Loading...
HomeMy WebLinkAboutWA ST Youth Soccer Association DBA Washington Youth Soccer - Certificate of Liability InsuranceoRn® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 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 rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER USI Insurance Services NW NAME: 601 Union Street, Suite 1000 HON E 206-441-6300 IV No: Seattle, WA 98101 E-MAIL ADDRESS: _ INSURED Washington State Youth Soccer Association dba Washington Youth Soccer 7100 Fort Dent Way, Suite 215 Tukwila WA 98188 t'n\/FRAGFC RFRTIFIRATIP NI IMRFR• Aoo�nA41 RFVIRInN NIIMRFR- NAIC M 11991 41343 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 OF INSURANCE ADDLSUBIRTYPE INSD Wvp POLICY NUMBER MM/DDY EFF MMIDDY� LIMITS A �/ COMMERCIAL GENERAL LIABILITY 6LKK00000009276100 9/112022 9/1/2023 EACH OCCURRENCE $ 1000000 CLAIMS -MADE ❑✓ OCCUR PREMISES EaEoccurrence) $ 50O 000 MED EXP (Any one person) $ 5 000 PERSONAL & ADV INJURY $ 1 000 000 GEHL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ $3,000,000 RPOLICY PROJECT LOC PRODUCTS - COMPIOP AGG $ 2 OOO 000 $ '/ OTHER: Team/League AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) _ $ ANY AUTO OWNED f SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ B UMBRELLA LIAB OCCUR �/ �/ 2FOEX0007001138100 9/1/2022 9/1/2023 EACH OCCURRENCE $ 5 000 000 EXCESS LU1B CLAIMS -MADE AGGREGATE $ 5 000 000 $ DIED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNERIEXECUTIVE STATUTE ERH E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? El N / A (Mandatory In. NH) E.L. DISEASE -EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below A Sexual Abuse & Molestation 6LKK000OOOO9276100 9/1/2022 9/1/2023 Each Occurrence $1,000,000 Aggregate: $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) This certificate is issued on behalf of Washington State Youth Soccer Ass. & Three Rivers Soccer Club Certificate holder is Additional Insured as respects the operations of the Named Insured for sanctioned activities of the State Association. Waiver of Subrogation and Primary NonContributory apply when required by written contract. City of Pasco 525 N. 3rd Avenue Pasco WA 99301 I.ArVI.CLLA I IVIY 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 Patterson ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 69920611 1 22/23 Master certificate I Keli Bitow 1 8/24/2022 1:42:16 Pm (PDT) I Page 1 of 6 CONNERCIAL GENERAL UAE31UTY CG 20 1104 13 '1;�3�•'�1:1�,�`. ['���y_�•��:;y_ldIto!_,:7421J�A'� y �1Fag g ".'re h;: 1 This endorsement modifies insurance provided under the following: *611FAIif,I Zel►_1 we] :11►10:7_lNI►_lQIIIV01i00:7_LC]OJ_l:41 Designation Of Premises (Part Leased To You): Narne Of Persons) Or Organizations) (Additional Insured): OWNERS AND/OR LESSORS OF THE PREMISES LEASED, RENTED OR LOANED TO YOU, BUT ONLY WITH RESPECT TO THE LIABILITY ARISING OUT OF YOUR OPERATIONS. AMtiOnal PreMUM INCLUDED Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises leased to you and shown in the Schedule and subject to the following additional exclusions: This insurance does not apply to 1. Any 'occurrence" which takes place after you cease to be a tenant in that premises. 2 Structural alterations, new construction or demolition operations performed by or on behalf of the person(s) or organization(s) shown in the Schedule. 2 If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or However: 2 Available under the applicable Limits of 1. The insurance afforded to such additional Insurance shown in the Declarations; insured only applies to the extent permitted by whichever is less. law; and This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. OG 20 1104 13 ©Insurance Services Office, Inc., 2012 Pagel of 1 69920611 1 22/23 Master Certificate I Keli Bitow 1 8/24/2022 1:42:16 PM (PDT) I Page 2 of 6 • '+. National Casualty Company ATrACFEDTOAND ENDORSEMENT EFFECTR/E DATE FORMNG A PART OF (12:01 AM STANDARD TINE) PoucY NUNBER NANM INSURED AGENT NO. 6LKK000000092761 