N. American Youth Activities Kidz Love Soccer 11/21/2016

Acc)REP CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) Ihr...-"- 10/27/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS j 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(les) 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 CONTNAME: Casey Kolb Van Beurden Tns. Serv, Inc. - Woodland BO Box 2053 WC,No, (530) 661-0666 OC,No):(530) 661-9032 E-MAIL Woodland CA 95776-2053 ADDRESS: ckolbiEvanbeurden.corn INSURER(S)AFFORDING COVERAGE NAIC S INSURER A:Nationwide Mutual Ins Co 23787 INSURED (408) 252-1894 INSURERS:Colony Ins Company 39993 North American Youth Activities LLC DBA Kids Love Soccer INSURER C: P.O. Box 337 INSURER D: Corte Madera CA 94976 INSURERS; INSURER F: COVERAGES CERTIFICATE NUMBER:Cert ID 22725 REVISION NUMBER: 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, 1 EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER POLICY EFF POLICY EXP l LTR TYPE OF INSURANCE NOD WVD POLICY NUMBER (MM/DD/YYYY) IMM/DD/YYYY) LIMITS B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 AMAGE RENTED CLAIMS-MADE X OCCUR 101E4(6003704301 10/31/2015 10/31/2016 PREM SES?aooccurrence) $ 100,000 _ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY _ $ 2,000,000 i GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY I I jRa LOC PRODUCTS-COMP/OP AGG $ 3,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) S 1,000,000 A X ANY AUTO ACP302 6389370 10/30/201510/30/2016 BODILY INJURY(Per person) $ ALL OWNED r— SCHEDULED BODILYINJURY(Peraccident $ AUTOS AUTOS } NON-OWNED PROPERTY DAMAGEli li HIRED AUTOS ^ AUTOS (Per accident) $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1 DED RETENTION$ WORKERS COMPENSATION - I PER OTH- AND EMPLOYERS'LIABILITY Y t N I STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N!A E.L.EACH ACCIDENT $ 1 OFFICER/MEMBER EXCLUDED? �{ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ II yes,describe under DESCRIPTION OF OPERATIONS below ELDISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS(VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Everett Parks and Recreation, the City of Everett, its officers, employees and agents are named Additional Insured as respects General Liability per attached form # 0156-0310only when required by written contract. I I 9 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. F Everett Parks and Recreation 802 E. Mukilteo Blvd. AUTHORIZED REPRESENTATIVE Everett WA 98203 446.-1 1 I ©1988-2014 ACORD CORPORATION. All rights reserved. s ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Page 1 of 1 1 g