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Francine R. Dig nairysigned byFrandners.
<br />Villareal
<br />Villareal Date: 2021.10.051227:18 07'00'
<br />USSOCC E-01 J R302827
<br />ACORO
<br />�,CERTIFICATE OF LIABILITY INSURANCE
<br />DAT7(MM/DDNYYY)
<br />7/2021
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER License # 194467
<br />CONTACT
<br />NAME:
<br />PHONE FAX
<br />(A/C, No, EXt): (678) 324-3300 (A/C, No):(678) 324-3303
<br />Edgewood Partners Insurance Center
<br />2727 Paces Ferry Road
<br />Building Two, Suite 1500
<br />Atlanta, GA 30339
<br />IL
<br />ADDRESS:
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURERA : Arch Insurance Company
<br />11150
<br />INSURED
<br />INSURER B : Hartford Insurance Company of the Midwest
<br />37478
<br />U.S. Soccer Foundation, Inc. dba U.S. Soccer Foundation
<br />1140 Connecticut Ave. N.W.
<br />INSURERC:
<br />Suite 1200
<br />INSURER D :
<br />INSURER E :
<br />Washington, DC 20036
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE X OCCUR
<br />X
<br />X
<br />SBCGL0283404
<br />7/1/2021
<br />7/1/2022
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />1,000,000
<br />$
<br />X
<br />IVIED EXP (Any oneperson)
<br />$ 0
<br />Participant Legal
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />GENT
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 5,000,000
<br />POLICY PRO ❑ LOC
<br />JECT
<br />PRODUCTS - COMP/OP AGG
<br />$ 5,000,000
<br />X
<br />OTHER: Per Event
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />1,000,000
<br />$
<br />BODILY INJURY Perperson)
<br />$
<br />ANY AUTO
<br />SBAUT0038004
<br />7/1/2021
<br />7/1/2022
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY Per accident
<br />$
<br />X
<br />PROPERTY DAMAGE
<br />Per accident)
<br />ccident
<br />$
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />A
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 3,000,000
<br />X
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />SBFXS0045204
<br />7/1/2021
<br />7/1/2022
<br />AGGREGATE
<br />$ 3,000,000
<br />DED X RETENTION $ 0
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />Y/ N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE �
<br />OFFICER/MEM BER EXCLUDED?
<br />(Mandatory in NH)
<br />N / A
<br />20WECZS4698
<br />7/1/2021
<br />7/1/2022
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />1,000,000
<br />$
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,UUU
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />1,000,000
<br />$
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Certificate holder is additional insured as required by written contract or agreement subject to the provisions and limitations of Form CG 2026 (04 13)
<br />Additional Insured - Designated Person or Organization and Form CG2037 (04 13) Additional Insured - Owners, Lessees or Contractors - Completed
<br />Operations. Primary and Non-contributory provisions apply as per Form CG2001 (04/13) - Primary and Noncontributory - Other Insurance Condition.
<br />A Waiver of Subrogation applies where required by written contract or written agreement as per FormSGL003100 (10/16) Commerical General Liability
<br />Enhancement Endorsement - Blanket Waiver of Subrogation.
<br />30 days Notice of Cancellation (10 days for nonpayment) will be sent out in accordance with the policy provisions.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana
<br />Y
<br />THE EXPIRATION DATE THEREOF,
<br />NOTICE WILL BE DELIVERED IN
<br />Risk Management Division
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza, 4th floor
<br />Santa Ana, CA 92702
<br />AUTHORIZED REPRESENTATIVE
<br />RisieMallagementDiviaian
<br />,�oRaN�
<br />REVIEWED & APPROVED BY.-
<br />oI
<br />�' v�
<br />ACORD 25 (2016/03)
<br />© 1988-2015 ACORD C
<br />'
<br />The ACORD name and logo are registered marks of ACORD
<br />RlskManagementAnalyst
<br />
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