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Home My WebLink About2010-09-01 (Tiburon Peninsula Soccer Club)-l e. 9-1 '4 ~IL4~ Of C109 Find the insurance certificate for Tiburon Peninsula Soccer Club and Marin FC soccer use. ►ou, Kim Stibich and Lynetta Matteo schedulers I S o s -T%LID v 1j)IL/ cjq~ZJ 4` . _.a1)nmU(t~\VUIt11P.t~~~ IsWSR" v+ y~y~N e ! ili It i Ilii ! !i!!! ! ! ! iii 1 t!! i!!! i il.i V t 4n 17AA ACf RQ CERTIFICATE OF LIABILITY INSURANCE 0ATE(W. -MI . 8/17/2010 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 Short Hills NJ 0 7 0 7 8 ALTER THE COVERAGE AFFORDED BY THE POLICIES BF-LUW. INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Phil adel hia Indemnity Ins Co 18058 California Youth Soccer 1040 Ser entine L S it 201 INSURERB:AIG Life Insurance Company p , u e 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 LT R DD' SRID TYPE cURw POLICY NUMBER POLICY EFFECTIVE MATE rMM10 POLICY EXPIRATION n T (MMJDDfYYI LIMITS A X GENERAL LIABILITY PHPK6 0 9410 9/1/2010 9/1/2011 EACH OCCURRENCE - $1,000,000 X COMMERCIAL GENERAL LIABILITY - DAMAGES ( RENTED TO PREMISES Ea occurence $1 000,000 CLAIMS MADE R 1 OCCUR I MED EXP (Any one person) $5,000 X Inrl Part- Li PERSONAL &ADV INJURY $1 000 000 GENERAL AGGREGATE , , $5 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: - PRODUCTS -COMP/OPAGG , , $2,000,000 POLICY P JECT RO-- 1 LOC 1 A AUT OMOBILE LIABILITY PHPK6 0 9410 9/1/2010 9/1/2011 ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $1,000,000 ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ X HIRED AUTOS X NON-OWNED AUTOS BODILY INJURY (Per accident) $ RFCFIV a PROPERTY DAMAGE (Per accident) $ GAR AGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO EAACC $ 9 OTHERTHAN AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ TOWN CLER $ DEDUCTIBLE -TOWN F T BU 0 RETENTION $ $ WORKERS COMPENSATION AND ' STATU OTH- WC TORY lMIT- R €`~PLOYERS LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? If d E.L. DISEASE - EA EMPLOYEE $ yes, escribe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ B OTHER Accident Coverage Full Excess SRG91225873 9/1/2010 9/1/2011 Medical Max: $300,000 ed: $250/Claim DESCRIPTION OF OPERATInMR I LOCATIONS I VEHICLES / E-XC'LUS ONS ADDED BY ENDORSENFNT / 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 (20011081 Amen d f%Don0Arinu 4 W20 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDNYYY) 1/28/2010 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 Short Hill NJ 0 7 0 7 8 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. s INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA:Markel Insurance Company 8970 U.S. Club Soccer 716 8th A N h INSURERB:Philadelphia Insurance Com an 3850 venue ort 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 LTR D' INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMIDDOM POLICY EXPIRATION DATE (MMIDDIM LIMITS B X GENERAL LIABILITY PHPK510 3 0 6 1/1/2010 1/1/2011 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurence $100,000 CLAIMS MADE k] OCCUR MED EXP (Any one person) $ Exc luded PERSONAL 8 ADV INJURY $1 000 000 , , GENERAL AGGREGATE $5 000 000 , , GEN'L AGGREGATE LIMIT APPLIES PER: - PRODUCTS - COMP/OP AGG $2,000,000 I POLICY PRO F x Abuse Mol $1,000,000 AuT OYOBILE LY16Y3TY COMBINED SINGLE UMrr $ ANY AUTO (Ea amt) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO EA ACC OTHER THAN $ AUTO ONLY: AGG $ B X LL 9NLJTY PHUB293506 1/1/2010 1/1/2011 EACHOccuRRENCE $1,000,000 X OCCUR CLAIMS MADE AGGREGATE $1,000,000 DEDUCTIBLE $ X RETENTION $10,000 $ WORKERS COMPENSATION AND ' WC STATU- O R EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE- POLICY LIMIT $ A OTHER 4102AH235479 1/1/2010 1/1/2011 ed Max: $100,000 Accident Insurance Ded- $500 Full Excess Limit: $2,000 Limit: $1,000 DESCRIPflON OF OPERATKNiS / LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVI11ONS he 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 Tiburon Peninsula Soccer Club, Club ID #4881. roup Code: Club #4881 CERTIFICATE HOLDER CANCELLATION Town of Tiburon 1505 Tiburon Blvd Tiburon CA 94920 ACORD 25 f200ilffil 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 .a Arln09% rru3on0A7U%U 4A44