Everett Lacrosse Club 1/23/2017 - Laserfiche WebLink

AC. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) ��.. 01/04/2017 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(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 CONTACT NAME: BOLLINGER,Inc. MOM FAX 151)JFK PARKWAY,4TH FLOOR PCD Box 390 (NC,tin_Ext):800-445-5311 (ps.NO:973-921-2876 E-WAIL SHORT HILLS,NJ 07078 ADDRESS: PHONE:1-800-445.5311 FAX:973-921-2878 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Hartel Insurance Company 38970 INSURED el SURER B: US Lacrosse,Inc. INSURER c: 2 Loveton Citrle Sparks,MD 21152 INSURER 0: Re:Everett Lacrosse Club INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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,TERN OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIE DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN NAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADM sum POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR NMD (lekteDDIYYTY) (Mll[UDIYYYY) GENERAL LIABILITY x A COMMERCIAL GENERAL LIABILITY R?ACItiH OCCURRENCE SI,000;600 [MAW TO RENTED $300;000 CLAIMS-MADE X OCCUR 8502AH2213119 01/01/2017 01/01/2018 PRENES{Ea oa l X Participants Liab MED En"(Ply mewarm) $5,1100 Social Abuse&Mofestatiaso Liab per occurrence:$1,000',01)3 PERSONAL&ADV INJURY $1;1100,000 GENT_AGGREGATE LIMIT APPLIES PER: $5 000;0134 Sexual Abuse&MolestatRan POLICY PRO LOC 7 negate rani[:252,020,803 GEN BrhLA9 tEGIVIE JECT X PRODUCTS-CCO.MCPA G $2000:000 S AUTOMOBILELIABILrTY ODVHDIED MIME IUIx4T4Eaa=CWl) $ ANY AUTO ODDLY INJURY Wer mem) 5 ALL OWNED SCHEDULED R36DLY ENDLRY per amide* AUTOS _AUTOS PROPER-IT DAInA $ HIRED AUTOS NON OWNED Ter e mbenD AUTOS X UMBRELLALlAB X OCCUR x EACH OCCLRR NCE 51,000,000 A EXCESS LIAB CLAMS- 4602AH221370 01/01/2017 01/01/2018 ArE SL000I1190 IMDC $ DED ri RETENTION$ WORKERS COMPENSATION YIN N!A nESTATU- $ AND EMPLOYERS'LIABILITY ANY PRaF7PREToRIARTNEVEXEcg1wE — TORY DINTS oFFICER9 EMDERs EXCLUDED? EACH ACCIDENT (Mandatory in NH) $ 5 ,describe r DESCRIPTIONOF El_rJ9�0.5E-EAE.TrI.oYE€ CPMATIONS beim CISEASE-COLICY IJIIAli $ A -ccident Medical 4102AH015E70 01/01/2017 01/0112018 Accident Limit 5100.000 tastrophicAcc 4102AH305882 01/01/2017 01/01/2018 Catastrophic Limit 51.000,000 DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Coverage applies only to teams/leagues comprised of 100%US Lacrosse member participants during scheduled&supervised lacrosse activates.Certificate Holder is named"Additional Insured"with respect to Everett Lacrosse Club. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Everett;its officers,agents,and employees ACCORDANCE WITH THE POLICY PROVISIONS. 502 Mnlc0teo Blvd Everett,WA 98201 • • AUTHORIZED REPRESENTATIVE B 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marls of ACORD