SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
INSURER(S) AFFORDING COVERAGE
INSURER F :
INSURER E :
INSURER D :
INSURER C :
INSURER B :
INSURER A :
NAIC #
NAME:
CONTACT
(A/C, No):
FAX
E-MAIL
ADDRESS:
PRODUCER
(A/C, No, Ext):
PHONE
INSURED
REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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).
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.
OTHER:
(Per accident)
(Ea accident)
$
$
N / A
SUBR
WVD
ADDL
INSD
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. $ $
$
$PROPERTY DAMAGE
BODILY INJURY (Per accident)
BODILY INJURY (Per person)
COMBINED SINGLE LIMIT
AUTOS ONLY
AUTOSAUTOS ONLY
NON-OWNED
SCHEDULEDOWNED
ANY AUTO
AUTOMOBILE LIABILITY
Y / N
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
DESCRIPTION OF OPERATIONS below
If yes, describe under
ANY PROPRIETOR/PARTNER/EXECUTIVE
$
$
$
E.L. DISEASE - POLICY LIMIT
E.L. DISEASE - EA EMPLOYEE
E.L. EACH ACCIDENT
ER
OTH-
STATUTE
PER
LIMITS(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY)
POLICY EFF
POLICY NUMBERTYPE OF INSURANCELTR
INSR
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
EXCESS LIAB
UMBRELLA LIAB $EACH OCCURRENCE
$AGGREGATE
$
OCCUR
CLAIMS-MADE
DED RETENTION $
$PRODUCTS - COMP/OP AGG
$GENERAL AGGREGATE
$PERSONAL & ADV INJURY
$MED EXP (Any one person)
$EACH OCCURRENCE
DAMAGE TO RENTED
$PREMISES (Ea occurrence)
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO-
JECT LOC
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
CANCELLATION
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03)
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED
AUTOS ONLY
7/2/2024
Insurance Office of America, Inc.
1855 West State Road 434
Longwood FL 32750
United States Fire Insurance Company
21113
USCLUBS-01
Accredited Surety & Cas Co Inc
26379
National Association of Competitive Soccer Clubs
dba US Club Soccer
774 S Shelmore Blvd Ste 104
Mount Pleasant SC 29464
HDI Global Specialty SE
380502745
B
X
2,000,000
2,000,000
5,000
X
Participant LL
2,000,000
4,000,000
X
Sanctioned Event
Y
Y
1-TRE-SC-17-01338515-02
8/1/2024
8/1/2025
2,000,000
Abuse & Molestation
2,000,000
B
X
3,000,000
X
Y
1-TRE-SC-17-01338516-02
8/1/2024
Y
8/1/2025
3,000,000
A
C
Accident Medical
Full Excess
Excess Liability
Y
Y
US1929911
HDHX003701251
8/1/2024
8/1/2024
8/1/2025
8/1/2025
Medical Maximum
Med. Deductible
Excess of $3mm primar
200,000
500
1,000,000
The Certificate Holder is included as an Additional Insured (per Form #RSCG0303 0921) with respect to General Liability on a Primary & Non-Contributory basis (per Form #CG2001) and includes Waiver of Subrogation (per Form CG2024) when required by written contract, but only with respect to the operations of the Named Insured per form (IL1201 1185), and only for liability arising directly from participation in an event or activity sanctioned or approved by US CLUB SOCCER. MEDICAL EXPENSE coverage only applies to Spectators at Covered Events and visitors at the National Association of Competitive Soccer Club's office location
This Certificate is issued on behalf of all valid YOUTH US CLUB SOCCER registered and approved players and staff participating in events with:
San Pablo United YSC
City of San Pablo, its Officers, Agents, Volunteers, &
Employees
1509 Rumrill Blvd
San Pablo CA 94806
POLICY NUMBER: 1-TRE-SC-17-01338515-02 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
RSCG 03 03 09 21 Includes copyrighted material of Insurance Services Office, Inc., with Page 1 of 2 its permission
BLANKET ADDITIONAL INSURED
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement.
