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PROOF OF INSURANCE (2020) CLOSED DATE IMMIDDIYYYY) ACORD- CERTIFICATE OF LIABILITY INSURANCE 2!112019 THIS ATE IS ISSUED As A mATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE FICATE HOLDER. THIS'' CERTIFICATES COERTIFICS NOT TE OF NSURANCEMATIVELY RNEGATIVELY AMENDt EXTEND OR DOES NOT CONSTITUTE A CONTRACTER THE BETWEEN COVERAGE ISS UNG INSURER(S),ITHE ZIED BELOW. THIS PRODUCER,to holders an ADDITID THE ONAL INSURED, R DLD h cy(les)must have ADDITIONAL INSURED provisions or be ondor d. IM�kPORTANT:REPRESENTATIVEa certificate DiT10NAL iN ,the Iaoii TiO e' . - 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 . K&K INSURANCE GROUP,WN C. CONTACT Chert Pettibone AME: 1712 MAGNAVOX WAY PHONE 600-736,7386 p FAx �r� 3 PO BOX 2338 (Arc No.Ext): W (AJC.Na): FORT WAYNE IN 46801 ADDR' Cheryl.Peltlbone@kandkinsurance.¢om ADORES»y: INSURED F— WSURERd'81 AFFORDING COVERAGE MAIC 0 MEMBER NO: INSURER A: N'ationvride MutK st tnsuraru:a Company� � 23767 INSURER'8' NaOonwide Life Insurance Company 65060 El SEGUNDO BABE RUTH LEAGUE INSURER C: _ 1 DBA:EI Segundo Babe Ruth INSURER D- 750 Sierra Street INSURER E: EI Segundo,CA, 90245 RISURERF: COVERAGES CERTIFICATE.NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED'BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVEFOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CON'T'RACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFF'O'RDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CIYEFF BY PAID CLAIMS, 'INSR'� 'AOI7L SUER ry f POLICY Ute. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED pp TYPE OF INSURANCE POLICY NUMBER f..t4`Y EFF POLICY EXP S LTR 1 IABD WVp IMMfDOniYYYI i X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $2.000,000 A CLAIM"ADE OoccuR 02/0112019 �IUAMAGS� Eh1ISSla1S 300,00002/0i/2020Y RPG302564-00 12:01 AM12:01 AM D EXP(Any one person) 5 5,000 PERSONAL&ADV INJURY $2,000,000 GEMLAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 55,000,000 POLICY EDPROJECT ❑LOC PRODUCTS-COMNOPAGG 52.OD0,�0 I' OTHER: PARTICIPANT LEGAL LIABILITY $2,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1.000,00 OEa Amidenl) ANY AUTO BODILY INJURY(Per parson) OWNED SCHEDULED 021012019 02/01/2020 — A OWNSAUTOONLY AUTOS RPG302864-00 t2:01AM BODILYINJURY(Peraccident) HIRED """""NON-OWNED 12:01 AM I-RO'PERTY OAM'AGE X AUTOS ONLY X AUTOS ONLY !Por accidenll I „, UMBRELLA LIAS # OCCUR EACH OCCURRENCE EXCESS LIAR # CLAIMS-MADE AGGREGATE DED V RETENTION WORKERS COMPENSATION Y!N' � IST TUTE i OTHER AND EMPLOYERS"LUABIL17Y ANY PROPRIETORIPARTNE4 JE7CECUTIVE I EL EACH ACCIDENT OFFICFRIN16MBER,EXCLUD>,r07 N f A Mandatory In NH) EL DISEASE-EA EMPLOYEE ( describe under DSCRIPTIONOF OPERATIONS below I E.L DISEASE-POLICY LIMIT 02/012019 02/01/2020 Excess Medical $250,000 B PARTICIPANT ACCIDENT BAX302565-00 12:01 AM 12:01 AM �AD&D S 15,000 DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached K more apace Is required) - THE CERTIFICATE HOLDER 16 AN ADDITIONAL INSURED,BUT SOLELY WITH RESPECT TO THE OPERATIONS OF THE NAMED INSURED. Owner,manager or lessor of the premises where you conduct pmacrs or games SEXUAL ABUSEIMOLESTATION:$1,000,000 PER OCCURRENCEK2,000,000AGGREGATE 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 EI Segundo AUTHORIZED REPRESENTATIVE 350 Main Street ✓11'�.1VL1�1 B Segundo,CA 90246 ACORD 25(2018103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: RPG-302564-00 COMMERCIAL GENERAL LIABILITY CG 20 26 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s)or Organization(s): City of El Segundo its officers,officials,employees,agents and volunteers 350 Main Street El Segundo,CA 90245 RE: El Segundo Babe Ruth League Information required to complete this Schedule, if not shown above,will be shown inthe Declarations. A. Section 11 — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III—Limits Of Insurance: with respect to liability for"bodily injury", "'property If coverage provided to the additional insured is damage" or "personal and advertising injury' required by a contract or agreement, the most we caused, in whole or in part, by your acts or Will pay on behalf of the additional insured is the omissions or the acts or omissions of those acting amount of insurance: on your behalf: 1. Required by the contract or agreement,or 1. In the performance of your ongoing operations; or 2. Available under the applicable Limits of 2. In connection with your premises owned by or Insurance shown in the Declarations; rented to you- whichever is less. However: This endorsement shall not increase the 1, The insurance afforded to such additional applicable Limits of Insurance shown in the insured only applies to the extent permitted by Declarations. law;and 2. 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. CG 20 26 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 1 EI Segundo Babe Ruth World Champions 1964-1969-1974-2002-2013 Shawn Green, 2/5/19 Business Automobile Insurance: EI Segundo Babe Ruth is an all-volunteer organization and does not own or lease any automobiles. Thanks Bob Motta President EI Segundo Babe Ruth PO Box 23 w El Segundo, CA 90245 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 pequry under the laws of California one of the following declarations: I___.)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§3,700 for the performance of the work set forth the agreement with the City of El 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 El Segundo is executed. My workers'compensation insurance carrier and policy number are: Carrier Policy Number Expiration Date Name of Agent Phone# ;ll certify that, in the performance of the work set forth In the agreement with the City of El 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 thea a provisions or the agreement will automatically become void, Signature of Apphcant � - Date Agreement for: i. Dated: ' . Reviewed by: ���