certificate of liability insurance...producer contact name: mass merchandising underwriting k&k...
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ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
01/15/2019THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE 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 REPRESENTATIVEOR 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. IfSUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on thiscertificate does not confer rights to the certificate holder in lieu of such endorsement(s).PRODUCER CONTACT NAME: Mass Merchandising UnderwritingK&K Insurance Group, Inc.1712 Magnavox WayFort Wayne IN 46804
PHONE(A/C, No, Ext): 1-800-426-2889 FAX
(A/C, No): 1-260-459-5105E-MAILADDRESS: [email protected] ID:
INSURER(S) AFFORDING COVERAGE NAIC #
INSURED INSURER A: Nationwide Mutual Insurance Company 23787Fountain Valley Youth BaseballDBA: Fountain Valley Pony BaseballP.O. Box 8218Fountain Valley, CA 92728A Member of the Sports, Leisure & Entertainment RPG
INSURER B: INSURER C: INSURER D: INSURER E: INSURER F:
COVERAGES CERTIFICATE NUMBER: W01369828 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 BEISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OFSUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.INSRLTR TYPE OF INSURANCE ADDL
INSDSUBRWVD POLICY NUMBER POLICY EFF
(MM/DD/YYYY)POLICY EXP
(MM/DD/YYYY) LIMITS
A X COMMERCIAL GENERAL LIABILITY 6BRPG0000006430100 02/01/201912:01 AM EDT
02/01/202012:01 AM
EACH OCCURRENCE $1,000,000 CLAIMS-
MADE X OCCUR DAMAGE TO RENTEDPREMISES (Ea Occurrence) $1,000,000
MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE $5,000,000GEN’L AGGREGATE LIMIT APPLIES PER: PRODUCTS – COMP/OP AGG $1,000,000 POLICY PRO-
JECT LOC PROFESSIONAL LIABILITY $1,000,000 OTHER: LEGAL LIAB TO PARTICIPANTS $1,000,000
A AUTOMOBILE LIABILITY 6BRPG0000006430100 02/01/201912:01 AM EDT
02/01/202012:01 AM
COMBINED SINGLE LIMIT(Ea accident) $1,000,000
ANY AUTO BODILY INJURY (Per person) OWNED AUTOS
ONLY SCHEDULEDAUTOS BODILY INJURY (Per accident)
X HIREDAUTOS ONLY X NON-OWNED
AUTOS ONLYPROPERTY DAMAGE(Per accident)
X NOT PROVIDED WHILE IN HAWAII UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION
WORKERS COMPENSATION ANDEMPLOYERS’ LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory in NH)
If yes, describe under DESCRIPTIONOF OPERATIONS below
N/A PERSTATUTE OTHER
Y / N E.L. EACH ACCIDENT E.L. DISEASE – EA EMPLOYEE E.L. DISEASE – POLICY LIMIT
A MEDICAL PAYMENTS FOR PARTICIPANTS 6BRPG0000006430100 02/01/201912:01 AM EDT
02/01/202012:01 AM
PRIMARY MEDICAL EXCESS MEDICAL $25,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)Legal Liability to Participants (LLP) limit is a per occurrence limit.Sport(s): Baseball Age(s): 12 and under, 13-15Sexual Abuse or Sexual Molestation Liability - $1,000,000 each occurrence (included above)/$1,000,000 aggregate (included above)
CERTIFICATE HOLDER CANCELLATIONEvidence of Coverage
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE WITH THE POLICY PROVISIONS.AUTHORIZED REPRESENTATIVE
Coverage is only extended to U.S. events and activities.** NOTICE TO TEXAS INSUREDS: The Insurer for the purchasing group may not be subject to all the insurance laws and regulations of the State of Texas
ACORD 27 (2016/03) © 1993 2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD
EVIDENCE OF PROPERTY INSURANCE W01369830
DATE (MM/DD/YYYY)
01/15/2019THIS EVIDENCE OF PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THEADDITIONAL INTEREST NAMED BELOW. THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THECOVERAGE AFFORDED BY THE POLICIES BELOW. THIS EVIDENCE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THEISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE ADDITIONAL INTEREST.AGENCY PHONE
(A/C, No, Ext): 1-800-426-2889 COMPANY
K&K Insurance Group, Inc.1712 Magnavox WayFort Wayne IN 46804
Nationwide Mutual Insurance Company
FAX(A/C, No): 1-260-459-5105 E-MAIL
ADDRESS: [email protected]: SUB CODE: AGENCYCUSTOMER ID: LOAN NUMBER POLICY NUMBER
INSURED 6BIM 0000021893800Fountain Valley Youth BaseballDBA: Fountain Valley Pony BaseballP.O. Box 8218Fountain Valley, CA 92728
EFFECTIVE DATE EXPIRATION DATE CONTINUED UNTIL TERMINATED IFCHECKED02/01/2019
12:01 AM EDT02/01/202012:01 AM EDT
THIS REPLACES PRIOR EVIDENCE DATED:
PROPERTY INFORMATIONLOCATION/DESCRIPTION
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 THISEVIDENCE OF PROPERTY INSURANCE 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.
COVERAGE INFORMATION PERILS INSURED BASIC BROAD SPECIAL
COVERAGE / PERILS / FORMS AMOUNT OF INSURANCE DEDUCTIBLE
Inland Marine-Miscellaneous Property: Business Personal Property including; Sports equipment, fieldmaintenance equipment, concession stand equipment (excluding products), small portable storageunits and miscellaneous equipment and supplies
$33,000
$1000*
REMARKS (including Special Conditions) * Deductible applies per claim
CANCELLATIONSHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE WITH THE POLICY PROVISIONS.ADDITIONAL INTERESTNAME AND ADDRESS ADDITIONAL INSURED LENDER’S LOSS PAYABLE LOSS PAYEE
Evidence of Coverage MORTGAGEE
LOAN #
AUTHORIZED REPRESENTATIVE
** NOTICE TO TEXAS INSUREDS: The Insurer for the purchasing group may not be subject to all the insurance laws and regulations of the State of Texas.