1. Additional Insured
Paragraph 2. of Section II – Who Is An Insured is amended by the addition of the following:
e. Any person or organization is included as an additional insured, but only to the extent such person or organization is held liable for “bodily injury”, “property damage” or “personal and advertising injury” caused by your acts or omissions. With respect to the insurance afforded to such insured, all of the following additional provisions apply:
(1) You and such person or organization have agreed in a written “insured contract” that such person or organization be added as an additional insured under this policy; (2) The “bodily injury”, “property damage” or “personal and advertising injury” for which said person or organization is held liable occurs subsequent to the execution of such “insured contract”; (3) The most we will pay is the lesser of either the Limits of Insurance shown in the Declarations or the Limits of Insurance required by the “insured contract”; (4) Such person or organization is an insured only with respect to:
(a) Their ownership, maintenance, or use of that part of the premises, or land, owned by, rented to, or leased to you, except such person or organization is not an insured with respect to structural alterations, new construction or demolition operations performed by or on behalf of such person or organization;
(b) Your ongoing operations performed for that insured; (c) Their financial control of you, except such person or organization is not an insured with respect to structural alterations, new construction or demolition operations performed by or on behalf of such person or organization;
(d) The maintenance, operation or use by you of equipment leased to you by such person or organization;
(e) Operations performed by you or on your behalf and for which a state or political subdivision has issued a permit, provided such operations are not performed for such state or political subdivision, and are not included within the “products-completed operations hazard”; (5) This insurance does not apply to “bodily injury”, “property damage”, “personal and advertising injury”, “occurrence” or offense:
(a) Which takes place at a particular premise after you cease to be a tenant of that premises; (b) Which ta kes place after all work, including materials, parts or equipment furnished in connection with such work to be performed by or on behalf of the additional insured at the site of the covered operations, has been completed;
(c) Which takes place after that portion of “your work” out of which the injury or damage arises has been put to its intended use by any other person or organization other than another contractor or subcontractor engaged in performing operations for a principal as part of the same project; (d) Which takes place after the expiration of any equipment lease to which (4)(d) above applies; (6) With respect to architects, engineers or surveyors, coverage does not apply to “bodily injury”,
RSCG 03 03 09 21 Includes copyrighted material of Insurance Services Office, Inc., with Page 2 of 2 its permission
“property damage” or “personal and advertising injury” arising out of the rendering or failure to render any professional services by or for you, including:
(a) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders, or drawings and specifications; (b) Supervisory, inspection, architectural or engineering services.
However, if an Additional Insured endorsement is attached to this policy that specifically names a person or organization as an insured, then this subsection 2.e. does not apply to such person or organization.
POLICY NUMBER: 1-TRE-SC-17-01338515-02 COMMERCIAL GENERAL LIABILITY CG 24 04 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 24 04 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US (WAIVER OF SUBROGATION)
Thi
s endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
ELECTRONIC DATA LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES
POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
RAILROAD PROTECTIVE LIABILITY COVERAGE PART
UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS
SCH
EDULE
Name Of Person(s) Or Organization(s):
ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
The f
ollowing is added to Paragraph 8. Transf er Of
Rights Of Recovery Against Others To Us of
Section IV – Conditions:
We waive any right of recovery against the person(s)
or organ ization(s) shown in the Schedule above
because of payments we make under this Coverage
Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against
such person(s) or organization(s) prior to loss. Th is
endorsement applies only to the person(s) or
organization(s) shown in the Schedule above.
COMMERCIAL GENERAL LIABILITY
CG 20 01 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 20 01 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 PRIMARY AND NONCONTRIBUTORY –
OTHER INSURANCE CONDITION
Thi
s endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
The f
ollowing is added to the Other Insurance
Condition and supersedes any provision to the
contrary:
Primary And Noncontributory Insurance
This insurance is primary to and will not seek
contribution from any other insurance available to
an additional insured under your policy provided
that:
(1) The additional insured is a Named Insured
under such other insurance; and
(2) You have agreed in writing in a contract or
agreement that this insurance would be
primary and would not seek contribution
from any other insurance available to the
additional insured.
POLICY NUMBER: 1-TRE-SC-17-01338515-02