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Sadler Sports: Amateur Teams / Leagues Insurance Plan
<br />,,. DATE (MM/ DD/YYYY)
<br />,2!!, r� '' CERTIFICATE OF LIABILITY INSURANCE 06/11/2020
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<br />THIS CERTIFICATE IS ISSUED ASA 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 POLICIES 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 terms and conditions ofthe 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 CONTACT NAME: Sports Dept
<br />SADLER & COMPANY, INC. PHONE (A/ C, No. Ext): 800-622-7370 1 FAX (A/ C, No): 803-256-4017
<br />P.O. BOX 5866 E-MAIL ADDRESS:amateur@sadlersports.com
<br />COLUMBIA, SOUTH CAROLINA 29250-5866 PRODUCER CUSTOMER ID#:
<br />INSURED
<br />1st & Goal flag Football
<br />1st& Goal flag Football INSURER(S) AFFORDING COVERAGE NAIL#
<br />11 124 Oriole Dr. INSURERA: NATIONWIDE MUTUAL INSURANCE COMPANY 23787
<br />Riverside, CA 92505
<br />INSURER B:
<br />Application ID: 292405 INSURERC:
<br />A Member of the Sports, Leisure & Entertainment RPG INSURER D:
<br />COVERAGES CERTIFICATE NUMBER 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 ISSUED OR MAY
<br />PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN
<br />MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSD TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br />LTR INSR WVD (MM/DD/YYYY) (MM/DD/ YYYY)
<br />A GENERAL LIABILITY X EACH OCCURRENCE $1,000,000
<br />®COMMERCIAL GENERAL LIABILITY DAMAGE TO PREMISES RENTED $1,000,000
<br />[_]CLAIMSMADE ®OCCUR TO YOU (Fire Legal Liability)
<br />MEDICAL EXPENSES (otherthan $5,000
<br />❑ participants)
<br />❑ 6B RPG 72586 11:52:13 AM 12:01AM ET PERSONAL&ADV INJURY $1,000,000
<br />GEN'L AGGREGATE LIMITAPPLIES PER: ET 05/04/2020 05/04/2021 GENERAL AGGREGATE(otherthan
<br />Products -completed Operations) $5,000,000
<br />POLICY ❑PROJECT ❑LOC
<br />PRODUCTS- COMP/OP AGG $1,000,000
<br />LEGAL LIAB TO PARTICIPANTS $1,000,000
<br />PROFESSIONAL LIABILITY $1,000,000
<br />AUTOMOBILE LIABILITY
<br />ANY AUTO APPROVED
<br />TALL OWNED AUTOS
<br />SCHEDULED AUTOS COMBINED SINGLE LIMIT (Ea $1,000,000
<br />Accident)
<br />11,52:13 AM 12:01AM ET
<br />®HIRED AUTOS (not provided while in 6B RPG 72586 ET 05/04/2020 05/04/2021 BODILY INJURY (Per person)
<br />Hawaii) BODILY INJURY (Per accident)
<br />® NON- OWNED AUTOS (not PROPERTY DAMAGE (Per accident)
<br />provided while in Hawaii)
<br />❑ UMBRELLA LIAB OCCUR EACH OCCURRENCE
<br />❑ EXCESS LIAB ❑ CLAIMS- MADE
<br />AGGREGATE
<br />❑ DEDUCTIBLE
<br />❑ RETENTION
<br />WORKERS COMPENSATION AND [_]WC STATUTORY LIMITS
<br />EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR / PARTNER / ❑ OTHER
<br />EXECUTIVE OFFICER/ MEMBER Y/ N E.L. EACH ACCIDENT
<br />EXCLUDED? ❑ N/A
<br />(Mandatory in NH)
<br />If yes, describe under E.L. DISEASE - EA EOMPLOYEE
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />A MEDICAL PAYMENTS TO EXCESS MEDICAL $25,000
<br />PARTICIPANTS 6B RPG 72586 11:52:13 AM 12:01AM ET AD&D NONE
<br />ET 05/04/2020 05/04/2021
<br />DEDUCTIBLE $100
<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, Football (Flag & Touch) 16-19,
<br />WAIVER OF RIGHT OF RECOVERY: We waiver all rights of recoverywhen you have agreed to waive your rights when required by a written contract. However, this provision only applies ifthe written
<br />contract was executed priorto the date ofthe "occurence".
<br />The certificate holder is added as an additional insured, but only with respect to the liability arising out ofthe operations ofthe insured above.
<br />High Brain Iniury Sports - For Deck/ Floor/ Field/ Street Hockey, Roller Hockey (quad), Cheerleading (age 19 & under); Lacrosse (age 19 & under); Tackle and contact football (age 19 & under), Soccer
<br />(age 19 & under), Water Hockey (age 19 & under), Wrestling (age 19 & under), and Umpire/ Referee Associations for the above High Risk Concussion Sports, Limited Coverage for "Brain Injury"
<br />endorsement applies- Brain Injury Limit: $1,000,000 occurrence/ $1,000,000 aggregate, Brain Injury Loss Adjustment Expense Limit: $1,000,000 occurrence/ $1,000,000 aggregate. "Brain Injury" means
<br />concussion, chronic traumatic encephalopathy, or any other injury to the brain and any symptoms, conditions, disorders and diseases, including death, resulting therefrom but only if such injury occurs as a
<br />result of specific events occurring during the policy period.
<br />CERTIFICATE HOLDER CANCELLATION
<br />RELATIONSHIP: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
<br />Property Owner/ Lessor DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
<br />The City of Riverside, its officers, employees and agents.
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