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PROOF OF INSURANCE (2019 - 2019) CLOSED op DATE flivmflrm[vrc tl 011" i-JABIL.1"T"Y' 1!1qSL)1R,,,ANG1E 4 V,1 1 fl f4lis cEkiiPicATii:' �IS IS'�jLb AS'AILO�li'M 01RIMATIOIN ONLY AND CONF-1:..M NO I UPOIN THE CERTFICATI:..11110�DER. THIS MIF: COVIERAGE AFFORIDII[M BY I'll-41E 1101 MES CIERYPACATI:.. IMES NOT AF"FIRIIIN' 011:1 NEGATIVELY All EXTII:..,NID OR ALTER IBM W THIS IrIERTWICATE OF INSURANCE PflFS, f1SO I Ot,"111'Wft� A COII BIC-.'II'WIlI:IlI.�.N ISSUING MIJRER(S), AU11ll0Il REPRESENlATIV11:1.1 OR PRODUCER,All THE C!:'RTT1 h PTE fffl P$17, JMFIOIIRMINT, If Ow CeFtlificalte IfmuroVu.Varro iis an ADDIMOINAL INSURED, the pullky(lJos) must be endorsed. 19 SUBROGATIJOIN JS WAlIVED, sull:qect to the tmns and condilbom of the poky, ce"Mri polfides may requfte an eindop-seil A sUnWeirwimit on WhlJs ce"Mcalie does not confer vighft; to flhe cerfificate holldm-in hou of such ondorsoncil PRODUCEIRPV, NFP I'Mmir, 8900 Kll:..:.YST0l14llEE MING S'TIE 300 110 ll 44992(PAymr-.14TS ONI Y) WDIANAPOLIS, IN 46240-4696 Ill AFWRWNc c0VE-R.AGE NAIC P 3178087109 INSURER A United States FlIre linrurakice 21113 INSUREV 9101pf!",AND I(111g]11 01N PROW)1111.4 INS A :Njiw,I[IIJW nil'u) INSURER B W,),Jjr�,Iljjy1,1111M jl"Jjj,p:l V1FP191r1R5: INSURIER C Southern Galliforinlia Masteirs SMI Oulb alka Swkm.Net 014SU.RI1'R 57,14 TeHeisoin Rd )NISUREIR E Cull Cott',CA 90230 CER11IFICATIE INUMBM 0,11 REVISION NUMBER: r'HIIS IS TO CERTIFY YHAII'"I'HE POLICIES OF INWRANCE. LISTED BELOW HAVE BIF1fl'"11' II.SUJEII)j jj( 1r11r'91f 1111HSLJIFU7.1) NAMED ABOVE FOR THL PoUCY PERIOL) �,:Ijjrl WDICATED, NOTVVIITHSYANDING ANY REQUIREMENT, TERIM op, %�v6 OR C�7'HLIR DOCUMENT VWTH RLSIFEC�' �O WHICH I HIS CERriFCATE MAY BIrl: ��3"1�1[11[.), I jl",1[111,,S��Qjj,l, 11'11,11t, All:l I fljrlij[.� I HERON IS SUBJECT TOALL YHE dub cioimbhlk)1`111,5� I)r N�'(")JIJICjjf-,:S �..Iilvlilns sHovwI iiyil,n� i,,1oV1[. I LIN "SIDEAJI01 ID R0,I0�,AAPVIE"�� ....... ...... ............. ...................— . :� . .. Aliril j�5i.RY1�� II mill 'T Y P E 0 F N SU RA IN C t` • POLICY NUME1EIR 011 GE10bRAL AIG6RIUIGIti�1 !$2 0013,10010 00 GII JAII I n l�:!:1[Apujjj rl,r PIRIA'WC:1`3 (.00ROF AGIG. $2,000,000.00 uNI!:1V�IF liz 051 8120 18 5,11 W,2D 119 SKFIGAFIM11 101-0717 1 kil I AIN14 11:2:�I All JiIv sil'oulo'bolum .................. .......... -X AVOM011 IUd5Rtl�IIN�UYY 0 i�I I) qU'Irjjjrjjpjql'N�),h ITIi IN ill'IJI(k;i,(0oir 4u Idkvinli� VINI:, ............ li VWQ D1 vNv VI ON 00I(I;;I 61h61RkLUACI I:Ki�10 "iEll ............. vl�XEss 11.111A q,a Pk I,GsJpj[.IrGj�jlrI, $ - I I I � I UG ---------- .................... „w..,.... ............. ........... -RAT=- VEOGLIl(Aftath ACORID 101, p II'INr ;t AddWaind�Ivvva�*s schaduw,v mare soca IIR m0humM 0 SCRIPWIN W:06 1 LOCIAne)N8 i. swWafling The Cordfic ate HoWa J5 added a%an addiffloinall lihsluired but only with resil We Iliabillfty ariisilng md of the il Vnsuved dull the ll pail ScIliedulJed Actlivitles ExclluMon Apphos-Please Wet to Narned lInsuved Mcil Ceftfficate of Coverage .......... CER"riFlICATE H011 CANCELLAT04 Ci'Wy-o"Ill ""' , , .............................................................................. ..... .. . ...... ............................. glundo SHOW ID ANY DIF TWE All-.30VE ViESCRIIII Poll JOIES BE CANCELLED il-rkl I)IN DAmTHL91I NOTIJIGIF.WHAL Ill.INUAIRED W 350 MWn 8trest AC"'CIDAI)ANCIF.Wl1nUTl)fl::.!PMJCY 11145.. IS Sequindo,CA 90245 ............ AUTH011 RIEPREHNWIVIE NFP ACOIRD 2.5(2010105)v141120,001 1988 2010 ACOREP CORPORATI10il Ah fights reserved. "rhe A COIR ul and Jogo wire regstered mairks ant ACOIRD GENFaRAI, LIABILITY ("'G 20 11 1111, '96 THIS ENDORSEMENTCHANGESTHE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MANAG111;11111RS OR L[.1SSORS OF l, ,F„ Poky Number: SRPGAPML.