The URL can be used to link to this page

Home My WebLink AboutINS CERT 2008-09-01 (2) ACORD... CERTIFICATE OF LIABILITY INSURANCE CSR BL I DATE (MM/I"I1IYYYY) CALIF-6 0506 08/26/2008 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Bollinger, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 101 JFK Parkway ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Short Hills NJ 07078-5000 Phone: 800-526-1379 Fax: 973-921-2876 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A Philadelphia Insurance Company 23850 INSURER B: Markel Insurance Company 38970 California Youth Soccer Associationt Inc.- North INSURER C: 1040 Serpen ine L6 Suite 201 INSURER 0: Pleasanton CA 945 6 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 ~~~~ POLICY NUMBER PD~1!~1ri~rD1f~E POLlCr(rXPIRA T~~N LIMITS LTR TYPE OF INSURANCE DA TE MM/DDIYY GENERAL LIABILITY EACH OCCURRENCE $1,000,000 t-- A X COMMERCIAL GENERAL LIABILITY PHPK339096 09/01/08 09/01/09 PREMISES '(E~~~~~~nce) $1,000,000 I-- n CLAIMS MADE [!] OCCUR MED EXP (Anyone person) $ 5,000 X Inc. Part. Lia PERSONAL & ADV INJURY $1,000,000 ~ GENERAL AGGREGATE $5,000,000 ,....- GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 I n PRO- nLOC POLICY JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT - $1,000,000 ANY AUTO (Ea accident) - ALL OWNED AUTOS BODILY INJURY - $ SCHEDULED AUTOS (Per person) - A X HIRED AUTOS PHPK339096 09/01/08 09/01/09 BODILY INJURY - $ A X NON-OWNED AUTOS PHPK339096 09/01/08 09/01/09 (Per accident) - - PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ R ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ o OCCUR D CLAIMS MADE AGGREGATE $ $ R DEDUCTIBLE $ RETENTION $ $ I WI: S lAlli-I /UIH- WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICERlMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ ~~~~I~~S~WoJ:sf~~s below E.L. DISEASE - POLICY LIMIT $ OTHER B Accident Coverage 4102AH024934 09/01/08 09/01/09 Med. Max: $300,000 Full Excess Ded: $250/Claim DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS ALL OPERATIONS OF CYSA-NO. ITS YOUTH MEMBER TEAMS & LEAGUES. THE CERTIFICATE HOLDER IS NAMED AS AN ADDITIONAL INSURED WITH RESPECTES TO THE LIABILITY COVERAGE. (TIBURON PENINSULA SOCCER LEAGUE) CERTIFICATE HOLDER TDTCB2DD812DD9 TOWN OF TIBURON AND CITY OF BELVEDERE INCLUDING ALL FIELDS, GROUNDS AND BUILDINGS 1505 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 ~ 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. AUTHORIZED REPRE ACORD 25 (2001/08) @ ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(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 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001/08)