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acoRo� CERTIFICATE OF LIABILITY INSURANCE
<br />1..-�
<br />OATE(MMIDOm Y,
<br />F 3 / 6 / 2015
<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(5), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER,
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />Risk 6 Insurance Consultants, Ina
<br />5416 Glanridge Drive
<br />Atlanta CIA 30342
<br />ONANTACT Lyshon Jackson
<br />PNONE"ESS (904)459-5975 FAXL,DI (AID Not' (404)459-5996
<br />'MAIL . 1.a i.on@riskinsuranceco.com
<br />INSURERS) AFFORDING COVERAGE
<br />NAIC N
<br />INSURER AMassachusetts Bay Ins
<br />22306
<br />INSURED
<br />Challenger Sports Corp
<br />8263 Flint St
<br />Lenexa KS 66214
<br />INSURER B Allmeri.ca Financial Benefit Ins
<br />41840
<br />INSURER C Hanover Insurance Co
<br />22292
<br />INSURER D:Technology Insurance Company
<br />42376
<br />INSURERE:9BE Ins Corp
<br />39217
<br />_
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER:CL1S1508135 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 />INSRR
<br />TYPE OF INSURANCE
<br />AODL
<br />V R
<br />P Y BE
<br />POLICY SEE
<br />POLICY EXP
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />UMA PREMISESa NI LUen
<br />$ 100,000
<br />A
<br />CLAIMS -MADE ❑X OCCUR
<br />ZDA 9436702-04
<br />1/1/2015
<br />1/1/2016
<br />MED EXP(Any one person)
<br />$ 5,000
<br />PERSONAL& ADV INJURY
<br />$ 1,000,000
<br />GENERALAGGREGA'rE
<br />$ 2,000,000
<br />GENL AGGREGATE
<br />LIMIT APPLIES PER:
<br />PRODUCTS-COMPIOP AGO
<br />$ 2,000,000
<br />X POLICY
<br />PIFr.TRO- LOG
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />(E..ormcntl
<br />1,_000,000
<br />B
<br />X
<br />ANY AUTO
<br />BODILY INJURY (Per parson)ALL
<br />BODILY INJURY (Per accidanl)
<br />$
<br />AUTOS AUTOS AUTOSULED
<br />A9399093
<br />1/1/2015
<br />1/1/2016
<br />NON -OWNED
<br />HIRED, AUTOS
<br />r
<br />PROPERTY DAMAGE
<br />Peraceldenl
<br />$
<br />Uninsured Melodist combined
<br />$ 11000,000
<br />-
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />-
<br />EACH OCCVRRENCE
<br />$ 5,000,000
<br />AGGREGATE
<br />$ 5,000,000
<br />L,
<br />EXCESS LIAB
<br />CLAIMB�MADE
<br />�HA9436692-03
<br />DED I X I RETEN'rIDN
<br />$
<br />1/1/2015
<br />/1/2016
<br />D
<br />WORKER$ COMPENSATION
<br />WC STATU- OTH-
<br />ANDEMPLOYERS'LIABILITY YINHOI
<br />x
<br />E.L. EACH ACCIDENT
<br />$ 11000,000
<br />ANY PRCPRIETOKPARTNERIEXECUTIVE
<br />OFFICERIMEMBER EXCLUDED)
<br />(Mandatory In NH)
<br />NIA
<br />TWC3395336
<br />1/1/2015
<br />1/1/2016
<br />E.L. DISEASE - EA EMPLOYE
<br />$ 11000,000
<br />It yes. describe Intl.,
<br />E.L.OISEASE POLICYLIMIT
<br />$ 1,000,000
<br />DESCRIPTION OF OPERATIONSbat.
<br />E
<br />Participant Accident
<br />UH006104
<br />1/1/2015
<br />1/1/2016
<br />AccidentAl lcal $25,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
<br />RE: British Soccer Camps
<br />Dates: British Soccer camps; Aug 9th - 15th , 2015
<br />City of Santa Ana, its officers, employees, agents and volunteers are recognized as Additional Insured,
<br />with respect to General Liability and defense of suits arising from the operations and uses performed by
<br />or on behalf of the named insured as required by written contract.
<br />CAcosta@santa-ana.org
<br />City of Banta Ana
<br />Attn: Carmen Acosta
<br />20 Civic Center Plaza
<br />P.O. Box 1988 M-16
<br />Santa Ana, CA 92702
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />REPRESENTATIVE
<br />Kitchen/SK
<br />INS025 omnnml n1 Th. Action name and Innn era r.ln cf,.r.A mar4c of Af npre,
<br />V\\\" 4 i�K
<br />
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