SRPG3500 CERT (02/05)
NON-PROFIT ORGANIZATION
DIRECTORS AND OFFICERSINCLUDING EMPLOYMENT PRACTICES LIABILITY
CERTIFICATE OF INSURANCE
Certificate Number: W01369829 01/15/2019 ISSUED: January 15, 2019 Company Affording Coverage: AUTHORIZED AGENT:Nationwide Mutual Insurance Company K&K Insurance Group, Inc.
THE COVERAGE SHOWN ON THIS CERTIFICATE IS CLAIMS MADE COVERAGEWHICH APPLIES ONLY TO CLAIMS FIRST MADE DURING THE COVERAGE PERIOD.
This Certificate of Insurance provides you (the Insured Member) with the insurance indicated below as part ofMaster Policy # 6BDNO0000006369600 issued to the Sports, Leisure and Entertainment RPG. This Certificate ofInsurance together with the Master Policy Declarations, Coverage Form, Endorsements and Enrollment Formconstitute the contact between the Insurer, the Organization and the Individual Insureds.
ITEM A. INSURED MEMBER/PARENT ORGANIZATIONFountain Valley Youth BaseballDBA: Fountain Valley Pony BaseballP.O. Box 8218Fountain Valley, CA 92728A Member of the Sports, Leisure & Entertainment RPG
ITEM B. COVERAGE PERIOD: Effective: 02/01/2019 Expiration: 02/01/2020 (at 12:01 a.m. Standard Time at the address of the Parent Organization)
ITEM C. LIMITS OF INSURANCE PREMIUM
$1,000,000 Limit of Liability $625.00 Maximum Aggregate Limit of Liability for each Policy Year: Excluded Outside Service Coverage:
$1,000 Retention (Each Claim):
Medical Payments for Participants $10,000 Directors: Excluded Volunteers:
Total Premium Fully Earned at Inception: $625.00
NOTICES: ALL NOTICES REQUIRED TO BE GIVEN TO THE INSURER UNDER THIS COVERAGE SHALL BE ADDRESSED TO: K&K Insurance Group P.O. Box 2338 Fort Wayne, IN 46801-2338 By:
AUTHORIZED REPRESENTATIVE SIGNATURE
ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
01/15/2019THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE 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 REPRESENTATIVEOR 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. IfSUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on thiscertificate does not confer rights to the certificate holder in lieu of such endorsement(s).PRODUCER CONTACT NAME: Mass Merchandising UnderwritingK&K Insurance Group, Inc.1712 Magnavox WayFort Wayne IN 46804
PHONE(A/C, No, Ext): 1-800-426-2889 FAX
(A/C, No): 1-260-459-5105E-MAILADDRESS: [email protected] ID:
INSURER(S) AFFORDING COVERAGE NAIC #
INSURED INSURER A: Nationwide Mutual Insurance Company 23787Fountain Valley Youth BaseballDBA: Fountain Valley Pony BaseballP.O. Box 8218Fountain Valley, CA 92728A Member of the Sports, Leisure & Entertainment RPG
INSURER B: INSURER C: INSURER D: INSURER E: INSURER F:
COVERAGES CERTIFICATE NUMBER: W01369831 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 BEISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OFSUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.INSRLTR TYPE OF INSURANCE ADDL
INSDSUBRWVD POLICY NUMBER POLICY EFF
(MM/DD/YYYY)POLICY EXP
(MM/DD/YYYY) LIMITS
A X COMMERCIAL GENERAL LIABILITY X 6BRPG0000006430100 02/01/201912:01 AM EDT
02/01/202012:01 AM
EACH OCCURRENCE $1,000,000 CLAIMS-
MADE X OCCUR DAMAGE TO RENTEDPREMISES (Ea Occurrence) $1,000,000
MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE $5,000,000GEN’L AGGREGATE LIMIT APPLIES PER: PRODUCTS – COMP/OP AGG $1,000,000 POLICY PRO-
JECT LOC PROFESSIONAL LIABILITY $1,000,000 OTHER: LEGAL LIAB TO PARTICIPANTS $1,000,000
A AUTOMOBILE LIABILITY 6BRPG0000006430100 02/01/201912:01 AM EDT
02/01/202012:01 AM
COMBINED SINGLE LIMIT(Ea accident) $1,000,000
ANY AUTO BODILY INJURY (Per person) OWNED AUTOS
ONLY SCHEDULEDAUTOS BODILY INJURY (Per accident)
X HIREDAUTOS ONLY X NON-OWNED
AUTOS ONLYPROPERTY DAMAGE(Per accident)
X NOT PROVIDED WHILE IN HAWAII UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION
WORKERS COMPENSATION ANDEMPLOYERS’ LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory in NH)
If yes, describe under DESCRIPTIONOF OPERATIONS below
N/A PERSTATUTE OTHER
Y / N E.L. EACH ACCIDENT E.L. DISEASE – EA EMPLOYEE E.L. DISEASE – POLICY LIMIT
A MEDICAL PAYMENTS FOR PARTICIPANTS 6BRPG0000006430100 02/01/201912:01 AM EDT
02/01/202012:01 AM
PRIMARY MEDICAL EXCESS MEDICAL $25,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)Sexual Abuse or Sexual Molestation Liability - $1,000,000 each occurrence (included above)/$1,000,000 aggregate (included above)Legal Liability to Participants (LLP) limit is a per occurrence limit.Sport(s): Baseball Age(s): 12 and under, 13-15The certificate holder is added as an additional insured, but only for liability caused, in whole or in part, by the acts or omissions of the named insured.
