Kidz Love Soccer 12/6/2017 - Laserfiche WebLink

A ® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 11/02/2017 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(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: Casey Kolb Van Beurden Ins. Serv, Inc. - Woodland PO Box 2053 PHONE FAX (530) 661-0666 jAiC NJ (530) 661-9032 E-MAIL ADDRESS: ckolb@vanbeurden.com Woodland CA 95776-2053 - - -_- - ---- INSURER(S)AFFORDING COVERAGE ti NAIC# INSURER A:Nationwide Mutual Ins Co 23787 INSURED (408) 252-1894 INSURERB:Colo Ins 139993 North American Youth Activities LLC DBA Kidz - - --- --- ----__--- ' Love Soccer INSURERC: P.O. Box 337 INSURERD: Corte Madera CA 94976 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER:Cert ID 28516 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR IADDLISUBR POLICY EFF POLICY EXP I LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 3,000,000 AMAGECLAIMS-MADE X OCCUR 101PKG003704303 10/31/2017 10/31/2018 PREMSESO(Ea occu RENTED $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 3,000,000 GE 'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 4,000,000 POLICY PE� LJ LOC PRODUCTS-COMP/OPAGG $ 4,000,000 OTHER. $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 _La accident) A ' X�ANY AUTO ACP3046389370 110/30/2017!10/30/2018 BODILY INJURY(Per person) $ ALL OWNED l SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) UMBRELLA LIAB ! OCCUR EACH OCCURRENCE _ $ —~ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below 1 E.L.DISEASE-POLICY LIMIT $ I $ $ 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 # U156A-0313 only when required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Everett Parks and Recreation 802 E. Mukilteo Blvd. AUTHORIZED REPRESENTATIVE Everett WA 98203 / 1(060'1 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Page 1 of 1