PROOF OF INSURANCE (2026)ACC>R" It: w
CERTIFICATE OF LIABILITY INSURANCE F.- 12118 wo 120012y4y Y Y
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(iss) must be endorsed. It 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
NAME;
Frazier Insurance Agency
PO BOX 1250 PHONE FAX 804-379-
(AJC� hio� EX0 I", NoI: 4606a804-7
MIDLOTHIAN, VA 23113-8250
INSURERJS) AFFORDING COVERAGE NAIC 9
INSURERA Great American Insurance CarnpOny 16691
INSURED 5POR1S AND RECREAT T,)N PROVIDEM ASSOCIAT ON (PURCHASING GKA)P) AN," INSURERS
ITS PARTICIPATING MFVDC' ' S
Ell Segundo lnfine Hockey Assa6afion INERc
SUR
PO Box 3061 INSURERD
....... . ...
El Segundo, CA 90245 INSURERE
INSURER
COVERAGES CERTIFICATE NUMBER: GAP136475 REVISION NUMBER:
FIHIS IS 1'0 CERTIFY IHAT TPIF P`01.10ES OF INSURANCE USTED BELOW HAVE BEEN ISSUES) TO THE INSf,.JRED NAMED ABOVE FOR THE POLIC.Y PERIOD
INDICATED NOTWITHSTANDiNG ANY 'REQUIREIVENT,
TERM OR CONDITON OF ANN GONTRAC, OR OTHER DOCUMENT WITH RESPECT' TO WHICH
THIS CER I-IFICATE MAY BE ISSUED OF MAY PERTAIN, 'TWE 1111SURANUE APFORDED BY THE POLICIES DESCRIn. 9."D HEREIN IS SUBJECT TO ALL, r'HE
rERNIS. wSUCH PUlCIES UN11"s SHOWN VnY HPVC 8,1"'EN REDJCED BY PAID
.�,.,,OF
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TYPE 9F INSURANCE
POLICY NUMBER UMITS
NVMPV0)1yy1i`
LIABILITY
S1 con 1-100
.9ENERAL
A0 000
h4F!) F)VP
II
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012025
A X
6A'V NJU 'Ry, no(s 019C
PAC 4725036 "2:00 AM 2:01 AM
GEN11:RA1 #GrP4E(AIF
I X
I'VATAPI'l IV
7X V1011 I C V 7 0
'11,111 C Q I," AC G
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AUTOMOBILE LIAEHUTY
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F-M", �J["�"JRRJME S 1 0110 300
JUMBRELLALIAB
C1104/2025 i 01�04f*2026 1A S' nor, ("(ffl
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A X EXCIESSUAS.
GAX100734 11 2: 00 AM 112:01 AM
0 liOd/2025 0110PM 11'S1 on", 0W,
A Professional Liability
:04/20215 Ear
, PAC 4725036 2�00 AM 121 AM �A-I 11111
0110412025 0 ,0412026 111a V
A Abuse and Molestation
AC 4725036 P 2:00 ANI 12:01 AM -,EV'oRrki ACRa R„,'OF
DA 510 C00
A AccidenUMedical Coverage
OV0412025 0110312026 VAAMMUM !,T[ I j�r - 325 000
BSR-F102505-01 'i 00 AM 11:59 PM
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DESCRIPTION OF OPERATIONS! LOCATIONS I VEHICLES (Attach ACCRO 101. Additional Remarks Schedula, if more SP2COIS rGrIulmd)
Covered Activities: Youth In -Line Hockey
Scheduled Activities Exclusion Applies -Please Refer to Named Insured Member Certificate of Coverage
CERTIFICATE HOLDER
CANCELLATION
Proof of Insurance
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
Fra,z" 1vvAA-raA,_t_&
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