HomeMy WebLinkAboutINS CERT 2008-09-10
,. .
ACORDTII CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDNYYY)
9/10/2008
PRODUCER Phone: 973-467-8005 Fax: 973-921-2876 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Bollinger Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
101 JFK Parkway ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Short Hills NJ 07078
INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A: Lexinaton Insurance [9437
U.S. Club Soccer INSURERB: Markel Insurance COffinanv
716 8th Avenue North
Myrtle Beach SC 29577 INSURER C:
INSURER D:
INSURER E:
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ~~~~ ~A1-~~:~~E '"g~W/~.&~~ON
LTR TYPE OF INSURANCE POLICY NUMBER LIMITS
A X GENERAL LIABILITY 9469782 3/1/2008 3/1/2009 EACH OCCURRENCE $2.000 000
-
1L COMMERCIAl GENERAL lIABILITY ~=~S lEa occurence} $100.000
- o CLAIMS MADE Ii] OCCUR MED EXP {Any one person) $ Exc 1 uded
- PERSONAL & ADV INJURY $2.000 000
- GENERAL AGGREGATE $5.000 000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2.000 000
I POLICY n ~~ !Xl LOC Abuse/Mol Sl 000.000
~OMOBILE LIABILITY COMBINED SINGLE LIMIT $
ANY AUTO (Ea accident)
-
- ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS {Per person)
-
I--- HIRED AUTOS BODilY INJURY
$
NON-OWNED AUTOS (Per accident)
~
~ PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EAACCIDENT $
~ ANY AUTO OTHER THAN EAACC $
AUTO ONLY: AGG $
EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $
=:J OCCUR D CLAIMS MADE AGGREGATE $
$
~ DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I T~~IfJNs I IOTH-
-FR
EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNERlEXECUTlVE EL EACH ACCIDENT $
OFFICERlMEMBER EXCLUDED? EL DISEASE - EA EMPLOYEE $
~~C~~~V~OOS below EL DISEASE - POLICY LIMIT $
B OTHER 4102AH235479 3/1/2008 3/1/2009 Med Max: $100,000
Accident Insurance Ded: $500
Full Excess PT Limit: $2,000
DME Limit: $1,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
~he certificate holder is named as an additional insured under the liability policy. This certificate is issued on
l:>ehalf of
~ll valid US Club Soccer passcard holders participating in Marin FC, Club ID #431.
Group Code: Club #431
~:\l U ..l\ <<'{ Soe t' -ea;'" Cl ~cJo
CERTIFICATE HOLDER
City of Tiburon
1155 Tiburon Blvd
Tiburon CA 94920
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER
WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE
CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO
SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON
THE INSURER, ITS AGENTS OR REPRESENTATIVES.
ACORD 25 (2001/08)
@ACORD CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the poIicy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the tenns 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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this fonn does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affinnatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25 (2001/08)