CERTIFICATE HOLDER CANCELLATIONFountain Valley School District10055 Slater Ave.Fountain Valley, CA 92708(Owner/Lessor of Premises)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE WITH THE POLICY PROVISIONS.AUTHORIZED REPRESENTATIVE
Coverage is only extended to U.S. events and activities.** NOTICE TO TEXAS INSUREDS: The Insurer for the purchasing group may not be subject to all the insurance laws and regulations of the State of Texas
ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
01/15/2019THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE 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 REPRESENTATIVEOR 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. IfSUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on thiscertificate does not confer rights to the certificate holder in lieu of such endorsement(s).PRODUCER CONTACT NAME: Mass Merchandising UnderwritingK&K Insurance Group, Inc.1712 Magnavox WayFort Wayne IN 46804
PHONE(A/C, No, Ext): 1-800-426-2889 FAX
(A/C, No): 1-260-459-5105E-MAILADDRESS: [email protected] ID:
INSURER(S) AFFORDING COVERAGE NAIC #
INSURED INSURER A: Nationwide Mutual Insurance Company 23787Fountain Valley Youth BaseballDBA: Fountain Valley Pony BaseballP.O. Box 8218Fountain Valley, CA 92728A Member of the Sports, Leisure & Entertainment RPG
INSURER B: INSURER C: INSURER D: INSURER E: INSURER F:
COVERAGES CERTIFICATE NUMBER: W01369832 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 BEISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OFSUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.INSRLTR TYPE OF INSURANCE ADDL
INSDSUBRWVD POLICY NUMBER POLICY EFF
(MM/DD/YYYY)POLICY EXP
(MM/DD/YYYY) LIMITS
A X COMMERCIAL GENERAL LIABILITY X 6BRPG0000006430100 02/01/201912:01 AM EDT
02/01/202012:01 AM
EACH OCCURRENCE $1,000,000 CLAIMS-
MADE X OCCUR DAMAGE TO RENTEDPREMISES (Ea Occurrence) $1,000,000
MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE $5,000,000GEN’L AGGREGATE LIMIT APPLIES PER: PRODUCTS – COMP/OP AGG $1,000,000 POLICY PRO-
JECT LOC PROFESSIONAL LIABILITY $1,000,000 OTHER: LEGAL LIAB TO PARTICIPANTS $1,000,000
A AUTOMOBILE LIABILITY 6BRPG0000006430100 02/01/201912:01 AM EDT
02/01/202012:01 AM
COMBINED SINGLE LIMIT(Ea accident) $1,000,000
ANY AUTO BODILY INJURY (Per person) OWNED AUTOS
ONLY SCHEDULEDAUTOS BODILY INJURY (Per accident)
X HIREDAUTOS ONLY X NON-OWNED
AUTOS ONLYPROPERTY DAMAGE(Per accident)
X NOT PROVIDED WHILE IN HAWAII UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION
WORKERS COMPENSATION ANDEMPLOYERS’ LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory in NH)
If yes, describe under DESCRIPTIONOF OPERATIONS below
N/A PERSTATUTE OTHER
Y / N E.L. EACH ACCIDENT E.L. DISEASE – EA EMPLOYEE E.L. DISEASE – POLICY LIMIT
A MEDICAL PAYMENTS FOR PARTICIPANTS 6BRPG0000006430100 02/01/201912:01 AM EDT
02/01/202012:01 AM
PRIMARY MEDICAL EXCESS MEDICAL $25,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)Sexual Abuse or Sexual Molestation Liability - $1,000,000 each occurrence (included above)/$1,000,000 aggregate (included above)Legal Liability to Participants (LLP) limit is a per occurrence limit.Sport(s): Baseball Age(s): 12 and under, 13-15The certificate holder is added as an additional insured, but only for liability caused, in whole or in part, by the acts or omissions of the named insured.
CERTIFICATE HOLDER CANCELLATIONWestminster Unified School District14121 Cedarwood Ave.Westminster, CA 92683(Owner/Lessor of Premises)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE WITH THE POLICY PROVISIONS.AUTHORIZED REPRESENTATIVE
Coverage is only extended to U.S. events and activities.** NOTICE TO TEXAS INSUREDS: The Insurer for the purchasing group may not be subject to all the insurance laws and regulations of the State of Texas
ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
01/15/2019THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE 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 REPRESENTATIVEOR 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. IfSUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on thiscertificate does not confer rights to the certificate holder in lieu of such endorsement(s).PRODUCER CONTACT NAME: Mass Merchandising UnderwritingK&K Insurance Group, Inc.1712 Magnavox WayFort Wayne IN 46804
PHONE(A/C, No, Ext): 1-800-426-2889 FAX
(A/C, No): 1-260-459-5105E-MAILADDRESS: [email protected] ID:
INSURER(S) AFFORDING COVERAGE NAIC #
INSURED INSURER A: Nationwide Mutual Insurance Company 23787Fountain Valley Youth BaseballDBA: Fountain Valley Pony BaseballP.O. Box 8218Fountain Valley, CA 92728A Member of the Sports, Leisure & Entertainment RPG
INSURER B: INSURER C: INSURER D: INSURER E: INSURER F:
COVERAGES CERTIFICATE NUMBER: W01369833 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 BEISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OFSUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.INSRLTR TYPE OF INSURANCE ADDL
INSDSUBRWVD POLICY NUMBER POLICY EFF
(MM/DD/YYYY)POLICY EXP
(MM/DD/YYYY) LIMITS
A X COMMERCIAL GENERAL LIABILITY X 6BRPG0000006430100 02/01/201912:01 AM EDT
02/01/202012:01 AM
EACH OCCURRENCE $1,000,000 CLAIMS-
MADE X OCCUR DAMAGE TO RENTEDPREMISES (Ea Occurrence) $1,000,000
MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE $5,000,000GEN’L AGGREGATE LIMIT APPLIES PER: PRODUCTS – COMP/OP AGG $1,000,000 POLICY PRO-
JECT LOC PROFESSIONAL LIABILITY $1,000,000 OTHER: LEGAL LIAB TO PARTICIPANTS $1,000,000
A AUTOMOBILE LIABILITY 6BRPG0000006430100 02/01/201912:01 AM EDT
02/01/202012:01 AM
COMBINED SINGLE LIMIT(Ea accident) $1,000,000
ANY AUTO BODILY INJURY (Per person) OWNED AUTOS
ONLY SCHEDULEDAUTOS BODILY INJURY (Per accident)
X HIREDAUTOS ONLY X NON-OWNED
AUTOS ONLYPROPERTY DAMAGE(Per accident)
X NOT PROVIDED WHILE IN HAWAII UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION
WORKERS COMPENSATION ANDEMPLOYERS’ LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory in NH)
If yes, describe under DESCRIPTIONOF OPERATIONS below
N/A PERSTATUTE OTHER
Y / N E.L. EACH ACCIDENT E.L. DISEASE – EA EMPLOYEE E.L. DISEASE – POLICY LIMIT
A MEDICAL PAYMENTS FOR PARTICIPANTS 6BRPG0000006430100 02/01/201912:01 AM EDT
02/01/202012:01 AM
PRIMARY MEDICAL EXCESS MEDICAL $25,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)Sexual Abuse or Sexual Molestation Liability - $1,000,000 each occurrence (included above)/$1,000,000 aggregate (included above)Legal Liability to Participants (LLP) limit is a per occurrence limit.Sport(s): Baseball Age(s): 12 and under, 13-15The certificate holder is added as an additional insured, but only for liability caused, in whole or in part, by the acts or omissions of the named insured.
