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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 Eosso122 Weston Ct. Bluffton, SC 29910 Application ID: 393078 |
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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
![]() ![]() ![]() ![]() ![]() GEN'L AGGREGATE LIMIT APPLIES PER:
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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
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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 |
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PLH01GL00000090 | 12:01AM ET 06/30/2023 | 12:01AM ET 06/30/2024 | ||||
EACH OCCURRENCE | $1,000,000 | |||||||
AGGREGATE | $2,000,000 | |||||||
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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 | |||||||
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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)![]() |
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AUTHORIZED REPRESENTATIVE (company B)![]() |
ACORD 25 (2014/01) | © 1988-2014 ACORD CORPORATION. All rights reserved. |
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:
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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. |
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