ACORD® DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 08/31/2023
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 INSURERS), 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 endorsements).
RODUCE Brenda Young-Epps
MARSH USA, LLO
PHONE (404) 995 3074
Two Alliance Cenler (A/C, No, Ext):
3560 Lenox Road, Suite 2400 E-MAIL [email protected] ADDRESS:
Atlanta, GA 30326
Altn: Atlanta CertRequest@marsh com / Fax: 212-948-4321 INSURER(S) AFFORDING COVERAGE NAIC # CN102326389-CAS-GAUWX-23-24 INSURER A : Evanston Insurance Company 35378 USURED INSURER B: Continental Casually Company 20443
lavcore wisconsin. Inc
Dba GameTime INSURER C: American Casualty Company Of Reading, Pa 20427 150 PlayCore Drive SE INSURER D: Transportation Insurance Co 20494 Fort Payne, AL 35967
INSURER E: N/A N/A
INSURER F: The Continental Insurance Company 35289
COVERAGES CERTIFICATE NUMBER: ATL-005640269.00 REVISION NUMBER: 0
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 ADDL SUBR
TYPE OF INSURANCE INSD WYD. POLICY NUMBER LIMITS
X COMMERCIAL GENERAL LIABILITY MKLV2PBC002028 08/01/2023 08/01/2024 EACH OCCURRENCE 2,000,000
DAMAGE TO RENTED
CLAIMS-MADE | X OCCUR PREMISES (Ea occurrence) 100,000
X SIR $250,000 Per Occ MED EXP (Any one person) 10,000
PERSONAL & ADV INJURY 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 4,000,000 POLICY LOC PRODUCTS - COMP/OP AGG 4,000,000
POLICY AGGREGATE 10,000,000
OTHER
AUTOMOBILE LIABILITY BUA 7039895527 08/01/2023 08/01/2024 COMBINED SINGLE LIMF 1,000,000 Ea accident
X ANY AUTO BODILY INJURY (Per person)
OWNED SCHEDULED
AUTOS ONLY AUTOS BODILY INJURY (Per accident) $
HIRED NON-OWNED PROPERTY DAMAGE
AUTOS ONLY AUTOS ONLY Per accident)
Comp./Coll, Ded.: $1,000
F IT UMBRELLA LIAB X OCCUR 7039984806 08/01/2023 08/01/2024 10,000,000 EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE RETENTION Umb Catastrophe $25,000 AGGREGATE 10,000,000
DED RETENTION O
WORKERS COMPENSATION WC 7 39895530 08701/2023 08701/2024 X STATUTE I AND EMPLOYERS' LIABILITY YIN WC 7 39895544
08/01/2023 08/01/2024 1.000,000
ANYPROPRIETOR/PARTNER/EXECUTIVE EL. EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? N/ A
(Mandatory in NH) WC 7 39919971 08/01/2023 08/01/2024 E.L. DISEASE - EA EMPLOYEE S 1,000,000 es, describe und 08/01/2024
SCRIPTION OF OPERATIONS bel WC 7 39929062 08/01/2023 E.L. DISEASE - POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Franklin Park Umbrellas
ty of Redondo Beach, its officers, agents and employees are listed as additional insured as their interests may appear, during and until completion of t ferenced project, on the General Liability via CG 2010 04/13 and Auto Liability via CA 2048, when required by writlen contract. A Waiver of Subrogatic applies in favor of the additional insureds on all policies, when required by written contract.
CERTIFICATE HOLDER CANCELLATION
ty of Redondo Beac SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 11 N. Gertruda Aven THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Redondo Beach, CA 90277 ACCORDANCE WITH THE POLICY PROVISIONS. © 1988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN102326389
LOC#: Atlanta
ACORD® ADDITIONAL REMARKS SCHEDULE Page 2 of 2
AGENCY NAMED INSURED
MARSH USA, LLC. PlayCore Wisconsin, Inc.
POLICY NUMBER
CARRIER NAIC CODE
EFFECTIVE DATE:
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Workers' Compensation (Continued):
Carrier: Transportation Insurance Company
Policy Number: WC 7 39918885
Dates: 08/01/2023 - 08/01/2024
WC 7 39895530 - AL,AZ, CA,CO,FL,GA,IL, IN,KY,MI,MN,MO,NV,NY,OK,OR,PA,SC, TN,TX,UT,VA WC 7 39895544 - CA.CO.FL, GA,IL. IN.MI, MN.MO.MT.NC.NM.NV.NY.OK,OR.PA,SC,TN,TX WC 7 39919971 - AZ, OR, WI
W07 39918885- OH. ND. WY. WA
ACORD 101(2008/01) © 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
POLICY NUMBER: MKLV2PBC002028
EFFECTIVE: AUGUST 1, 2023
EXPIRES: • AUGUST 1, 2024
COMMERCIAL GENERAL LIABILITY
CG 20 10 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED 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) Location(s) Of Covered Operations
As required by written contract executed by both parties All locations prior to loss
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II - Who Is An Insured is amended to 1. All work, including materials, parts equipment furnished in connection with such
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only work, on the project (other than service, with respect to liability for "bodily injury", "property maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the
damage" or "personal and advertising injury"
location of the covered operations has been
caused, in whole or in part, by: completed; or
1. Your acts or omissions; or
2. That portion of "your work" out of which the
2. The acts or omissions of those acting on your injury or damage arises has been put to its behalf; intended use by any person or organization
in the performance of your ongoing operations for other than another contractor or subcontractor the additional insured(s) at the location(s) engaged in performing operations for a designated above. principal as a part of the same project.