CERTIFICATE HOLDER CANCELLATIONCity of Fountain ValleyCommunity Services, 10200 Slater Ave.Fountain Valley, CA 92070(Owner/Lessor of Premises)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE WITH THE POLICY PROVISIONS.AUTHORIZED REPRESENTATIVE
Coverage is only extended to U.S. events and activities.** NOTICE TO TEXAS INSUREDS: The Insurer for the purchasing group may not be subject to all the insurance laws and regulations of the State of Texas
ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
01/15/2019THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE 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 REPRESENTATIVEOR 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. IfSUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on thiscertificate does not confer rights to the certificate holder in lieu of such endorsement(s).PRODUCER CONTACT NAME: Mass Merchandising UnderwritingK&K Insurance Group, Inc.1712 Magnavox WayFort Wayne IN 46804
PHONE(A/C, No, Ext): 1-800-426-2889 FAX
(A/C, No): 1-260-459-5105E-MAILADDRESS: [email protected] ID:
INSURER(S) AFFORDING COVERAGE NAIC #
INSURED INSURER A: Nationwide Mutual Insurance Company 23787Fountain Valley Youth BaseballDBA: Fountain Valley Pony BaseballP.O. Box 8218Fountain Valley, CA 92728A Member of the Sports, Leisure & Entertainment RPG
INSURER B: INSURER C: INSURER D: INSURER E: INSURER F:
COVERAGES CERTIFICATE NUMBER: W01369834 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 BEISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OFSUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.INSRLTR TYPE OF INSURANCE ADDL
INSDSUBRWVD POLICY NUMBER POLICY EFF
(MM/DD/YYYY)POLICY EXP
(MM/DD/YYYY) LIMITS
A X COMMERCIAL GENERAL LIABILITY X 6BRPG0000006430100 02/01/201912:01 AM EDT
02/01/202012:01 AM
EACH OCCURRENCE $1,000,000 CLAIMS-
MADE X OCCUR DAMAGE TO RENTEDPREMISES (Ea Occurrence) $1,000,000
MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE $5,000,000GEN’L AGGREGATE LIMIT APPLIES PER: PRODUCTS – COMP/OP AGG $1,000,000 POLICY PRO-
JECT LOC PROFESSIONAL LIABILITY $1,000,000 OTHER: LEGAL LIAB TO PARTICIPANTS $1,000,000
A AUTOMOBILE LIABILITY 6BRPG0000006430100 02/01/201912:01 AM EDT
02/01/202012:01 AM
COMBINED SINGLE LIMIT(Ea accident) $1,000,000
ANY AUTO BODILY INJURY (Per person) OWNED AUTOS
ONLY SCHEDULEDAUTOS BODILY INJURY (Per accident)
X HIREDAUTOS ONLY X NON-OWNED
AUTOS ONLYPROPERTY DAMAGE(Per accident)
X NOT PROVIDED WHILE IN HAWAII UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION
WORKERS COMPENSATION ANDEMPLOYERS’ LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory in NH)
If yes, describe under DESCRIPTIONOF OPERATIONS below
N/A PERSTATUTE OTHER
Y / N E.L. EACH ACCIDENT E.L. DISEASE – EA EMPLOYEE E.L. DISEASE – POLICY LIMIT
A MEDICAL PAYMENTS FOR PARTICIPANTS 6BRPG0000006430100 02/01/201912:01 AM EDT
02/01/202012:01 AM
PRIMARY MEDICAL EXCESS MEDICAL $25,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)Sexual Abuse or Sexual Molestation Liability - $1,000,000 each occurrence (included above)/$1,000,000 aggregate (included above)Legal Liability to Participants (LLP) limit is a per occurrence limit.Sport(s): Baseball Age(s): 12 and under, 13-15The certificate holder is added as an additional insured, but only for liability caused, in whole or in part, by the acts or omissions of the named insured.
CERTIFICATE HOLDER CANCELLATIONCounty of Orange - State of CaliforniaOrange County Parks Headquarters, 13042 Old Myford RoadIrvine, CA 92602(Owner/Lessor of Premises)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE WITH THE POLICY PROVISIONS.AUTHORIZED REPRESENTATIVE
Coverage is only extended to U.S. events and activities.** NOTICE TO TEXAS INSUREDS: The Insurer for the purchasing group may not be subject to all the insurance laws and regulations of the State of Texas
ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
01/15/2019THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE 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 REPRESENTATIVEOR 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. IfSUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on thiscertificate does not confer rights to the certificate holder in lieu of such endorsement(s).PRODUCER CONTACT NAME: Mass Merchandising UnderwritingK&K Insurance Group, Inc.1712 Magnavox WayFort Wayne IN 46804
PHONE(A/C, No, Ext): 1-800-426-2889 FAX
(A/C, No): 1-260-459-5105E-MAILADDRESS: [email protected] ID:
INSURER(S) AFFORDING COVERAGE NAIC #
INSURED INSURER A: Nationwide Mutual Insurance Company 23787Fountain Valley Youth BaseballDBA: Fountain Valley Pony BaseballP.O. Box 8218Fountain Valley, CA 92728A Member of the Sports, Leisure & Entertainment RPG
INSURER B: INSURER C: INSURER D: INSURER E: INSURER F:
COVERAGES CERTIFICATE NUMBER: W01369835 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 BEISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OFSUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.INSRLTR TYPE OF INSURANCE ADDL
INSDSUBRWVD POLICY NUMBER POLICY EFF