p0 09/01/22 WASHINGTON STATE YOUTH SOCCER ASSOC.; THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CLZ This endorsement modifies insurance provided under the following: CONIVERCIAL GENERAL UABIUTY COVERAGE FORM A SECTION 1—COVERAGES, COVERAGE A BODILY INJURY AND PROPERLY DAMAGE LIABILITY, subsection 2 Exclusions, paragraph a is replaced by: a "Bodily injury' or "property damage" expected or intended from the standpoint of the insured. This exclu- sion does not apply to "bodily injury' or "property damage" resulting from the use of reasonable force to protect persons or property. B. SECTION I --COVERAGES, Coverage A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, subsec- tion 2. Exclusions, paragraph g.(2) is replaced by: (2) A watercraft you do not own that is: (a) Less than fifty-one (51) feet long; and (b) Not being used to carry persons or property for a charge. C. SECTION I --COVERAGES, Coverage B PERSONAL AND ADVERTISING INJURY LIABILITY, subsection 2 Exclusions, paragraph b. and a are replaced by: b. Material Published With Knowledge of Falsity "Personal and advertising injury" arising out of publication of material, including, but not limited to, oral, written, televised, videotaped or electronically transmitted publication of material, if done at the direction of the insured with knowledge of its falsity. c. Material Published Prior To Policy Period "Personal and advertising injury' arising out of publication of material, including, but not limited to, oral, written, televised, videotaped or electronically transmitted publication of material, whose first publication took place before the beginning of the policy period. D. SECTION k-COVERAGES, SUPPLEMENTARY PA ES A and B., paragraph 1.b. and 1.d. are replaced by: b. Up to $1,000 for the cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit," including actual loss of earnings up to five hundred dollars ($500) a day because of time off from work. Includes copyrighted material of ISO Properties, Inc., with its peirnission. Copyright, ISO Properties, Inc., 2012 KR-GL-94 (2-15) Page 1 of 3 69920611 J 22/23 Master Certificate I Keli Bitow 1 8/24/2022 1:42:16 PM (PDT) I Page 3 of 6 E The following replaces SECTION II-4UI1O IS AN INSURED, 3.a.: a. Coverage under this provision is afforded only until the one hundred eightieth (180'h) day after you acquire or form the organization or the end of the policy period, whichever is earlier. F. The following are added to SECTION IV—CCIVMERCIAL GENERAL UAE31UTY CONDITIONS, paragraph 2 Duties In The Event of Occurenc% Offense, Claim Or Suit: Knowledge of the "occurrence," offense, claim or "suit' by the agent, servant, or "employee" of an insured shall not in itself constitute your knowledge unless one of your officers, manager or partners has received notice of the "occurrence," offense, claim or "suit." Failure by the agent, servant or "employee" of an insured (other than an officer, manager or partner) to notify us of an "occurrence" shall not constitute a failure to comply with items a. and b, of this condition. G. The following are added to SECTION IV—COIVMERCIAL GENERAL UAE31UTY CONDITIONS: Urunitenbonal Error or Omission Any unintentional error or omission in the description of or failure to completely describe, any premises or operations intended to be covered by this Coverage Part will not invalidate or affect coverage for those premises or operations. However, you must report such error or omission to us as soon as practicable after its discovery. Waiver of Right of Recovery We waive all rights of recovery when you have agreed to waive your rights of recovery when required by a written contract. However, this provision only applies if the written contract was executed prior to the date of the "occurrence." H. With respect to this endorsement, the following replaces SECTION V—DEFINITIONS, paragraph 3. and 14.: 3. "Bodily injury' means bodily injury, sickness or disease sustained by a person. This includes mental an- guish, mental injury, shock, fright, humiliation, emotional distress or death resulting from bodily injury, sickness or disease. 