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<br />DATE (MW DD/ YYYY)
<br />CERTIFICATE OF LIABILITY INSURANCE 03/07/2018
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR
<br />NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN
<br />THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the teens and conditions of the policy, certain policies may
<br />require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />SADLER & COMPANY, INC.
<br />P.O. BOX 5866
<br />COLUMBIA, SOUTH CAROLINA 29250-5866
<br />CONTACT NAME: Sports Dept
<br />PHONE (A/ C, No. Ext): 800-622-7370 1 FAX (A/ C, No): 803-256-4017
<br />E- MAIL ADDRESS: amateurQsadlersports.com
<br />PRODUCER CUSTOMER IDS:
<br />INSURED
<br />1st & Goal flag Football
<br />1st & Goal flag Football
<br />11124 Oriole Dr.
<br />11124 Oriole Dr.
<br />Riverside, CA 92505
<br />APPROVED
<br />Application ID: 221719
<br />A Member of the Sports, Leisure & Entertainment RPG
<br />COVERAGES
<br />INSURER(S) AFFORDING COVERAGE
<br />INSURER A: NATIONWIDE MUTUAL INSURANCE COMPANY
<br />INSURERS:
<br />INSURER C:
<br />INSURER 0:
<br />NAIC fI
<br />CERTIFICATE NUMBER
<br />REVISION NUMBER
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE
<br />NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />PERTAIN. THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS
<br />MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />—
<br />POLICY PERIOD INDICATED,
<br />CERTIFICATE MAY BE ISSUED OR MAY
<br />OF SUCH POLICIES. UMITS SHOWN
<br />INSD
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSR
<br />SUER
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />(MW DD! YYYY)
<br />POUCY EXP
<br />(MMI DD/ YYYY)
<br />UMITS
<br />A
<br />GENERAL LIABILITY
<br />X
<br />EACH OCCURRENCE
<br />$1,000,000
<br />RICOMMERCIAL GENERAL LIABILITY
<br />DAMAGE TO PREMISES RENTED
<br />TO YOU (Fire Legal Liability)
<br />51,000,000
<br />❑CLAIMS MADE ®OCCUR
<br />MEDICAL EXPENSES (other than
<br />participants)
<br />55,000
<br />❑
<br />0
<br />6B RPG 60551
<br />12:01AM ET
<br />12:01AM ET
<br />PERSONAL &ADV INJURY
<br />51,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />03/11/2018
<br />03/11/2019
<br />GENERAL AGGREGATE (other than
<br />Products- completed Operations)
<br />55,000,000
<br />❑POLICY ❑PROJECT 0 LOC
<br />PRODUCTS- COMP/ OP AGG
<br />51,000,000
<br />LEGAL LIAB TO PARTICIPANTS
<br />51,000,000
<br />AUTOMOBILE LIABILITY
<br />['ANY AUTO
<br />❑ ALL OWNED AUTOS
<br />❑ SCHEDULED AUTOS
<br />12:01AM ET
<br />12:01AM ET
<br />COMBINED SINGLE LIMIT (Ea
<br />Accident)
<br />51 ,000,000
<br />BODILY INJURY (Per person)
<br />® HIRED AUTOS (not provided while in
<br />6B RPG 60551
<br />03/11/2018
<br />03/11/2019
<br />Hawaii)
<br />BODILY INJURY (Per accident)
<br />® NON- OWNED AUTOS (not
<br />provided while in Hawaii)
<br />'
<br />PROPERTY DAMAGE (Per accident)
<br />❑ UMBRELLA LIAB ❑OCCUR
<br />EACH OCCURRENCE
<br />❑ EXCESS LIAB ❑ CLAIMS- MADE
<br />AGGREGATE
<br />❑ DEDUCTIBLE
<br />❑ RETENTION
<br />WORKERS COMPENSATION AND
<br />❑ WC STATUTORY UMITS
<br />EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR / PARTNER /
<br />.OTHER
<br />EXECUTIVE OFFICER / MEMBER W N
<br />EXCLUDED? ❑
<br />N/ A
<br />E.L EACH ACCIDENT
<br />(Mandatory in NH)
<br />E.L DISEASE - EA EOMPLOYEE
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />.
<br />E.L DISEASE - POLICY LIMIT
<br />A
<br />MEDICAL PAYMENTS TO
<br />EXCESS MEDICAL
<br />525,000
<br />PARTICIPANTS
<br />6B RPG 60551
<br />12:01AM ET
<br />03/11/2018
<br />12:01AM ET
<br />03/11/2019
<br />AD&o
<br />NONE
<br />DEDUCTIBLE
<br />5100
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />RE: COVERED SPORTS Football (Flag & Touch) 12 & Under, Football (Flag & Touch) 13-15, Umpires/ Referees Assoc. for
<br />Class B Sports 16-19, Umpires/ Referees Assoc. for Class B Sports 20 & Over,
<br />The certificate holder is added as an additional insured, but only with respect to the liability arising out of the operations of the insured above.
<br />)lIoh Brain Iniury Sports - For Deck/ Floor/ Feld Hockey,
<br />Roller Hockey (quad), Cheerleading (ago 19 & under); Lacrosse (age 19 & under); Tackle and contact football (age 19 & under), Soccer (age 19 &
<br />under), Water Hockey (age 19 & under), Wresting (age 19
<br />& under), and Umpire/ Referee Associations for the above High Risk Concussion Sports, the Legal Liability to Participants (LLP) limit will be
<br />limited to 51,000,000 regardless of general liability occurrence limits purchased.
<br />CERTIFICATE HOLDER CANCELLATION
<br />RELATIONSHIP:
<br />SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION
<br />Property Owner/ Lessor
<br />DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
<br />City of Riverside PRCSD
<br />AUTHORIZED REPRESENTATIVE
<br />6927 Magnolia Ave. 2nd Floor
<br />Riverside, CA 92506
<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 (2014/01) ®1988-2014 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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