(MM/DD/YYYY)POLICY EXP
(MM/DD/YYYY) LIMITS
A X COMMERCIAL GENERAL LIABILITY X 6BRPG0000006430100 02/01/201912:01 AM EDT
02/01/202012:01 AM
EACH OCCURRENCE $1,000,000 CLAIMS-
MADE X OCCUR DAMAGE TO RENTEDPREMISES (Ea Occurrence) $1,000,000
MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE $5,000,000GEN’L AGGREGATE LIMIT APPLIES PER: PRODUCTS – COMP/OP AGG $1,000,000 POLICY PRO-
JECT LOC PROFESSIONAL LIABILITY $1,000,000 OTHER: LEGAL LIAB TO PARTICIPANTS $1,000,000
A AUTOMOBILE LIABILITY 6BRPG0000006430100 02/01/201912:01 AM EDT
02/01/202012:01 AM
COMBINED SINGLE LIMIT(Ea accident) $1,000,000
ANY AUTO BODILY INJURY (Per person) OWNED AUTOS
ONLY SCHEDULEDAUTOS BODILY INJURY (Per accident)
X HIREDAUTOS ONLY X NON-OWNED
AUTOS ONLYPROPERTY DAMAGE(Per accident)
X NOT PROVIDED WHILE IN HAWAII UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION
WORKERS COMPENSATION ANDEMPLOYERS’ LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory in NH)
If yes, describe under DESCRIPTIONOF OPERATIONS below
N/A PERSTATUTE OTHER
Y / N E.L. EACH ACCIDENT E.L. DISEASE – EA EMPLOYEE E.L. DISEASE – POLICY LIMIT
A MEDICAL PAYMENTS FOR PARTICIPANTS 6BRPG0000006430100 02/01/201912:01 AM EDT
02/01/202012:01 AM
PRIMARY MEDICAL EXCESS MEDICAL $25,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)Sexual Abuse or Sexual Molestation Liability - $1,000,000 each occurrence (included above)/$1,000,000 aggregate (included above)Legal Liability to Participants (LLP) limit is a per occurrence limit.Sport(s): Baseball Age(s): 12 and under, 13-15The certificate holder is added as an additional insured, but only for liability caused, in whole or in part, by the acts or omissions of the named insured.
CERTIFICATE HOLDER CANCELLATIONGarden Grove Unified School District10331 Stanford AvenueGarden Grove, CA 92640(Owner/Lessor of Premises)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE WITH THE POLICY PROVISIONS.AUTHORIZED REPRESENTATIVE
Coverage is only extended to U.S. events and activities.** NOTICE TO TEXAS INSUREDS: The Insurer for the purchasing group may not be subject to all the insurance laws and regulations of the State of Texas
ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
01/15/2019THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE 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 REPRESENTATIVEOR 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. IfSUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on thiscertificate does not confer rights to the certificate holder in lieu of such endorsement(s).PRODUCER CONTACT NAME: Mass Merchandising UnderwritingK&K Insurance Group, Inc.1712 Magnavox WayFort Wayne IN 46804
PHONE(A/C, No, Ext): 1-800-426-2889 FAX
(A/C, No): 1-260-459-5105E-MAILADDRESS: [email protected] ID:
INSURER(S) AFFORDING COVERAGE NAIC #
INSURED INSURER A: Nationwide Mutual Insurance Company 23787Fountain Valley Youth BaseballDBA: Fountain Valley Pony BaseballP.O. Box 8218Fountain Valley, CA 92728A Member of the Sports, Leisure & Entertainment RPG
INSURER B: INSURER C: INSURER D: INSURER E: INSURER F:
COVERAGES CERTIFICATE NUMBER: W01369836 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 BEISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OFSUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.INSRLTR TYPE OF INSURANCE ADDL
INSDSUBRWVD POLICY NUMBER POLICY EFF
(MM/DD/YYYY)POLICY EXP
(MM/DD/YYYY) LIMITS
A X COMMERCIAL GENERAL LIABILITY X 6BRPG0000006430100 02/01/201912:01 AM EDT
02/01/202012:01 AM
EACH OCCURRENCE $1,000,000 CLAIMS-
MADE X OCCUR DAMAGE TO RENTEDPREMISES (Ea Occurrence) $1,000,000
MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE $5,000,000GEN’L AGGREGATE LIMIT APPLIES PER: PRODUCTS – COMP/OP AGG $1,000,000 POLICY PRO-
JECT LOC PROFESSIONAL LIABILITY $1,000,000 OTHER: LEGAL LIAB TO PARTICIPANTS $1,000,000
A AUTOMOBILE LIABILITY 6BRPG0000006430100 02/01/201912:01 AM EDT
02/01/202012:01 AM
COMBINED SINGLE LIMIT(Ea accident) $1,000,000
ANY AUTO BODILY INJURY (Per person) OWNED AUTOS
ONLY SCHEDULEDAUTOS BODILY INJURY (Per accident)
X HIREDAUTOS ONLY X NON-OWNED
AUTOS ONLYPROPERTY DAMAGE(Per accident)
X NOT PROVIDED WHILE IN HAWAII UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION
WORKERS COMPENSATION ANDEMPLOYERS’ LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory in NH)
If yes, describe under DESCRIPTIONOF OPERATIONS below
N/A PERSTATUTE OTHER
Y / N E.L. EACH ACCIDENT E.L. DISEASE – EA EMPLOYEE E.L. DISEASE – POLICY LIMIT
A MEDICAL PAYMENTS FOR PARTICIPANTS 6BRPG0000006430100 02/01/201912:01 AM EDT
02/01/202012:01 AM
PRIMARY MEDICAL EXCESS MEDICAL $25,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)Sexual Abuse or Sexual Molestation Liability - $1,000,000 each occurrence (included above)/$1,000,000 aggregate (included above)Legal Liability to Participants (LLP) limit is a per occurrence limit.Sport(s): Baseball Age(s): 12 and under, 13-15The certificate holder is added as an additional insured, but only for liability caused, in whole or in part, by the acts or omissions of the named insured.
