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HomeMy WebLinkAboutUSA Swimming, Inc. DBA USA Swimming - Certificate of Liability Insurance"C)REP® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 4/17/2023 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 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 riahts to the certificate holder in lieu of such endorsement(s). PRODUCER NAME Insurance Office of America PHONE FAX 200 Broad Street, SW, Suite 100 0 • 678-919-1150 ac No): 678-450-9180 Gainesville GA 30501 nooRess: usascol@ioausa.com INSURED USASWIM-01 INSURER B : USA Swimming, Inc. dba USA Swimming; USA Swimming Foundation, and USA Swimming Local Swimming INSURERC: Committees & Member Clubs INSURER0: 1 Olympic Plaza INSURERE: Colorado Springs CO 80909-5780 - — — INSURER F COVERAGES CERTIFICATE NUMBER:936400336 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. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF FOLIC EXP LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y 1-TRE-CO-17-01338546-00 1/1/2023 1/1/2024 EACH OCCURRENCE $2,000,000 CLAIMS -MADE I —XI OCCUR AMAGE TO RENTED PREMISES Ea occurrence $2,000,000 MED EXP Any one person) $ 5,000 PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 POLICY PRO- JECT LOC PRODUCTS - COMP/OP AGG $ 2,000,000 Abuse/Molestation $2,000,000 X OTHER: Event AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ A UMBRELLA LIAB X OCCUR Y Y 1 -TRE-CO-1 7-01338547-00 1/1/2023 1/1/2024 EACH OCCURRENCE $3,000,000 X AGGREGATE $3,000,000 EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE STATUTE ER E.L. EACH ACCIDENT $ ED? OFFICER/MEMBER EXCLUDEl N / A (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Verification of General Liability and Excess Liability coverage for COVERED ACTIVITIES: Abuse and Molestation Aggregate on the General Liability policy is $4,000,000. Medical Expense Coverage applies to Office Premises and Event Spectators only. General Liability policy includes a 30 Day Notice of Cancellation per policy provisions. Other Insureds includes the following: USA Swimming, Inc. member clubs, in which all athletes or participants and coaches are members of USA Swimming, Inc., group members, volunteers and "member coaches" solely as respects to "bodily injury" and "property damage" arising from "covered activities" for which a group member has received approval from USA Swimming, Inc. or its authorized representative. See Attached... SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Pasco ACCORDANCE WITH THE POLICY PROVISIONS. 525 N 3rd Avenue Pasco WA 99301 AUTHORIZE REPRESENTATIVE United States J) 14�'i:a�lii is Y ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: USASWIM-01 LOC #: ,4 0 ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Insurance Office of America USA Swimming, Inc. dba USA Swimming; USA Swimming Foundation, and USA Swimming Local Swimming Committees & Member Clubs POLICY NUMBER 1 Olympic Plaza Colorado Springs CO 80909-5780 CARRIER NAIC CODE EFFECTIVE DATE: L KtMA THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Covered Activities With respect to USA Swimming member clubs, group members, member coaches, volunteers and additional insured owners/lessors of premises, sponsors and co -promoters, "Covered Activities" are defined as: 1. Swimming meets that have been issued a written sanction or approval. Approval means a permit issued by one to the USA Swimming, Inc. Local Swimming Committees for swimming meets conducted in conformance with USA Swimming, Inc. technical rules in which members and non-members may compete. USA Swimming, Inc. member clubs that either host or participate in a swimming meet that has been issued an approval will be considered an insured provided that all of its athletes or participants and coaches are members of USA Swimming, Inc. 2. Swimming practices, dry land training activities, camps and learn to swim programs where all swimmers or participants are members of USA Swimming, Inc. or U.S. Masters Swimming and are conducted under direct and active supervision of a member coach. Dry land training activities means weight training, running calisthenics, exercise machine training, and any other activity for which an insured has received approval from USA Swimming, Inc. or its authorized representative. 3. USA Swimming, Inc., Swim-A-Thons, fundraising activity which clubs can purchase for lap-a-thons. 4. Approved social events and approved fundraising activities that are social events and activities for which an insured has received approval from USA Swimming, Inc. or its authorized representative. 5. Swimming tryouts. Swimming tryouts means swimming practices where a swimmer(s) who is not and how has never been a member of USA Swimming, Inc. participates with a USA Swimming, Inc. club for a period not to exceed thirty (consecutive days in a twelve-month period to determine the swimmer's interest in becoming a member of USA Swimming, Inc. 6.Office premises liability for member clubs and LSCs. 7. STSC, CPR and Lifeguard Certifications of USA Swimming member coaches done by USA Swimming member coaches that are member representatives of one of the approved agencies listed on the USA Swimming STSC In -Water Skills Checklist. 8. "Organized practices" that have been reported and a premium has been paid for. Organized practices are defined as recreation league meets hosted by USA member clubs with community teams that are not USA Swimming member clubs. The Certificate Holder is included as an Additional Insured on a Primary and Non -Contributory baisis as required by written agreement. A Waiver of Subrogation also applies in favor of the Additional Insured as required by written agreement. Member Club: Tri-City Channel Cats RE: outdoor, long course pool use ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD