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2017/12/15 Sports IT, Inc. Certificate of Liability Insurance AC R" CERTIFICATE OF LIABILITY INSURANCE FDATE(MM/DDYYYY) �—� 10/12/2018 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 Phone: (804)354-9020 CONTACT Kristin Lloyd Fax: (866)352-1401 NAME: The Monument Sports Group PHONE FAX (A/C.No Ezt): 1365 Overbrook Road E-MAIL ADDRESS: @ Kristin monumelrtp s orts.com Rich #I R INSURER(S)AFFORDING COVERAGE NAICn Richmond. Virginia 23220 INSURER A: The Hanover Insurance Company 22292 INSURED INSURER B: Sports IT,Inc.dba DASH Platform INSURER C: 12402 SE 38th Street#201 Bellevue, WA 98006 INSURER D INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:1767 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. INSR ADOL SUBR LTR TYPE OF INSURANCE NSD WVD POLICY NUMBER MM/DD/YYYY MMLDD YYYY LIMITS V/ COMMERCIAL GENERAL LIABILITY ZDR980835105 12/15/2017 12/15/2018 EACH OCCURRENCE $ 1,000.000 A CLAIMS-MADE OCCUR ­IIAMAGE TO-RENTED -PREMISES(Ea occurrence) S 100'000 ✓ MED EXP(Any one person) S PERSONAL 3 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $' 2,000:000 ✓ POLICY❑jE O LOC PRODUCTS-COMP/OP AGG S 2.0i000 OTHER $ A AUTOMOBILE LIABILITY ZDR 9808351 05 12/15/2017 12/1 J/2O]g COMBINED SINGLE LIMIT S 1,000,0�O 11 ANY AUTO Ea accident OWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ ✓ HIRED ✓ NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident S S UMBRELLA LIAB OCCUR I EXCESS LIAB EACH OCCURRENCE S '11 CLAIMS-MADE AGGREGATE S DED I RETENTIONS S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N/A E.L.EACH ACCIDENT S (Mandatory in NH)If yes.describe under E.L.DISEASE-EA EMPLOYEE S DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The Certificate holder is named as additional insured if required by written contract per form 4421-2915. This certificate is issued in reference to the named insured's operations and subject to the terms, conditions and other provisions of the policies. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The City Of Menifee THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 29714 Haun Road Menifee,CA 92586 AUTHORIZED REPRESENTATIVE } ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of g 9 ACORD CERTIFICATE OF LIABILITY INSURANCE FDATE(MM/DD/YYYY) 10/12/2018 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 Phone: (804)354-9020 CONTACT Lisa George Fax: (866)352-1401 NAME: The Monument Sports Group PHONE FAX A/C.No Ezt: A/C No): 1365 Overbrook Road ADDRESS: lisa,c monumentsports.com Suite#I INSURER(S)AFFORDING COVERAGE NAIC# Richmond.Virginia 23220 INSURER A: Underwriters At Lloyd'S,London 15792 INSURED _--- -- INSURER B: Sports IT. Inc.dba DASH Platform INSURER C: 12402 SE 38th Street#201 Bellevue,WA 98006 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:2040 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. INSR ADDL SUBRI POLICY EFF POLICY EXP LTR TYPE OF INSURANCE NSD WVD i POLICY NUMBER MM/DD/YYYY MMIDD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE RE S CLAIMS-MADE JI OCCUR PREMISES(O urr (Ea TO S MED EXP(Any one person) I S PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE S POLICY u PE O C LOC PRODUCTS-COMP/OP AGG S OTHER' S AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT $ ANY AUTO Ea accident OWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident S S UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE S DED I I RETENTIONS WORKERS COMPENSATION PER I. OTH- $ IAND EMPLOYERS'LIABILITY ANYPROPRIETORIPARTNER/EXECUTIVE Y/N STATUTE ER OFFICERIMEMBEREXCLUDED? ❑ N/A E.L EACH ACCIDENT S (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S A Errors&Omissions � IESH00774957 9/24/2018 9/24/2019 Per incident pl 1,000.000 S 250,000 Cyber Crime 2.,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate of insurance is issued as proof of coverage. Retention: $25,000 CERTIFICATE HOLDER CANCELLATION Holder's Nature of Interest:Certificate Holder SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The Cit3'of Menifee THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 29714 Haun Road IVIeni ee.CA 92586 AUTHORIZED REPRESENTATIVE r{ I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD I-Innm Fspauol Contact Search L&I A-Z.Index Help A[v L&I Safety&Health Claims&Insurance Workplace Rights -Trades& Licensing Washington State Department of Labor & Industries SPORTS IT INC Owner or tradesperson 9040 WILLOWS RD NE STE 102 DON CROWE REDMOND,WA 98052-6576 Doing business as SPORTS IT INC WA UBI No. Governing persons 602 187 161 DON G CROWE STEWART KONZEN; TIM CARLSON; TARN SUBLETT; DAVID LAUB; MARK RUSHING; JONATHAN ROBERTS; TOM CARRIKER; LARRY MANA'O; STEWART KONZEN; TIM CARLSON; TARN SUBLETT; DAVID LAUB; MARK RUSHING; JONATHAN ROBERTS; TOM CARRIKER; LARRY MANA'O; Workers' comp Do you know if the business has employees?If so,verify the business is up-to-date on workers'comp premiums. L&I Account ID Account is current. 895,032-11 ...........I.................... Doing business as SPORTS IT INC Estimated workers reported Quarter 2 of Year 2018"11 to 20 Workers" L&I account contact T1/ANDREW BRYAN(360)902-4261-Email:BRYF235@lni.wa.gov Public Works Strikes and Debarments Verify the contractor is eligible to perform work on public works projects. Contractor Strikes ........................................................ No strikes have been issued against this contractor. Contractors not allowed to bid No debarments have been issued against this contractor. Workplace safety and health No inspections during the previous 6 year period. Help us improve