CERTIFICATE HOLDER CANCELLATIONHuntington Beach Union High School District5832 Bolsa Ave.Huntington Beach, CA 92649(Owner/Lessor of Premises)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE WITH THE POLICY PROVISIONS.AUTHORIZED REPRESENTATIVE
Coverage is only extended to U.S. events and activities.** NOTICE TO TEXAS INSUREDS: The Insurer for the purchasing group may not be subject to all the insurance laws and regulations of the State of Texas
ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
01/15/2019THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE 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 REPRESENTATIVEOR 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. IfSUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on thiscertificate does not confer rights to the certificate holder in lieu of such endorsement(s).PRODUCER CONTACT NAME: Mass Merchandising UnderwritingK&K Insurance Group, Inc.1712 Magnavox WayFort Wayne IN 46804
PHONE(A/C, No, Ext): 1-800-426-2889 FAX
(A/C, No): 1-260-459-5105E-MAILADDRESS: [email protected] ID:
INSURER(S) AFFORDING COVERAGE NAIC #
INSURED INSURER A: Nationwide Mutual Insurance Company 23787Fountain Valley Youth BaseballDBA: Fountain Valley Pony BaseballP.O. Box 8218Fountain Valley, CA 92728A Member of the Sports, Leisure & Entertainment RPG
INSURER B: INSURER C: INSURER D: INSURER E: INSURER F:
COVERAGES CERTIFICATE NUMBER: W01369837 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 BEISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OFSUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.INSRLTR TYPE OF INSURANCE ADDL
INSDSUBRWVD POLICY NUMBER POLICY EFF
(MM/DD/YYYY)POLICY EXP
(MM/DD/YYYY) LIMITS
A X COMMERCIAL GENERAL LIABILITY X 6BRPG0000006430100 02/01/201912:01 AM EDT
02/01/202012:01 AM
EACH OCCURRENCE $1,000,000 CLAIMS-
MADE X OCCUR DAMAGE TO RENTEDPREMISES (Ea Occurrence) $1,000,000
MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE $5,000,000GEN’L AGGREGATE LIMIT APPLIES PER: PRODUCTS – COMP/OP AGG $1,000,000 POLICY PRO-
JECT LOC PROFESSIONAL LIABILITY $1,000,000 OTHER: LEGAL LIAB TO PARTICIPANTS $1,000,000
A AUTOMOBILE LIABILITY 6BRPG0000006430100 02/01/201912:01 AM EDT
02/01/202012:01 AM
COMBINED SINGLE LIMIT(Ea accident) $1,000,000
ANY AUTO BODILY INJURY (Per person) OWNED AUTOS
ONLY SCHEDULEDAUTOS BODILY INJURY (Per accident)
X HIREDAUTOS ONLY X NON-OWNED
AUTOS ONLYPROPERTY DAMAGE(Per accident)
X NOT PROVIDED WHILE IN HAWAII UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION
WORKERS COMPENSATION ANDEMPLOYERS’ LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory in NH)
If yes, describe under DESCRIPTIONOF OPERATIONS below
N/A PERSTATUTE OTHER
Y / N E.L. EACH ACCIDENT E.L. DISEASE – EA EMPLOYEE E.L. DISEASE – POLICY LIMIT
A MEDICAL PAYMENTS FOR PARTICIPANTS 6BRPG0000006430100 02/01/201912:01 AM EDT
02/01/202012:01 AM
PRIMARY MEDICAL EXCESS MEDICAL $25,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)Sexual Abuse or Sexual Molestation Liability - $1,000,000 each occurrence (included above)/$1,000,000 aggregate (included above)Legal Liability to Participants (LLP) limit is a per occurrence limit.Sport(s): Baseball Age(s): 12 and under, 13-15The certificate holder is added as an additional insured, but only for liability caused, in whole or in part, by the acts or omissions of the named insured.
CERTIFICATE HOLDER CANCELLATIONOcean View Elementary School District17200 Pinehurst LaneHuntington Beach, CA 92648(Owner/Lessor of Premises)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE WITH THE POLICY PROVISIONS.AUTHORIZED REPRESENTATIVE
Coverage is only extended to U.S. events and activities.** NOTICE TO TEXAS INSUREDS: The Insurer for the purchasing group may not be subject to all the insurance laws and regulations of the State of Texas
ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
01/15/2019THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE 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 REPRESENTATIVEOR 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. IfSUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on thiscertificate does not confer rights to the certificate holder in lieu of such endorsement(s).PRODUCER CONTACT NAME: Mass Merchandising UnderwritingK&K Insurance Group, Inc.1712 Magnavox WayFort Wayne IN 46804
PHONE(A/C, No, Ext): 1-800-426-2889 FAX
(A/C, No): 1-260-459-5105E-MAILADDRESS: [email protected] ID:
INSURER(S) AFFORDING COVERAGE NAIC #
INSURED INSURER A: Nationwide Mutual Insurance Company 23787Fountain Valley Youth BaseballDBA: Fountain Valley Pony BaseballP.O. Box 8218Fountain Valley, CA 92728A Member of the Sports, Leisure & Entertainment RPG
INSURER B: INSURER C: INSURER D: INSURER E: INSURER F:
COVERAGES CERTIFICATE NUMBER: W01369838 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 BEISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OFSUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.INSRLTR TYPE OF INSURANCE ADDL
INSDSUBRWVD POLICY NUMBER POLICY EFF
(MM/DD/YYYY)POLICY EXP
(MM/DD/YYYY) LIMITS
A X COMMERCIAL GENERAL LIABILITY X 6BRPG0000006430100 02/01/201912:01 AM EDT
02/01/202012:01 AM
EACH OCCURRENCE $1,000,000 CLAIMS-
MADE X OCCUR DAMAGE TO RENTEDPREMISES (Ea Occurrence) $1,000,000
MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE $5,000,000GEN’L AGGREGATE LIMIT APPLIES PER: PRODUCTS – COMP/OP AGG $1,000,000 POLICY PRO-
JECT LOC PROFESSIONAL LIABILITY $1,000,000 OTHER: LEGAL LIAB TO PARTICIPANTS $1,000,000
A AUTOMOBILE LIABILITY 6BRPG0000006430100 02/01/201912:01 AM EDT
02/01/202012:01 AM
COMBINED SINGLE LIMIT(Ea accident) $1,000,000
ANY AUTO BODILY INJURY (Per person) OWNED AUTOS
ONLY SCHEDULEDAUTOS BODILY INJURY (Per accident)
X HIREDAUTOS ONLY X NON-OWNED
AUTOS ONLYPROPERTY DAMAGE(Per accident)
X NOT PROVIDED WHILE IN HAWAII UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION
WORKERS COMPENSATION ANDEMPLOYERS’ LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory in NH)
If yes, describe under DESCRIPTIONOF OPERATIONS below
N/A PERSTATUTE OTHER
Y / N E.L. EACH ACCIDENT E.L. DISEASE – EA EMPLOYEE E.L. DISEASE – POLICY LIMIT
A MEDICAL PAYMENTS FOR PARTICIPANTS 6BRPG0000006430100 02/01/201912:01 AM EDT
02/01/202012:01 AM
PRIMARY MEDICAL EXCESS MEDICAL $25,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)Sexual Abuse or Sexual Molestation Liability - $1,000,000 each occurrence (included above)/$1,000,000 aggregate (included above)Legal Liability to Participants (LLP) limit is a per occurrence limit.Sport(s): Baseball Age(s): 12 and under, 13-15The certificate holder is added as an additional insured, but only for liability caused, in whole or in part, by the acts or omissions of the named insured.
