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HomeMy WebLinkAboutInsurance Certificate: Oregon Youth Soccer Association AC O® GATE(MM DD YVY) �.- CERTIFICATE OF LIABILITY INSURANCE 9/12/2011 THIS CERTTFICATE 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 . 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 Pullen Insurance Services, Inc. CONTACT NAME. S arts Division 2560 River Park Plaza, Suite 300 PHONE: (817) 738-6100 FAX (817)738-2993 Fort Worth, TX 76116 E-MAIL ADDRESS contact ullenins.com PRODUCER CUSTOMER IDp. QR INSURERS AFFORDING COVERAGE NAIC# INSURED Oregon Youth Soccer Association Insurer A: National Casualty Com an 4840 SW Western Ave., Suite 800 Insurer B: National Union Fire Insurance Com an Beaverton, OR 97005 Insurer C: Insurer D: Insurer E: Insurer F: COVERAGES CERTIFICATE NUMBER: 11012125 REVISION NUMBER: 0 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. ILTR TYPE OF IN3UMNOE ADp'L SUER LTR INS pO YND POLICY NUMBEfl POU,YMMID� POLICY EXPIRATION A GENERAL UAe1LRY DATE MMID UNITS X KRO 2060200 9/1/2011 9/1/2012 EACH OCCURENCE $1,000,000 7X COMMERCIAL GENERAL LIABILITY DAMA E TO RENTED PRE M SES Ea emu an<e $300,000 ❑CLAIMS MADE OCCUR MEDEXP(An one rson $5,000 PERSONAL A ADV INJURY $1,000,000 GENL AGGREGATE LIMIT APPLIES PER-. GENERAL AGGREGATE UNLIMITED POLICY PROJECT LOC PRODUCTS-COMP/OPgGG $1,000,000 A AUTOMOBILE LpBWTY KRO 2060200 9/1/2011 9/1/2012 COMBINDED SINGLE LIMIT $1,000,000 ANY AUTO (ED accident) ALL OWNED AUTOS BODILY INJURY Per on SCHEDULED AUTOS BODILY INJURY Per acadent X HIREDAUTOS PROPERTY DAMAGE X NON-OWNED AUTOS (Per amden) A UMBRELLA UAB X OCCUR XKO 2060300 9/1/2011 9/1/2012 EACH OCCURANCE $5,000,000 X EXCESS LIAR CLAIMS-MADE - DEDUCTIBLE - - AGGREGATE RETENTION f WORKERS COMPENSATION we s1Am- ANDEMPLOYERS'LIABILITY YIN TOO STATU- T ANYPROPRIETORPARTNEVE%FCUDVF ER OFHC MEMBER EXCLUDES, Oked q N NMI NIA E.LEACH ACCIDENT Ily, aFFmbe order E.L.DISEASE-EA EMPLOYEE DESCRIPTION OF OPERATIONS bNw E.L. B PARTICIPANT ACCIDENT MEDICAL, SRG 9115331 9/1/2011 9/1/2012 DISEASE-POLICY LIMIT 8100,000 DESCRIPTION OF OPERATIONS i LOCATIONS I VEHICLES(AMaCA ACORD 101,Ad6Donal Remarks SCIPP100 d more space is reeured) This certificate is issued on behalf of Oregon Youth Soccer Association& Ashland Soccer Club. Certificate Holder is Additional Insured as respects the operations of the Named Insured for sanctioned activities of the state,association. CERTIFICATE HOLDER CANCELLATION City of Ashd Attn: Rachel Dlan ials SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE 20 E. Main St WITH THE POLICY PROVISIONS. - Ashland, OR 97520 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION.All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: KR00000002060200 COMMERCIAL GENERAL LIABILITY CG 20 11 01 96 ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE 1. Designation of Premises (Part Leased to You): 2. Name of Person or Organization (Additional Insured): OWNERS AND/OR LESSORS OF THE PREMISES LEASED, RENTED OR LOANED TO YOU, BUT ONLY WITH RESPECT TO THE LIABILITY ARISING OUT OF YOUR OPERATIONS. 3. Additional Premium: INCLUDED (If no entry appears above, the information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II)is amended to include as an insured the person or organization shown in the Schedule but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises leased to you and shown in the Schedule and subject to the following additional exclusions: This insurance does not apply to: 1. Any"occurrence"which takes place after you cease to be a tenant in that premises. 2. Structural alterations, new construction or demolition operations performed by or on behalf of the person or organization shown in the Schedule. CG 20 11 01 96 Copyright, Insurance Services Offices, Inc., 1994 Page 1 of 1