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 |
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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
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE OCCUR ____________________ ____________________ GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PROJECT LOCOTHER |
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
ANY AUTO
ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS |
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 |
SEXUAL ABUSE / MOLESTATION
|
n/a | n/a | n/a | ||||
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 | |||||||
PER STATUE OTHER |
||||||||
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 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 3 Amigos LLC 5615 Kies Ave Niagara Falls , NY 14304 |
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. |
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. |
OVE-0000286-00 | 08/23/2023 | 16 Athletics Inc |
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
LIQUOR LIABILITY COVERAGE PART
A. SECTION II—WHO IS AN INSURED is amended to include as an additional insured any per- son(s) or organization(s) of the types indicated by an “x” in any boxes shown below, but only with respect to liability for “bodily injury,” “property damage” or “personal and advertising injury” caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf:
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B. With respect to the insurance afforded to these additional insureds, the following is added to SECTION III—LIMITS OF INSURANCE: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance:
This endorsement shall not increase the applicable Limits of insurance shown in the declarations. Schedule of Additional Insureds:
[X] Owners and/or Lessors of the premises leased, rented or loaned to you
[X] Sponsors [X] Co-Promoters [ ] Any individual person(s) or organization(s) listed below
COACHES, OFFICIALS AND VOLUNTEERS
WHILE ACTING WITHIN THE SCOPE OF THEIR DUTIES FOR THE INSURED. |
KR-GL-56 (7-18)
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