CERTIFICATE HOLDER CANCELLATIONHuntington Beach City School District20451 Craimer LNHuntington Beach, CA 92646(Owner/Lessor of Premises)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE WITH THE POLICY PROVISIONS.AUTHORIZED REPRESENTATIVE
Coverage is only extended to U.S. events and activities.** NOTICE TO TEXAS INSUREDS: The Insurer for the purchasing group may not be subject to all the insurance laws and regulations of the State of Texas
ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
01/15/2019THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE 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 REPRESENTATIVEOR 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. IfSUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on thiscertificate does not confer rights to the certificate holder in lieu of such endorsement(s).PRODUCER CONTACT NAME: Mass Merchandising UnderwritingK&K Insurance Group, Inc.1712 Magnavox WayFort Wayne IN 46804
PHONE(A/C, No, Ext): 1-800-426-2889 FAX
(A/C, No): 1-260-459-5105E-MAILADDRESS: [email protected] ID:
INSURER(S) AFFORDING COVERAGE NAIC #
INSURED INSURER A: Nationwide Mutual Insurance Company 23787Fountain Valley Youth BaseballDBA: Fountain Valley Pony BaseballP.O. Box 8218Fountain Valley, CA 92728A Member of the Sports, Leisure & Entertainment RPG
INSURER B: INSURER C: INSURER D: INSURER E: INSURER F:
COVERAGES CERTIFICATE NUMBER: W01369839 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 BEISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OFSUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.INSRLTR TYPE OF INSURANCE ADDL
INSDSUBRWVD POLICY NUMBER POLICY EFF
(MM/DD/YYYY)POLICY EXP
(MM/DD/YYYY) LIMITS
A X COMMERCIAL GENERAL LIABILITY X 6BRPG0000006430100 02/01/201912:01 AM EDT
02/01/202012:01 AM
EACH OCCURRENCE $1,000,000 CLAIMS-
MADE X OCCUR DAMAGE TO RENTEDPREMISES (Ea Occurrence) $1,000,000
MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE $5,000,000GEN’L AGGREGATE LIMIT APPLIES PER: PRODUCTS – COMP/OP AGG $1,000,000 POLICY PRO-
JECT LOC PROFESSIONAL LIABILITY $1,000,000 OTHER: LEGAL LIAB TO PARTICIPANTS $1,000,000
A AUTOMOBILE LIABILITY 6BRPG0000006430100 02/01/201912:01 AM EDT
02/01/202012:01 AM
COMBINED SINGLE LIMIT(Ea accident) $1,000,000
ANY AUTO BODILY INJURY (Per person) OWNED AUTOS
ONLY SCHEDULEDAUTOS BODILY INJURY (Per accident)
X HIREDAUTOS ONLY X NON-OWNED
AUTOS ONLYPROPERTY DAMAGE(Per accident)
X NOT PROVIDED WHILE IN HAWAII UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION
WORKERS COMPENSATION ANDEMPLOYERS’ LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory in NH)
If yes, describe under DESCRIPTIONOF OPERATIONS below
N/A PERSTATUTE OTHER
Y / N E.L. EACH ACCIDENT E.L. DISEASE – EA EMPLOYEE E.L. DISEASE – POLICY LIMIT
A MEDICAL PAYMENTS FOR PARTICIPANTS 6BRPG0000006430100 02/01/201912:01 AM EDT
02/01/202012:01 AM
PRIMARY MEDICAL EXCESS MEDICAL $25,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)Sexual Abuse or Sexual Molestation Liability - $1,000,000 each occurrence (included above)/$1,000,000 aggregate (included above)Legal Liability to Participants (LLP) limit is a per occurrence limit.Sport(s): Baseball Age(s): 12 and under, 13-15The certificate holder is added as an additional insured, but only for liability caused, in whole or in part, by the acts or omissions of the named insured.
