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Home My WebLink AboutINS CERT 2009 (TPSL)AcoRO~ CERTIFICATE OF LIABILITY INSURANCE CALIF-6 BL BL °0"506 08/2 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 INSURED California Youth Soccer Association Inc.- North 1040 Serpentine f, Suite 201 Pleasanton CA 94516 COVERAGES INSURERS AFFORDING COVERAGE NAICe# INSURER A, Philadelphia Insurance Company 23850 INSURER B: Markel Insurance Com an 38970 INSURER C: INSURER D: INSURER E: 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. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $11000,000 A X COMMERCIAL GENERAL LIABILITY PHPK3 3 90 9 6 09/01/08 09/01/09 PREMISES Ea occurence $ 0 0 0 0 0 0 CLAIMS MADE I X] OCCUR MED EXP (Any one person) s5,000 X Inc. Part. Lia PERSONAL & ADV INJURY $1 000 000 , , GENERAL AGGREGATE $5 000 00 ' , 0 1 GEN L AGGREGATE LIMIT APPLIES PER: PRO- PRODUCTS - COMP/OP AGG s2,000,000 POLICY JECT LOC AU TOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $1000000 , r ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ A X HIRED AUTOS PHPK339096 09/01/08 09/01/09 A X NON-OWNED AUTOS PHPK3 3 90 9 6 09/01/08 09/01/09 BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG S EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR FICLAIMS MADE AGGREGATE $ S DEDUCTIBLE $ RETENTION $ = WORKERS COMPENSATION AND EMPLOYERS' LIABILITY TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? If yes, describe under E.L. DISEASE - EA EMPLOYEE $ SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ B DESC OTHER Accident Coverage Full Excess RIPTION OF OPERATIONS I LOCATIONS / VEHIC 4102AH024934 LES / EXCLUSIONS ADDED BY ENDORSE 09/01/08 MENT / SPECIAL PROV 09/01/09 ISIONS Med. Max: $300,000 Ded• $250/Claii J'LL Vk%itATIONS 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 CANCELLATION MTC02008/2009 TOWN OF TIBURON AND CITY OF BELVEDERE INCLUDING ALL FIELDS, GROUNDS AND BUILDINGS 1505 TIBURON BLVD. TIBURON, CA. 94920 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRAII DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTE NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHA IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AU I MURIZED 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 (2001108)