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HomeMy WebLinkAbout2009-10 TPSL /California Youth SoccerACORD CERTIFICATE OF LIABILITY INSURANCE DATE 1 YY) (MM/DD YY M /200 9 9/18/ 2009 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 101 JFK Parkway HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Short Hills NJ 07078 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA:Philadel hia Indemnity Ins Co 8058 California Youth Soccer INSURERB:AIG Life 1040 Serpentine L, Suite 201 Pleasanton CA 94566 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 LTR DD'L NSRD TYPE F INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/YY POLICY EXPIRATION DATE MM/DDlYY LIMITS A X GENERAL LIABILITY PH PK4 619 6 2 9/1/2009 9/1/2010 EACH OCCURRENCE $ 1 000, 000 DAMAGETO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurence $1 000, 000 1 1 CLAIMS MADE X OCCUR MEDD EXP (Any one person) $ 5j 000 X Tnrl Part T l a PERSONAL BADVINJURY $ 1 000, 000 GENERAL AGGREGATE $ 5 000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2 000, 000 PRO- POLICY PRO- LOC AUT OMOBILE LIABILITY PH PK4 619 6 2 9/1/2009 9/1/2010 COMBINED SINGLE LIMIT $ 1' 000' 000 ANY AUTO ALL OWNED AUTOS D SCHEDULED AUTOS X HIREDAUTOS X NON-OWNEDAUTOS /©,.I Lt'`~t~ ~T GA RAGE LIABILITY ANY AUTO i ~ P e c' C 71 L' - ; - r EXCESS/UMBRELLA LIABILITY i OCCUR CLAIN {J i DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTI OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below B OTHER SRG91225873 9/1/2009 9/1/2010 Medical Max: $300,000 Accident Coverage ed: $250/Claim Full Excess DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS 11 operations of CYSA North, its youth member teams, & leagues. The certificate holder is named as an additional. insured with respects to the liability coverage.THIS CERTIFICATE IS VALID ONLY FOR CYSA-NORTH SANCTIONED VENTS/ACTIVITIES. Certificate is issued on behalf of IBURON PENINSULA SOCCER CLUB Group Code: 5-06 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER TOWN OF TIBURON WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE INCLUDING ALL FIELDS, GROUNDS AND BUILDINGS CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO 1505 TIBURON BLVD. SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON TIBURON CA 94920 THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2001/08) - f ©ACORD CORPORATION 1988 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) r, 1/4/2010 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 101 JFK Parkway HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Sh t Hill NJ 0707 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. or s 8 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA Markel Insurance Com an 8970 U.S. Club Soccer 716 8th Avenue N rth INSURER B: Philadel hia Insurance Com an 3850 o Myrtle Beach SC 29577 INSURER C: INSURER D: INSURER E: c;ovtkAues 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 DD' LORD TYPEOFINSURANCF POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMBS B X GENERAL LIABILITY PHPK510 3 0 6 1/1/2010 1/1/2011 EACH OCCURRENCE O - $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEU PR EMISES (Ea ocauence $100.000 CLAIMS MADE a OCCUR MED EXP (Any one person) $ Exc luded PERSONAL & ADV INJURY $1 000 000 , , GENERAL AGGREGATE $ 5 000 0 00 , GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMP/OP AGG $2,000,000 POLICY PRO LOC Abu e M l 1 0 0 0 0 0 AU TOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea ac ddenl) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Peraa~denf) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO EA ACC OTHER THAN $ AUTO ONLY: AGG $ B X EXCESSIUMBReLLA UABwTY PHUB2 9 3 5 0 6 1/1/2010 1/1/2011 EACH OCCURRENCE $ OCCUR FICLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC TAT O R EMPLOYERS' LIABILITY Y TS ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? If yes describe under E.L. DISEASE - EA EMPLOYEE $ SPECIAL PROVISIONS b l e ow E_L DISEASE - POLICY LIMIT $ A OTHER Accident Insurance 4102AH235479 1/1/2010 1/1/2011 ed Max: $100,000 Full Excess ed• $500 PT Limit: $2,000 ME Limit: $1,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS e certificate holder is named as an additional insured under the liability policy. This certificate is issued on behalf of 11 valid US Club Soccer passcard holders participating in Marin FC, Club ID #431. roup Code: Club #431 . .vw vA - - \rNPILCLLFIII%JN City of Tiburon 1155 Tiburon Blvd Tiburon CA 94920 ACORD 25 (2001/081 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL <30> 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 REPRESENTATIVE m Af`ADr% r~AbnAnAVI^Ll 4noo 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)