-101--0'717/LJSP266525 InSt.Jired: Southern Cafifornia Masters Swimming ClIub aka Swim.Net This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL UABHU'ry COVERAGE IPART SCHEIDULIE .!qq�iqnati99 of Premises (11y Of I:J N1, D Segundo, CA P0245 1. Designation of Piremirses (Part ILeased to You): IRefer to the Schedule of Additional Insureds sliown ort the Mernber Cerfificate of IInsurarnce. 2. Name of Vclson or Organiz,,,Ikn Wk%ukhtionW Insured): Refer to the Schedule of Addttioina� Insureds drown on the Wni0jer Certificate 0 & Ad&flonall Pirerniurn: flif no en4y appears above, the inforimotion required to compete this endWsernent wiH The shown ih the Dedaraflu!i,rz, as 8ppkaOe to this is "Imendrd tc+ in(Jutle 0d at) 01! umf tff+ p�,15;uii (n orgotfi?;,iflon shovv,n inflie but oftly %'W' re-'pe(I 10 Pr Arrj+:,'jrj(j (r1.1 'vf thrr,'^ oy'olelnWct, wol0inlenatwe oe Xtse of 0iM pnd of the plemist,'s 1ryou on shov,,,n iti 11'Ie Sn,hedtfle ond ':AttIect Ito fl ie fo'lkm'ilig znfifitkWial This insurance does not apolly to: 1. Any"occu' rireince"which talkes ptDace after you cease to be a tenant in that jpremuses. 2. Sbui!Jvt,.rsl alten,nliuns, nevo a,sonstlrucfioh or demolition operations performed by or on behalf of the person or orpaniz;'ftn showh ih the "-'�(heoule, CG 20 1101 96 Copyright, DIntWance Services Office, hic., 1994 1page'l of I TGG' I DATE(MMIDDIYWY) . ,Cle?RV CERTIFICATE OF LIABILITY INSURANCE 09/11/2018 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). PRODUCERy CONTACT Lisa Anderson d NAME: Shaw Moses Mendenhall&Associates Ins Agency actino EIIII: (626)799-7813 k tlo9, (626)799-8764 License#OD94511 AD...... lisa@smmainsurance.com 625 Fair Oaks,Suite 158 INSURER(S)AFFORDING COVERAGE NAIC A South Pasadena CA 91030 INSURERA: State Compensation Ins Fund INSURED INSURER B: Southern California Aquatics Swim Club INSURER C: 4 3646 Barry Avenue V INSURER D: Cy INSURER E: I Los Angeles CA 90066 fl INSURER F: COVERAGES CERTIFICATE NUMBER: 2018-2019 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. INSH arww'r.gaxamn' PULICY EFF FULK:Y EXP LTR TYPE OF INSURANCE /NSD U WVD POLICY NUMBER IMWDDIYYYY) (MM/DDIYYYY)li LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS-MADE OCCUR PREMISES Ea occurrence) S C MED EXP(Any one person) S U,PERSONAL 6 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ JECI LOC PRODUCTS-COMP/OPAGG S POLICY JE'C'Y"RO' S OTHER AUTOMOBILE LIABILITY 14 araceidelf)S"INGh„E LIPM7tlf S ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) 5 AUTOS ONLY AUTOS HIRED NON-OWNED PRTP'e�4'Y OFI�MM�4.',E� S AUTOS ONLY AUTOS ONLY [(PerawdNill S UMBRELLA LIABHCLAIMS-MADE OCCUR EACH OCCURRENCE SEXCESS LAB uuRu AGGREGATE S DED [RETENTION S I, S XI WORKERS COMPENSATION IV !PER g 07H- AND EMPLOYERS'LIABILITY STATUTE R I ER YIN 1,000,000 A ANY PROPRIETORIPARTNERIEXECUTIVE NIA 9135796 06/18/2018 06/18/2019 E.L EACHACCIDENT s OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory In NH) EL DISEASE-EA EMPLOYEE 5 If yes,deicnbe under 1,000,000 DESCRIPT'I'ON OF OPERATIONS below EL DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schodule,may be attached If more space Is required) Waiver of Subrogation Included CERTIFICATE HOLDER CANCELLATION 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. 350 Main Street AUTHORIZED REPRESENTATIVE EI Segundo CA 90245 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION 9135796-18 RENEWAL SC ® B-74-63-10 PAGE 1 HOME OFFICE SAN FRANCISCO EFFECTIVE SEPTEMBER 12, 2018 AT 12. 01 A.M. AND EXPIRING JUNE 18, 2019 AT 12 . 01 A.M. ALL EFFECTIVE DATES ARE 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, 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 SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: SEPTEMBER 13, 2018 2570 AUTHORIZED REPRESENT IVE PRESIDENT AND CEO SCIF FORM 10217 (REV.4-2018) OLD DP 217