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3 USABA-2 OP ID: AY ACO~Q DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 02128/12 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 endorsements . CONTACT PRODUCER 800-526-1379 N AME: Bollinger, Inc. 973 921-2876 PHONE FAX 101 JFK Parkway (A/C, No, Ext): (A/C, No): Short Hills, NJ 07078-5000 N_2008-038-004 E-MAIL AJ Morgan ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:Markel Insurance Company 38970 INSURED USA Badminton INSURER B: & its member clubs One Olympic Plaza INSURER C Colorado Springs, CO 80909 INSURER D : INSURER E : INSURER F : 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. INSR- TYPE OF INSURANCE ADDC SUBR POLICY EFF POLICY EXP R POLICY NUMBER MM/DD1YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY X 8502AH024504 03/01112 03/01/13 DAMAGE TO RENTED 100,00 PREMISES (Ea occurrence) $ CLAIMS-MADE X OCCUR MED EXP (Any one person) $ 5,00 X Incl Participants PERSONAL &ADV INJURY S 1,000,00 X Incl Drug Testing GENERAL AGGREGATE $ 5,000,00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 1,000,00 POLICY PRO- X LOC Abuse/Mol $ $1mil/$2mi AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY (Per person) S ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON-OWNED _ PROPERTY DAMAGE $ AUTOS (Per accident) UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 1,000,00 A EXCESS LIAB CLAIMS-MADE 4602AH024505 03/01112 03101/13 AGGREGATE $ 1,000,00 DED RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY YIN TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ? N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Accident Insurance 4102AH022026 03/01/12 03/01/13 Med Max 25,00 Full Excess Ded 1,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The certificate holder is listed as an additional insured on the liability policy. Coverage is provided under this policy only for sponsored/su ervised activities of the named insured for which a premium has been paid. The certificate is issued on behalf of USBNF - Irvine Badminton Club. CERTIFICATE HOLDER CANCELLATION USBNCA2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Salgado Community Center THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 706 North Newhope Street Santa Ana, CA 92703 AUTHORIZED REPRESENTATIVE - Y ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD L