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OP ID: CF .4 Ro CERTIFICATE OF LIABILITY INSURANCE DAT10/07DYYYY) 10/07/1 1 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 800-526-1379 Bollinger, Inc. 101 JFK Parkway Short Hills, NJ 07078-5000 Cathy A. Fonseca Ext. 8124 N-2011-136 CONTACT NAME:973-921-2876 PHE FAX ac ONNo E:1 ac No E-MAIL PRODUCER CUSTOMER ID, NORT035 INSURERS AFFORDING COVERAGE NAIC Y GENERAL LIABILITY INSURED North American Yth Activities INSURERA: Markel Insurance Company 38970 LLC dba Kidz Love Soccer PO Box 337 INSURER B: Corte Madera, CA 94976 INSURER C X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE IX] OCCUR INSURER D, INSURER E 12/01/10 INSURER F Tn PREMISES Ea occurrence 100.00 COVERAGES CERTIFICATE NUMBER- RFVLRIr1N kl IMRFR- 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. ILTR TYPE OF INSURANCE L B POLICY NUMBER MM DD/YEYW POLICY EXP MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE 1,000,00 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE IX] OCCUR 8502AH021045 12/01/10 12/01/11 Tn PREMISES Ea occurrence 100.00 MED EXP (Any one person) 5100 Incl Participants PERSONAL 8 ADV INJURY 1 1,000,00 GENERAL AGGREGATE 3,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG 1,000.00 - `t POLICY PRO LOC _ $ AUTOMOBILE LIABILITY' - :.: COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO-'- ( _ � BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS J `� 111 BODILY INJURY (Per accid—t) $ PROPERTY DAMAGE Per a cident) $ NON -OWNED AUTOS - $ UMBRELLA LIAB OCCUR - EACH OCCURRENCE AGGREGATE EXCESS LIAB CLAIMS -MADE DEDUCTIBLE Is RETENTION WORKERS COMPENSATION WC STATU- O AND EMPLOYERS' LIABILITY �. / N ANY PROPRIETOR/PARTNEWEXECUTIVE OFFICER/MEMBER EXCLUDED? N / A T Y M R E.L. EACH ACCIDENT EL_ DISEASE - EA EMPLOYEE (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT A Accident Insurance 4102AH021044 12/01/10 12/01/11 Med Max: 100,00 Full Excess Ded: 50 DESCRIPTIONOF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarha Schedule, If more space is requlred) Coverage is provided under this policy only for sponsored/supervised activities of the named insured for which a premium has been paid. Certificate Holder is named as an additional insured with respect to the named insureds activities for which a premium has been paid. Coverage is rima and non-contributory over an,, n coveracie ity of Santa Ana may carry CCK 1 IrIGA 1 C 1'1VLOEK CANCELLATION SANT090 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of Santa Ana, Its THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Officers, Agents and ACCORDANCE WITH THE POLICY PROVISIONS. Employees 1825 W Civic Center AUTHORIZED REPRESENTATIVE Santa Ana, CA 92701 © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD