY(Per accident) $ / AUTOS ONLY AUTOS V AUTOS ONLY AUTOS ONLY (Per acc, T nt F4fi.NAGE HIRED NON-OWNED PROPS $ ,i�tr p„ $ UMBRELLA LIAB I Y OCCUR EACH OCCURRENCE EXCESS LIAR 1 CLAIMS-MADE AGGREGATE DED I I RETENTIONWORKERS NSA $ _ M y I ",,, H_ AND EMPLOYOERSEL ABIILOITY STATUTE ER IYIN� PLR 07 ANYPROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $ 500,000 A OFFICE R/MEMBER EXCLUDED? N NIA Y WHH A407573 04 08/28/2018 08/28/2019 (Mandatory in NH) E L DISEASE-EA EMPLOYEE $ 500,000 yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE•P'OLK,YLIMIT $ 500,000 A Misc,Professional Liability OHH A407981 04 08/28/2018 08/28/2019 $1,000,000 General Agg/$1,000 Ded DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder is an Additional Insured on the General Liability with respects to Ongoing and Completed Works/Operations pursuant to the terms and conditions by forms 391-1941 and 391-1602,Waiver of Subrogation as provided by form WC000313, CERTIFICATE HOLDER 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. CITY OF EL SEGUNDO AUTHORIZED REPRESENTATIVE 350 MAIN ST kl' i^` EL SEGUNDO CA 90245 �' Y ( ("G°�'J, ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Policy Number: OHH A407981 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 insurance afforded to such additional insured endorsement, the following changes are made to will not be broader than that which you are SECTION II — LIABILITY: required by the contract or agreement to A. The following is added to SECTION II — provide for such additional insured. LIABILITY, C. Who Is An Insured: B. The following is added to SECTION II — Any person or organization shown in the Schedule LIABILITY, D. Liability And Medical Expenses above is also an additional insured, but only with Limits Of Insurance: respect to liability for "bodily injury" or "property If coverage provided to the additional insured is damage" caused, in whole or in part, by "your required by a contract or agreement, the most we work"at the location designated and described in will pay on behalf of the additional insured is the the Schedule above, performed for that additional amount of insurance: insured and included in the "products-completed 1. Required by the contract or agreement; or operations 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 by This endorsement shall not increase the law; and applicable Limits of Insurance shown in the 2. If coverage provided to the additional insured Declarations. is required by a contract or agreement, the ALL OTHER TERMS, CONDITIONS AND EXCLUSIONS REMAIN UNCHANGED. 391-1602 08 16 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 1 of 1 Insurance- A compiq of The H mover Inmmice Group WHFJA407573 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 WC 00 03 13 (Ed.4-84) Copyright 1983 National Council on Compensation Insurance.