14, "Personal and advertising injury" means injury, including consequential "bodily injury," arising out of one or more of the following offenses: a. False arrest, detention or imprisonment; b. Malicious prosecution or abuse of process; c. The wrongful eviction from, wrongful entry into, or invasion of the right of private occupancy of a room, dwelling or premises that a person occupies, committed by or on behalf of its owner, landlord or lessor; d Any publication of material including, but not limited to oral, written, televised, videotaped or electroni- cally transmitted publication of material that slanders or libels a person or organization or disparages a person's or organization's goods, products or services; e. Any publication of material, including but not limited to oral, written, televised, videotaped or electroni- cally transmitted publication of material that violates a person's right of privacy; f. The use of another's advertising idea in your "advertisement"; or g. Infringing upon another's copyright, trade dress or slogan in your "advertisement." 1. The word fire is replaced with the phrase fire or explosion where it appears in: a. SECTION 1­-COVERAGES, Coverage A, 2 Exclusions, j. Damage to Properly; b. SECTION !--�ZAGES, Coverage A, 2 Exclusions, last paragraph; Includes copyrighted material of ISO Properties, Inc., with its penrission Copyright, ISO Properties, Inc., 2012 hit-GL-94 (2-15) Page 2of3 69920611 1 22/23 Master Certificate I Keli Bitow 18/24/2022 1:42:16 PM (PDT) I Page 4 of 6 c. SECTION III—LIMTS OF INSURANCE, Item 6.; and d SECTION IV—CCONMERCIAL GENERAL LIABILITY CONDITIONS, 4, Odw Insurance, item b.(1)(aKii). 2 The Limit of Insurance applicable to Damage to Premises Rented to You is $300,000 unless a higher limit is specified on the Commercial General Liability Coverage Part Supplemental Declarations. AUTHORIZED REPRESENTATIVE DATE Includes copyrighted material of ISO Properties, Inc., with its permission Copyright, ISO Properties, Inc., 2012 KR-GL--94 (2-15) Page 3 of 3 69920611 1 22/23 Master Certificate I Keli Hitow 1 8/24/2022 1:42:16 PM (PDT) I Page 5 of 6 National Casualty Company 01, llkV. =L I= off$ ATTACHED TO AND FORMNG A PART OF POLICYNL9 3ER EPDORSQJENi EFFECTIVE DATE NAMED INSURED (12:D1 AM STANDARD Wp 09/01/22 WASHINGTON STATE YOUTH SOCCER ASSOC.; AGENT NO. KKK000000092761 Q0 THIS ENDORSEAAENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: The Other Insurance condition of this Coverage Part is replaced by the provision marked below with an 'Win the box: Other Insurance LJ If other valid and collectible insurance with any other insurer including any formal self -insured retention programs is available to you covering a loss also covered by this Coverage Part, other than insurance that is in excess of the insurance afforded by this Coverage Part, the insurance afforded by this Coverage Part shall be in excess of and shall not contribute with such other insurance. Nothing herein shall be construed to make this insurance subject to the terms, conditions and limitations of other insurance. Coverage afforded under this Coverage Part is primary insurance and Other Insurance shall not apply as respects AS REQUIRED BY WRITTEN CONTRACT as additional insureds. The Cancellation condition of this Coverage Part is amended by the addition of the following if an "X" is in the box: Cancellation The following is added: It is a condition of the Policy by this Endorsement that the Policy will not be can- celled without 30 days' prior written notice to: AS REQUIRED BY WRITTEN CONTRACT and further, that the person(s) named above are not liable for the payment of any premiums or assess- ments on this Policy. AUTHORIZED REPRESENTATIVE DATE IR-GL-79 (4-07) Page 1 of 1 69920611 1 22/23 Master Certificate I Keli Bitow 1 8/24/2022 1:42:16 PM (PDT) I Page 6 of 6