![]() |
CERTIFICATE OF LIABILITY INSURANCE |
DATE (MM/DD/YYYY)
07/03/2024 |
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: soda@sadlersports.com |
PRODUCER CUSTOMER ID#: |
INSURED D/B/A SPORTSPLEX OPERATORS AND DEVELOPERS ASSOCIATION 16 Athletics Inc 2010 ConnecticutNiagara Falls, NY 14305 Club #: C.89203 |
|
INSURER(S) AFFORDING COVERAGE | NAIC # |
INSURER A: State National Insurance Company | 12831 |
INSURER B: SeriousPoint America Company | 38776 |
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. |
INSD 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:
![]() ![]() ![]() ![]() |
X | OVE-0000286-00 | 12:01AM ET 08/30/2023 | 12:01AM ET 08/30/2024 | |||
EACH OCCURRENCE | $2,000,000 | |||||||
DAMAGE TO RENTED PREMISES (Ea occurrence) | $1,000,000 | |||||||
MEDICAL EXPENSES (other than participants) | $5,000 | |||||||
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 | |||||||
AUTOMOBILE LIABILITY
![]() ![]() ![]() ![]() ![]() |
n/a | n/a | n/a | |||||
COMBINED SINGLE LIMIT (Ea Accident) | $1,000,000 | |||||||
BODILY INJURY (Per person) | ||||||||
BODILY INJURY (Per accident) | ||||||||
PROPERTY DAMAGE (Per accident) | ||||||||
A |
![]() |
n/a | n/a | n/a | ||||
EACH OCCURRENCE | $1,000,000 | |||||||
AGGREGATE | $2,000,000 | |||||||
![]() ![]() ![]() ![]() ![]() ![]() |
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 | |||||||
![]() ![]() |
||||||||
E.L. EACH ACCIDENT | ||||||||
E.L. DISEASE - EA EOMPLOYEE | ||||||||
E.L. DISEASE - POLICY LIMIT | ||||||||
B | PARTICIPANT ACCIDENT | PHSA-BAM-10089-C.89203 | 12:01AM ET 08/30/2023 | 12:01AM ET 08/30/2024 | ||||
EXCESS MEDICAL | $100,000 | |||||||
AD&D | $10,000 |
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
RE: COVERED
Team(s) - Youth - Accident & General Liability |
CERTIFICATE HOLDER | CANCELLATION |
RELATIONSHIP: Tournament Host PBR OHIO 5592 FAWNBROOK LN DUBLIN, OH 43017 |
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)![]() |
|
AUTHORIZED REPRESENTATIVE (company B)![]() |
ACORD 25 (2014/01) | © 1988-2014 ACORD CORPORATION. All rights reserved. |