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PRINT DATE: 7/6/2017 <br /> CERTIFICATE OF INSURANCE <br /> CERTIFICATE NUMBER: 20160906469522 <br /> AGENCY: <br /> ESIX,a division of Integro USA Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND <br /> d/b/a Integro Insurance Brokers CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES <br /> 2727 Paces Ferry Road,Building Two,Suite 1500 NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> Atlanta,GA 30339 BELOW. <br /> 678-324-3300(Phone),678-324-3303(Fax) <br /> NAMED INSURED: INSURERS AFFORDING COVERAGE: <br /> USA Volleyball(National Office) PUGET SOUND REGION INSURER A:Greenwich Ins.Co.NAIC#:22322 <br /> 4065 Sinton Road,Suite 200 22617 76th Ave W Suite 201 <br /> Colorado Springs CO 80907 Edmonds WA 98026 <br /> EVENT INFORMATION: <br /> Puget Sound Region Volleyball Events(-) <br /> POLICY/COVERAGE INFORMATION: <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY <br /> REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE <br /> INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE <br /> LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INS TYPE OF INSURANCE: POLICY NUMBER(S): EFFECTIVE: EXPIRES: LIMITS: <br /> A GENERAL LIABILITY <br /> X Occurrence ASG089572002 9/1/2016 9/1/2017 GENERAL AGGREGATE(Applies Per Event) $5,000,000 <br /> 12:01 AM 12:01 AM ---------- <br /> X Participant Legal Liability EACH OCCURRENCE $1,000,000 <br /> DAMAGE TO RENTED PREMISES(Each Occ.) $1,000,000 <br /> MEDICAL EXPENSE(Any one person) EXCLUDED <br /> PERSONAL&ADV INJURY $1,000,000 <br /> PRODUCTS-COMP/OP AGG $5,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS: <br /> The certificate holder is an additional insured,as required by written contract or written agreement, but only with respect to the operations of the named insured,and <br /> subject to the provisions and limitations of form CG2026-Additional Insured- Designated Person or Organization, but only with respect to sanctioned USAV and <br /> Regional Volleyball Association events,effective the date of this certificate issuance. <br /> All participants must be registered with a regional volleyball association in order for coverage to apply. No coverage will apply for regions and clubs for events <br /> conducted in which all participants are not USAV members. <br /> The General Liability Policy includes$1,000,000 Each Occurrence/$2,000,000 Aggregate of Sexual Abuse and Molestation coverage. <br /> Coverage is available under a Participant Accident policy#9907-8534 with Federal Insurance Company on file with the policyholder-Accident Medical Coverage <br /> $25,000,deductible$250-Accidental Death&Dismemberment$10,000.Policy effective date:September 1,2016/Policy expiration date:September 1,2017. <br /> CERTIFICATE HOLDER: NOTICE OF CANCELLATION: <br /> City of Everett,it's officers,agents and employees Should any of the above described policies be cancelled before the expiration date thereof, <br /> 2930 Wetmore Ave. notice will be delivered in accordance with the policy provisions. <br /> Everett WA 98201 <br /> AUTHORIZED REPRESENTATIVE: <br /> 1 <br />