However: C. With respect to the insurance afforded to these
1. The insurance afforded to such additional additional insureds, the following is added to insured only applies to the extent permitted by Section III - Limits Of Insurance:
law; and
will not be broader than that which you are 1. Required by the contract or agreement; or required by the contract or agreement to
provide tor such additional insured.
B. With respect to the insurance afforded to these
additional insureds, the following additional
exclusions apply:
This insurance does not apply to "bodily injury" or
"property damage" occurring after:
© Insurance Services Office, Inc., 2012 Page 1 of 2
CG 20 10 04 13
2. Available under the applicable Limits
Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the
applicable Limits of Insurance shown in
Declarations.
© Insurance Services Office, Inc., 2012 Page 2 of 2
CG 20 10 04 13
POLICY NUMBER: MKLV2PBC002028
EFFECTIVE: AUGUST 1, 2023
EXPIRES: AUGUST 1, 2024
COMMERCIAL GENERAL LIABILITY
CG 24 04 05 09
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Name Of Person Or Organization:
As required by written contract executed by both parties prior to loss Information required to complete this Schedule, if not shown above, will be shown in the Declarations. le following is added to Paragraph 8. Transfer (
ahts Of Recovery Against Others To Us !
Section IV - Conditions:
Ne waive any right of recovery we may have agains
he person or organization shown in the Schedule
bove because of payments we make for injury o
amage arising out of vour ongoing operations o
"your work" done under a contract with that person
or oraanization and included in the "products-
completed operations hazard". This waiver applies
only to the person or organization shown in the
Schedule above.
© Insurance Services Office, Inc., 2008 Page 1 of 1
CG 24 04 05 09
Product Name
CNA Workers' Compensation
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. "Any person or organization whom you have agreed to waive your right of recovery in a written contract, provided such contract was executed prior to the date of loss"
The premium charge for the endorsement is reflected in the Schedule of Operations.
All other terms and conditions of the policy remain unchanged.
This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below.
Form No: WC 00 03 13(04-1984)
Endorsement Effective Date: 08/01/2023 Policy No: W739895530; WC739895544 Endorsement Expiration Date:07/31/2024 WC739918871; WC739929062 Endorsement No: TBD; Page: TBD Policy Effective Date: 08/01/2023 RANSPORTATION INSURANCE COMPAN AMERICAN CASUALTY COMPANY OF READING PENNSYLVANI/ Policy Page: TBD Copyright 1983 National Council on Compensation Insurance.
Product Name
Business Auto
CNA
DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the following:
AUTO DEALERS COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement.
This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form.
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below.
Named Insured: PlayCore Group, Inc.
Endorsement Effective Date: 8/1/2023
SCHEDULE
Name Of Person(s) Or Organization(s): " Any person or organization whom you have agreed to include as an additional insured under a written contract, provided such contract was executed prior to the date of loss." Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II - Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section 1 - Covered Autos Coverages of the Auto Dealers Form No: CA 20 48 10 13 Policy No: BUA 70389552:
Boley Page: Ve Date: 08101202
* Copyright Insurance Services Office, Inc., 2011
Product Name
BUSINESS AUTO
CNA
WAIVER OF TRANSFER RIGHTS OF RECOVERY AGAINST OTHERS
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the following:
BUSINESS AUTO
SCHEDULE
Name of Person or Organization: " Any person or organization whom you have agreed to include as an additional insured under a writter contract, provided such contract was executed prior to the date of loss." (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.)
We waive any right of recovery we may have against the person or organization shown in the Schedule because of payments we make for the injury or damage. This injury or damage must arise out of your activities under a contract with that person or organization. The waiver applies only to the person or organization shown in the Schedule.
All other terms and conditions of the policy remain unchanged.
This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy.
Form No: 9-23186-B (12-2010) Policy No: BUA 7039895527
Endorsement Effective Date: 08/01/2023 Policy Effective Date: 08/01/2023 Endorsement No: TBD ; Page: TBD Policy Page: TBD
Underwriting Company: CONTINENTAL CASUALTY COMPANY
• Copyright CNA All Rights Reserved.