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HomeMy WebLinkAbout2013-14 (Tiburon Peninsula Soccer League)ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYM 12/19/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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). PRODUCER CONTACT NAME: Bollinger Insurance P HONE T _FA X 101 JFK Parkwa M ' im. No. Em):973-467-8005 IC No y Short Hills NJ 07078 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A:Philadelphia Insurance INSURED INSURER B : U.S. Club Soccer INSURER C : 716 8th Avenue North M rtle Beach SC 29577 INSURER D : y INSURER E INSURER F : %0UVCrCAfiDt, cEH 111-ICA I E NUMHFR 4AR7624 40()4 DGVIQInN1 h111a11RCD• THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTRR TYPE OF INSURANCE INSR ADOL SUBR POLICY NUMBER MM/DCD1 EFF MWDD/ EXP LIMITS A GENERAL LIABILITY Y PHPK955911 1/1/2013 /1/2014 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY - DAMAGE TO ENTED PREMISES Ea occurrence) $300,000 CLAIMS I OCCUR MADE li - MED EXP (Any one person) $Excluded X Inc. Part. Liab. PERSONAL & ADV INJURY $1 000 000 , , GENERAL AGGREGATE $5 000 000 , , GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 POLICY PRO- X LOC Abuse/Molestation $1,000,000 AUT OMOBILE LIABILITY C('M111NED SINGLE LIMIT Ea accdent ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY Per accident) ( ) $ HIRED AUTOS NON-OWNED AUTOS PROPERTY DAMAGE Per accident $ $ A UMBRELLA LIAR X OCCUR PHUB405070 /1/2013 /1/2014 EACH OCCURRENCE $1 000 000 X EXCESS LIAR CLAIMS-MADE AGGREGATE , , $1 000 000 DED X RETENTION $10,000 , , $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY ITOR R Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N/A E.L. EACH ACCIDENT $ (Mandatory In NH) If d ib E.L. DISEASE - EA EMPLOYE $ yes, escr e under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) The certificate holder is named as an additional insured under the liability policy. This certificate is issued on behalf of All valid US Club Soccer passcard holders participating with Marin FC, club #431 and playing in the Nor Cal Premier League Group Code: C 431 v~r~ r ~rwr~ r nvLUGR L.AN6tLLA 1 IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Tiburon ACCORDANCE WITH THE POLICY PROVISIONS. 1155 Tiburon Boulevard Tiburon CA 94920 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD