Get a PDF version to Print
Acord Logo CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
06/27/2023
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
SADLER & COMPANY, INC.
P.O. BOX 5866
COLUMBIA, SOUTH CAROLINA 29250-5866
CONTACT NAME: Sports Dept
PHONE (A/C, No. Ext): 800-622-7370   |   FAX (A/C, No): 803-256-4017
E-MAIL ADDRESS: ayf@sadlersports.com
PRODUCER CUSTOMER ID#:
INSURED
AMERICAN YOUTH FOOTBALL, INC. AND
AMERICAN YOUTH CHEER AS MEMBERS OF

Coastal Cudas Youth Football and Cheer Org.

c/o William Eosso
122 Weston Ct.
Bluffton, SC 29910

Application ID: 393078

INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A: SiriusPoint America Insurance Company, Inc. 38776
INSURER B: Zurich American Insurance Company 16535
INSURER C:
INSURER D:
COVERAGES CERTIFICATE NUMBER 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
LTR
TYPE OF INSURANCE ADDL
INSR
SUBR
WVD
POLICY NUMBER POLICY EFF
(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY)
LIMITS
A GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
   CLAIMS MADE   OCCUR
____________________
____________________
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY   PROJECT   LOC
X   PLH01GL00000090 12:01AM ET 06/30/2023 12:01AM ET 06/30/2024
EACH OCCURRENCE $2,000,000
DAMAGE TO PREMISES RENTED TO YOU (Ea occurrence) $300,000
PREMISES MEDICAL PAYMENTS EXCLUDED
PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE $3,000,000
PRODUCTS-COMP/OP AGG $1,000,000
LEGAL LIAB TO PARTICIPANTS $1,000,000
   
C AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
    PLH01GL00000090 12:01AM ET 06/30/2023 12:01AM ET 06/30/2024
COMBINED SINGLE LIMIT (Ea Accident) $1,000,000
BODILY INJURY (Per person)  
BODILY INJURY (Per accident)  
PROPERTY DAMAGE (Per accident)  
   
A
SEXUAL ABUSE / MOLESTATION
    PLH01GL00000090 12:01AM ET 06/30/2023 12:01AM ET 06/30/2024
EACH OCCURRENCE $1,000,000
AGGREGATE $2,000,000
 
UMBRELLA LIAB   OCCUR
EXCESS LIAB   CLAIMS-MADE
DEDUCTIBLE
RETENTION
    N/A N/A N/A
EACH OCCURRENCE N/A
AGGREGATE N/A
   
  WORKERS COMPENSATION AND EMPLOYERS' LIABILITY
Y/N
ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under DESCRIPTION OF OPERATIONS below
    N/A
WC STATUTORY LIMITS

OTHER
 
E.L. EACH ACCIDENT  
E.L. DISEASE - EA EOMPLOYEE  
E.L. DISEASE - POLICY LIMIT  
B PARTICIPANT ACCIDENT     ZPX0000556385900 12:01AM ET 06/30/2023 12:01AM ET 06/30/2024
EXCESS MEDICAL $100,000
DEATH + SPECIFIC LOSS $10,000
DEDUCTIBLE $100
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)

RE: COVERED SPORTS NOTE: The maximum number of players cannot exceed 36 players per team. Tackle Football - 8u Division (1 teams), Tackle Football - 10u Division (2 teams), Tackle Football - 12u Division (2 teams), Cheer / Dance / Step / Majorette Squads / Inspiration - Class 1 (no charge) (3 teams)

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.
CERTIFICATE HOLDER CANCELLATION
RELATIONSHIP:
Property Owner/Lessor

City of Hardeeville
205 Main Street
Hardeeville, SC 29927
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE (company A)
Company A Signature
AUTHORIZED REPRESENTATIVE (company B)
Company B Signature

Coverage is only extended to U.S. events and activities
** 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.
ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD

---

ENDORSEMENT NO. 0000

ATTACHED TO AND FORMING A PART OF POLICY NUMBER ENDORSEMENT EFFECTIVE DATE
(12:01 A.M. STANDARD TIME)
NAMED INSURED AGENT NO.
PLH01GL00000090 06/27/2023 Coastal Cudas Youth Football and Cheer Org.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

ADDITIONAL INSUREDS OWNERS AND/OR LESSORS OF PREMISES, SPONSORS OR CO-PROMOTERS

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

The policy is amended to include as an additional Insured any person or organization of the types indicated by an "X" in any boxes shown below, but only with respect to liability arising out of your operations:
[X] Owners and/or lessors of the premises leased, rented, or loaned to you, subject to the following additional exclusions:

  1. This insurance applies only to an "occurrence" which takes place while you are a tenant in the premises;

  2. This insurance does not apply to "bodily injury" or "property damage" resulting from structural alterations, new construction or demolition operations performed by or on behalf of the owner and/or lessor of the premises;

  3. This insurance does not apply to liability of the owners and/or lessors for "bodily injury" or "property damage arising out of any design defect or structural maintenance of the premises or loss caused by a premises defect.

With respect to any additional insured included under this policy, this insurance does not apply to any negligence of such additional insured.

[X] Sponsors
[X] Co-Promoters
[X] Any individual person(s) or organization(s) listed below:

COACHES, OFFICIALS AND VOLUNTEERS
WHILE ACTING WITHIN THE SCOPE OF THEIR DUTIES FOR THE INSURED.

PH-GL-CW-0128 (04/22)

Includes copyrighted material of Insurance Services Office, Inc., with its permission.
© 2022 SiriusPoint America Insurance Company
All Rights Reserved. May not be copied without permission.

Page 1 of 1