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DATE(MM/DD/YYYY)
<br /> Acc o CERTIFICATE OF LIABILITY INSURANCE
<br /> 04/11/2017
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
<br /> THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT NAME: Mass Merchandising
<br /> K&K Insurance Group,Inc. PH Nri, Ext): 1-800-426-2889 (a� No): 1-260-459-5105
<br /> 1712 Magnavox Way E-MAIL
<br /> Fort Wayne IN 46804 ADDRESS: inth@sportsinsurance-kk.com
<br /> PRODUCER
<br /> CUSTOMER ID:
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURED 2000671560 CP#50 INSURER A: Nationwide Mutual Insurance Company 23787
<br /> First Swing Foundation INSURER B:
<br /> P.O.BOX 497 INSURER C:
<br /> Medina,WA 98039 INSURER 0:
<br /> A Member of the Sports,Leisure&Entertainment RPG INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:2000298910 REVISION NUMBER:
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
<br /> NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE
<br /> ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF
<br /> SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD (MM/DD/YYYY) (MM/DD/YYYY)
<br /> A X COMMERCIAL GENERAL LIABILITY X 6BRPG0000006054900 06/01/17 06/01/18 EACH OCCURRENCE $1,000,000
<br /> CLAIMS-MADE X OCCUR 12:01 AM 12:01 AM DAMAGE TO RENTED $1,000,000
<br /> PREMISES(Ea Occurrence) _
<br /> MED EXP(Any one person) $5,000
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $5,000,000
<br /> POLICY PROJECT LOC PRODUCTS—COMP/OP AGG $1,000,000
<br /> OTHER: PROFESSIONAL LIABILITY $1,000,000
<br /> LEGAL LIAB TO PARTICIPANTS $1,000,000
<br /> A AUTOMOBILE LIABILITY 6BRPG0000006054900 06/01/17 06/01/18 COMBINED SINGLELIMIT(Ea
<br /> 12:01 AM 12:01 AM accdent) $1,000,000
<br /> ANY AUTO BODILY INJURY(Per person)
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY(Per accident)
<br /> HIRED NON-OWNED PROPERTY DAMAGE 1
<br /> X AUTOS ONLY X AUTOS ONLY (Per accident)
<br /> X Not provided while in Hawaii
<br /> UMBRELLA OCCUR
<br /> LIAR EACH OCCURRENCE
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE
<br /> DED n RETENTION
<br /> WORKERS COMPENSATION N/A
<br /> AND EMPLOYERS'LIABILITY PER STATUTE OTHER
<br /> ANY PROPRIETOR/PARTNER/ Y/N E.L.EACH ACCIDENT
<br /> EXECUTIVE OFFICER/MEMBER
<br /> EXCLUDED?(Mandatory In NH) E.L.DISEASE—EA EMPLOYEE
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE—POLICY LIMIT
<br /> A MEDICAL PAYMENTS FOR PARTICIPANTS 06/01/17 06/01/18 PRIMARY MEDICAL
<br /> 6BRPG0000006054900 12:01 AM 12:01 AM
<br /> EXCESS MEDICAL $25,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
<br /> Medical Expense Reimbursement for Participants(illness)included-$1,000 per participant/claim.
<br /> Legal Liability to Participants(LLP)limit is a per occurrence limit.
<br /> Type of Camp: Baseball&Softball Camp Dates: 06/26/17-06/30/17,07/10/17,07/14/17,07/17/17-07/21/17
<br /> Camp Location: 400 W.Sievers-Duecy Road,Everett,WA 98201
<br /> The certificate holder is added as an additional insured,but only for liability caused,in whole or in part,by the acts or omissions of the named insured.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> City of Everett,its officers,employees,agents SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br /> ATTN:Cory Rettemier EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH
<br /> 2930 Wall St., Suite 10 THE POLICY PROVISIONS.
<br /> Everett,WA 98201 AUTHORIZED REPRESENTATIVE
<br /> Owner/Manager/Lessor of Premises /
<br /> i L
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> Coverage is only extended to U.S.events and activities.
<br /> "NOTICE TO TEXAS INSUREDS:The Insurer for the purchasing group may not be subject to all the insurance laws and regulations of the State of Texas.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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