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PROOF OF INSURANCE (2015) CLOSED
RGN 0092 C "RE) '�' DATE (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE z/z7/DDrN 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 endorsement(s). PRODUCER �».m ...._ Veach Concourse Corporate Center Five ro "o "rE F „ (8001872 2976E 7961 .......... FAX N.J. 310,-5,25-11.5.5. iljiS insurance Services of Georgia, Inc. NAME Holly 18th Floor E-MAIL SS. ecerts Atlanta, GA 30328 ADDRESS' s(cDayso.orammmmmmmm www.ayso.org .._.............. .. ....- ------------ .�.�-- n. - -.... m. INSURED American, Youth Soccer Organization AYSO Re ion 0092 19780 S. errnont Avenue,, Suite 200 Torrance CA 902.00 NSURER(Sl AFFORDING COVERAGE INSURER A... Ph•ladelDh'a lndennnity In..uranc............ II n� Ins urance .. �. �. �. �. �. �. �. �. �. �. �. �. �. �. �. �. �. �. �. � .............. �. �. �. �. �.. �. �. �. �..... .�.�.�......................��. a Co INSURER B : INSURERD: INSURER E: ... .. . �. �. � .............................. .. ...� COVERAGES CERTIFICATE NUMBER- as fist RFVrSION NUMRER- NAIC # 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 VVITH 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�R. I TR TYPE OF INSURANCE POLICY NUMBER' . ............ CY EXP (MM DIDYIYYYYI ( MM( D. �._._............ p/yYYy) ...................,.....,... ... ...._ LIMITS A ✓ COMMERCIAL GENERAL LIABILITY PHPK1153828 7/1/2014 7/1/2015 EACH OCCURRENCE $ 1,000,0 CLAIMS -MADE ,/ OCCUR m PRPvTM �"GiSF rTVi FFr nce) $ ... 1,000,000 MED EXP (AnV one person) $ 5000" Participant & Legal Liability PERSONAL &ADV INJURY $ 1,000,000 _ GEN' AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 Ty..... POLICY 0 PRO- [ LOC . .- JECT PRODUCTS - COMP /OPAGG $ 3,000,000 $ OTHER: Per Region AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1 $ ...... _(Fa scddent) BODILY INJURY (Per person) $ ANY AUTO . mmm ALL OWNED .�..�. SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON -OWNED FROPLRrWDAMAGE $ HIRED AUTOS ..,.,.,., AUTOS (OraCCUtdeM) $ A UMBRELLA LIAB OCCUR PHUB454554 7/1/2014 7/1/2015 EACH OCCURRENCE $ 3000.000 ..... EXCESS LIAB CLAIMS -MADE ...... ...... �.... .. . .... AGGREGATE $ 3,000,000, F" DED ✓ RETENTION $10,000 I .. $ WORKERS COMPENSATION OF RH PE�R.n AND EMPLOYERS' LIABILITY Y / N irr= ......�.� �....:.:T.:ITF ...... ....... r.................................................... ............,...,...,........, ECUTIVE EACH BER EXCLUDED? � NIA mE LITmD (Mandatory in SEASECEDA EMPLOYES $ If desc be mE ES6 OF OPERATIONS below D.- _ ... E L DDS P01.94µ Y LtlMI'r $ A Abuse & Molestation PHPK1153828 7/1/2014 7/1/2015 $1,000,000 Each Occurrence $2,000,000 Aggregate DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required( "Med Pay applies only to spectators at an AYSO Event. Certificate Holder is an Additional Insured as respects AYSO sanctioned events only and where endorsement is attached and required by contract. General Aggregate Limit Applies on a per Region basis. CERTIFICATE HOLDER CANCELLATION Se Undo Recreation Bc Parks THE ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ell . THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The Pity of El Se undo, Its off c S`„ als' ACCORDANCE WITH THE POLICY PROVISIONS. emf toy ees, agen and volu ers. 40, Strejdon El Segundo CA 00248 AUTHORIZED REPRESENTATIVE / + Terry Michelitch Ui ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD CERT NO.: 23ij9 x,148 Region 0(192 2/27/2015 11:07:10 AM (PST) P:gotl. 1 of 2 This certi a.cate cancels and supersedes ALL previously issued certificates. 0 PHPK1153828 American Youth Soccer Organization 2/27/2015 PI -AS -010 (04/04) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED: OWNERS AND / OR LESSORS OF PREMISES, LESSORS OF LEASED EQUIPMENT, SPONSORS OR CO- PROMOTERS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART This policy is amended to include as an additional Insured any p on or organ ion of the types designated below, but only with respect to liability arising out o your operatio 1. Owners and / or lessors of the premises leased, rented, or loare to you, subject to the following additional exclusions: a. This insurance applies only to an "occurrence" which takes place while you are a tenant in the premises; b. This insurance does not apply to "bodily injury" or "property damage" resulting from structural alterations, new construction or demolition operations performed by or on behalf of the owner and / or lessor of the premises; c. This insurance does not apply to liability of the owners and / or lessors for "bodily injury" or "property damage" arising out of any design defect or structural maintenance of the premises or loss caused by a premises defect. With respect to any additional insured included under this policy; this insurance does not apply to the sole negligence of such additional insured. 2. Lessor of Leased Equipment, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person(s) or organization(s) subject to the following additional exclusions: a. This insurance does not apply to any "occurrence" which takes place after the equipment lease expires. 3. Sponsors 4. Co- Promoters Eli Se undo Recreation Parks The My of EI Se undo, its officers, officals, em lo ees, agens and volunteers. 40Sheldon El Segundo CA 90245 CERT NO.: 23639348 Region 0092 2/27/2015 11:07:10 AM (PST) Page 2 of 2 This certificate cancels and supersedes ALL previously issued certificates„ Workers Compensation Insurance Date: 3-19-2015 AYSO Region 92 (Agency's name) isa ofor8onbation),and therefore not required to carry Workers Compensation by the State of California. AYSO Region,92 (Agency's name) staff are volunteers. Timm Lawson, AYSO Region 92 RC Business Automobile Insurance Date: AYSO Region 92 nuy's name) isu 5016 Youth Soccer PMgrarn (type of organization) do not own or lease a Business Automobile. Timm Lawson, AYSO Region 92 RC