PROOF OF INSURANCE (2023) CLOSED" '7 0 DATE (MM/DD/YYYY)
ACM CERTIFICATE OF LIABILITY INSURANCE 11/21/2022
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 pollcy(ies) must have ADDITIONAL INSURED provisions or 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 CONTA' Michele Reitz
NAME.
Correll Insurance Group of Hilton Head PHONE (843) 785.7733 1. pAac Na a
PO Box 6869 ADDRESS;
mreitz@correllhhi.com
INSURER(S) AFFORDING COVERAGE NAIC #
Hilton Head Island SC 29938 INSURER A: Philadelphia Indemnity 18058
INSURED INSURER B :
INSURER C :
Professional Pickleball Registry, Inc. INSURER D :
PO Box 4739 INSURER E :
Hilton Head Island SC 29938 INSURER F:
COVERAGES CERTIFICATE NUMBER: CL20921514ti 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.
LTR
TYPE OF INSURANCE
IN D
yyyp
POLICY NUMBER _
MM/DD/YYYY
MMMDPYYY
LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
7SC�EFf
PREMISES Ea occurrence
100,000
CLAIMS -MADE iC OCCUR
MED EXP (Any one person)
$ Excluded
A
PHPK2443121
09/01t2022
09/01/2023
PERSONAL &ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 3,000,000
GEWL.AGGREGATE LIMITAPPLIES PER:
POLICY ECLOC
JECT
PRODUCTS - COMP/OP AGG
3,000,000
$
OTHER:
$
AUTOMOBILE LIABILITY
C BON -D SBNGI.E. O..tlMIT'
acCd nt
$
BODILY INJURY (Per person)
$
ANY AUTO
OWNED SCHEDULED
BODILY INJURY (Per accident)
$
AUTOS ONLY AUTOS
PROPERI"YDAMAGE
Peer accxdenl
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
X
UMBRELLA LIAB X OCCUR
EACH OCCURRENCE
$ 5,000,000
AGGREGATE
$ 5,000,000
A
EXCESS LIAB CLAIMS -MADE
PHUB825358
09/01/2022
09/01/2023
❑EO I X1 RETENTION S 101000
$
WORKERS COMPENSATION
PTATUTE ER
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOMPARTNER/EXECUTIVE
E,L. EACH ACCIDENT
$
OFFICERPMEMBER EXCLUDED? ❑
N / A
(Mandatory in NH)
E L DISEASE - EA EMPLOYEE
$
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$
DESCRIPTION OF OPERATIONS /LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
Cade Erickson,
Member # 122863
Effective Through: August 31, 2023
CERTIFICATE HOLDER CANCELLATION
Cade Erickson SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Redondo Beach, ACCORDANCE WITH THE POLICY PROVISIONS.
CA AUTHORIZED REPRESENTATIVE
@ 19L _..... ,..,._ , ......JN. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
DATE (MMIDDIYYM
CERTIFICATE OF LIABILITY INSURANCE 09/01/2022
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 pollcy(les) 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 CONTACT NMark H. Lincoln
Ar
InsureWorkforce, LLC PHONE 615 405 7750 FAX
104 Woodmont Blvd E440JL liraoDln@insatmwor�for
ce.conl
......... _.,.,..... _
Ste 219 INSURER(S)AFFOROING COVERAGE NAIC M
Nashville TN 37205 INSURER A: United States Fire Insurance Company 21113
_. _...._................ ,,,, .,. ._.... ... ... ,
INSURED.........�.....,..m,.. ,....... � .... ....�
INSURER B :
_...... ............... ._.w.. .,.. ..... .,, ... ,.._....___
Professional Tennis Registry INSURER C :
4 Office Way INSURER D :
...,_ _..n.n.............
Ste 200
INSURER E :
Hilton Head SC 29928 299 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.
IT
�L $ SR`y
ILT R _— —
TYPE OF INSURANCE POLICY NUMBERm MwnD 1 MM=mYYY
LIMITS
GENERAL LIABILITY ....
EACH OCCURRENCE $
_
COMMERCIALCLAIMS-MADE E RAL LIABILITY
m OCCUR
MED EXP (Any one Person) $
,,GEN
PERSONAL 8 ADV INJURY , $
,.. .„ m .,. �...
GENERALAGGREGATE $
L AG REGATE-LIMIT APPLIES PER.
PRODUCTS
_ _ ..
� _ � r�Ro-
-,_1,",COMPIOP
POLICY" Loc
$
AUTOMOBILE
LIABILITY
Ey�aw 0w 0 LIMIT
�
..-.
ANY=AUTO
BODILY INJU RY (Per person)
$
ALL OWNED SCHEDULED
BODILY INJURY ....... .
URY (Per acndent)
........ ...v
$
- ,
AUTOS A UTOS
.,,._
NON-O
ETtid"rY',iAAIPi'1µ
$
HIRED AUTOS AUTOSWNEDepF
—.
UMBRELLA LIAB OCCUR
EACH OCCURRENCE
$
EXCESS LIAR CLAIMS -MADE
AGGREGATE
$
DEO RETENTION $
$
WORKERS COMPENSATION
WC STAru OTH-
AND EMPLOYERS, LIABILITY YIN
."'""'. ARY.�Umn "S ..."_.„ ".
ANY PROPRIETORIPARTNERIEXECUTIVE
ACCIDENT
E.L EACH A
$
OFFICERIMEMBER EXCLUDED?
NIA
'.•-• ,_
(Mandatory in NH)
E.L. DISEASE -EA EMPLOYE.,
S
If yes doscrlR a under
ASP$TION
--- — --- Y
DI OF OPERATIONS t 1.
L. DISEASE- POLICY LIMIT
$
A Accident Only Insurance US1833892-00 09/01/2022 09/01/2023 Accident Medical Expense Limit $25,000
Deductible $100
'.. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101. Additional Remarks Schedule, If more apace Is required)
Primary Excess Medical Expense is first $100 or eligible expenses subject to deductible amount.
Additional Expenses paid only when expenses are in excess amounts payable by any other Health Care Plan.
Accidental Death Maximum Benefit: $10,000
Accidental Dismembennent & Paralysis Maximum Benefits: $10,000
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
ACORD 25 (20101051 01988-2640 ACORD CORPORATION. All riahts reserved.
The ACORD name and logo are registered marks of ACORD
Pollcy No.
)1 have and; will maintain workers'
of the work for which the agreernont
carrier and policy number are,
Carrier
Name of Agent,
[z] I certify that, in the performan
employ any person in any manner
agree that, if I should become sut
immediately comply with those prov
Signature of Applicant
Print Name
Agreement for:_t
Dated
4/
Reviewed by:
i
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