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ACC)R o® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE
<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(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, Inc
<br />5416 Glenridge Drive
<br />Atlanta GA 30392
<br />CONTACT
<br />NAME: pool HLOuBSdrd
<br />ac No,.Enl; (404) 459-5975 !PNC Nal (AOq Q&9-6976
<br />"DUBS: pbroussard@riskinsuranceco.com
<br />INSURERS AFFORDING COVERAGE NAIC9
<br />INSURER A:SCOtiSdale Insurance Company 41297
<br />INSURED
<br />Challenger Sports Corp
<br />8263 Flint St
<br />Lenexa KS 66214
<br />INSURER a Nationwide Mutual Insurance Co 123787
<br />INSURER c Technology Insurance Company 42376
<br />INSURERD., BE Ins -Corp !39217
<br />NSURER E:
<br />IINSURERF:
<br />COVERAGES CERTIFICATE NUMBER:17 18 rev MASTER REVISIONNUMBER:
<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
<br />WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL
<br />THE TERMS,
<br />EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />NI
<br />TYPE OF INSURANCE
<br />ADDLSQB'' POLICY NUMBERMU,ocD
<br />POLICY EFFSR
<br />!MOODY EXP LIMITS
<br />R iCOMMERCIALGENERALLUIBWTY
<br />I
<br />EACH OCCURRENCE 1E
<br />1,000,000
<br />A GIAIM$MOCCUR
<br />T,
<br />rYOR6NYA➢E
<br />EMISES.(Ed-Qaun'.ence} L S
<br />3(10,000
<br />X 1LTUCS0000006678900
<br />1/1/2017
<br />! 1/1/2018
<br />MED EXP (Ay one person) IS
<br />1,000
<br />PERSONAL&ADV INJURY 1E
<br />1,000,000
<br />AGGREGATE E
<br />2,000,000
<br />GENL AGGREGATE UMITAPPLIES PER:GENERAL
<br />X1 POLICY E jEa LOC
<br />I PROOUCTE-COMP/OP AGG 1$
<br />2,000,000
<br />OTHER:
<br />'Employee Benefits LiabRy Is
<br />1,000,000
<br />AUTOMOBILE LIABILITY !
<br />JCO EDISINGLE LIMIT!E
<br />1,000,000
<br />B R'ANY AUTO
<br />!BODILY INJURY (Per person) Is
<br />_ AUTOS I IAUTOSULED 1LXR5001)0I106679000
<br />r—t
<br />1/1/2017 1/1/2D18 BODILY INJURY (Peraodden0I5
<br />NON OWNED
<br />X HIRED AUTOS I X AUTOS
<br />PiiOPERTY DAMAGE
<br />! �_LParedenl E
<br />Unnwred Matanet Is
<br />1,000,000
<br />X UMBRELLA UAB R OCCUR
<br />EACH OCCURRENCE Is
<br />5,000,000
<br />A r— EXCESS UAB CLAIMSMADEI
<br />I ! AGGREGATE S
<br />5,000,000
<br />OED I R I RETENTIONS 0: 11=000000667890D
<br />1/1/2017 i 1/1/2018 ! S
<br />WORT ERSCOMPENSAUON
<br />ANO EMPLOYERS' LIABILITY I
<br />IR PER 0TH -
<br />4STATUIE � EN
<br />_
<br />YI N
<br />ANY PROPRIETORIPARTNERIEXECURVE
<br />OFFICERIMEMBER EXCLUDED? JiNIA!
<br />EL EACH ACCIDENT is
<br />1,000,000
<br />C (Mandamry In NHl
<br />;THC3603036
<br />1/1/2017 1/1/2018 1 E DISEASE - EA EMPLOYEE S
<br />1,000,000
<br />Iyyes, des
<br />IESCRIPTION ION OOF F OPERATIONS bebw
<br />0
<br />( IEL DISEASE -POLICY LIMIT 15
<br />11000,000
<br />D Participant Accident
<br />�AB8006104
<br />11/1/2017
<br />i
<br />1/1/2018 Aeddenl/Medal
<br />$25,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS IVEHICLES(ACORD 101, AdWdonal Remarks ScWule, may be efhched if more spaAk,,n
<br />City of Santa Ana is additional insured, with regards
<br />to General Li'vi-Xty, as per itten contract.
<br />TinyTykes
<br />�\"\
<br />Dates: Feb 15th -May 20U, 2017
<br />�e�\e
<br />British Soccer Camp
<br />Ja
<br />vPy •\'�'
<br />Dates: July 16th - 22nd, 2017
<br />•\�\a.CJ Ad�
<br />SCuevas@santa-ana.org
<br />City of Santa Ana
<br />ATTN: Silvia Cuevas
<br />726 S Center Street
<br />Santa Ana, CA 92704
<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 />teve Molina/BECKY-'- ---�
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />INS025 fMl4mi
<br />
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