CERTIFICATE HOLDER CANCELLATIONCounty of Orange and the State ofCalifornia OC Parks and Permits, 13042 Old Myford RoadIrvine, CA 92602(Owner/Lessor of Premises)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE WITH THE POLICY PROVISIONS.AUTHORIZED REPRESENTATIVE
Coverage is only extended to U.S. events and activities.** NOTICE TO TEXAS INSUREDS: The Insurer for the purchasing group may not be subject to all the insurance laws and regulations of the State of Texas
ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
01/15/2019THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE 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 REPRESENTATIVEOR 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. IfSUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on thiscertificate does not confer rights to the certificate holder in lieu of such endorsement(s).PRODUCER CONTACT NAME: Mass Merchandising UnderwritingK&K Insurance Group, Inc.1712 Magnavox WayFort Wayne IN 46804
PHONE(A/C, No, Ext): 1-800-426-2889 FAX
(A/C, No): 1-260-459-5105E-MAILADDRESS: [email protected] ID:
INSURER(S) AFFORDING COVERAGE NAIC #
INSURED INSURER A: Nationwide Mutual Insurance Company 23787Fountain Valley Youth BaseballDBA: Fountain Valley Pony BaseballP.O. Box 8218Fountain Valley, CA 92728A Member of the Sports, Leisure & Entertainment RPG
INSURER B: INSURER C: INSURER D: INSURER E: INSURER F:
COVERAGES CERTIFICATE NUMBER: W01369840 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 BEISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OFSUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.INSRLTR TYPE OF INSURANCE ADDL
INSDSUBRWVD POLICY NUMBER POLICY EFF
(MM/DD/YYYY)POLICY EXP
(MM/DD/YYYY) LIMITS
A X COMMERCIAL GENERAL LIABILITY X 6BRPG0000006430100 02/01/201912:01 AM EDT
02/01/202012:01 AM
EACH OCCURRENCE $1,000,000 CLAIMS-
MADE X OCCUR DAMAGE TO RENTEDPREMISES (Ea Occurrence) $1,000,000
MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE $5,000,000GEN’L AGGREGATE LIMIT APPLIES PER: PRODUCTS – COMP/OP AGG $1,000,000 POLICY PRO-
JECT LOC PROFESSIONAL LIABILITY $1,000,000 OTHER: LEGAL LIAB TO PARTICIPANTS $1,000,000
A AUTOMOBILE LIABILITY 6BRPG0000006430100 02/01/201912:01 AM EDT
02/01/202012:01 AM
COMBINED SINGLE LIMIT(Ea accident) $1,000,000
ANY AUTO BODILY INJURY (Per person) OWNED AUTOS
ONLY SCHEDULEDAUTOS BODILY INJURY (Per accident)
X HIREDAUTOS ONLY X NON-OWNED
AUTOS ONLYPROPERTY DAMAGE(Per accident)
X NOT PROVIDED WHILE IN HAWAII UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION
WORKERS COMPENSATION ANDEMPLOYERS’ LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory in NH)
If yes, describe under DESCRIPTIONOF OPERATIONS below
N/A PERSTATUTE OTHER
Y / N E.L. EACH ACCIDENT E.L. DISEASE – EA EMPLOYEE E.L. DISEASE – POLICY LIMIT
A MEDICAL PAYMENTS FOR PARTICIPANTS 6BRPG0000006430100 02/01/201912:01 AM EDT
02/01/202012:01 AM
PRIMARY MEDICAL EXCESS MEDICAL $25,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)Sexual Abuse or Sexual Molestation Liability - $1,000,000 each occurrence (included above)/$1,000,000 aggregate (included above)Legal Liability to Participants (LLP) limit is a per occurrence limit.Sport(s): Baseball Age(s): 12 and under, 13-15The certificate holder is added as an additional insured, but only for liability caused, in whole or in part, by the acts or omissions of the named insured.
CERTIFICATE HOLDER CANCELLATIONIrvine PONY BaseballP.O. BOX 4790 IRVINE BLVD., SUITE 105-339IRVINE, CA 92620(Owner/Lessor of Premises)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE WITH THE POLICY PROVISIONS.AUTHORIZED REPRESENTATIVE
Coverage is only extended to U.S. events and activities.** NOTICE TO TEXAS INSUREDS: The Insurer for the purchasing group may not be subject to all the insurance laws and regulations of the State of Texas
ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
01/15/2019THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE 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 REPRESENTATIVEOR 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. IfSUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on thiscertificate does not confer rights to the certificate holder in lieu of such endorsement(s).PRODUCER CONTACT NAME: Mass Merchandising UnderwritingK&K Insurance Group, Inc.1712 Magnavox WayFort Wayne IN 46804
PHONE(A/C, No, Ext): 1-800-426-2889 FAX
(A/C, No): 1-260-459-5105E-MAILADDRESS: [email protected] ID:
INSURER(S) AFFORDING COVERAGE NAIC #
INSURED INSURER A: Nationwide Mutual Insurance Company 23787Fountain Valley Youth BaseballDBA: Fountain Valley Pony BaseballP.O. Box 8218Fountain Valley, CA 92728A Member of the Sports, Leisure & Entertainment RPG
INSURER B: INSURER C: INSURER D: INSURER E: INSURER F:
COVERAGES CERTIFICATE NUMBER: W01369841 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 BEISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OFSUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.INSRLTR TYPE OF INSURANCE ADDL
INSDSUBRWVD POLICY NUMBER POLICY EFF
(MM/DD/YYYY)POLICY EXP
(MM/DD/YYYY) LIMITS
A X COMMERCIAL GENERAL LIABILITY X 6BRPG0000006430100 02/01/201912:01 AM EDT
02/01/202012:01 AM
EACH OCCURRENCE $1,000,000 CLAIMS-
MADE X OCCUR DAMAGE TO RENTEDPREMISES (Ea Occurrence) $1,000,000
MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE $5,000,000GEN’L AGGREGATE LIMIT APPLIES PER: PRODUCTS – COMP/OP AGG $1,000,000 POLICY PRO-
JECT LOC PROFESSIONAL LIABILITY $1,000,000 OTHER: LEGAL LIAB TO PARTICIPANTS $1,000,000
A AUTOMOBILE LIABILITY 6BRPG0000006430100 02/01/201912:01 AM EDT
02/01/202012:01 AM
COMBINED SINGLE LIMIT(Ea accident) $1,000,000
ANY AUTO BODILY INJURY (Per person) OWNED AUTOS
ONLY SCHEDULEDAUTOS BODILY INJURY (Per accident)
X HIREDAUTOS ONLY X NON-OWNED
AUTOS ONLYPROPERTY DAMAGE(Per accident)
X NOT PROVIDED WHILE IN HAWAII UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION
WORKERS COMPENSATION ANDEMPLOYERS’ LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory in NH)
If yes, describe under DESCRIPTIONOF OPERATIONS below
N/A PERSTATUTE OTHER
Y / N E.L. EACH ACCIDENT E.L. DISEASE – EA EMPLOYEE E.L. DISEASE – POLICY LIMIT
A MEDICAL PAYMENTS FOR PARTICIPANTS 6BRPG0000006430100 02/01/201912:01 AM EDT
02/01/202012:01 AM
PRIMARY MEDICAL EXCESS MEDICAL $25,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)Sexual Abuse or Sexual Molestation Liability - $1,000,000 each occurrence (included above)/$1,000,000 aggregate (included above)Legal Liability to Participants (LLP) limit is a per occurrence limit.Sport(s): Baseball Age(s): 12 and under, 13-15The certificate holder is added as an additional insured, but only for liability caused, in whole or in part, by the acts or omissions of the named insured.
CERTIFICATE HOLDER CANCELLATIONCalvary Chapel High School3800 S. FairviewSanta Ana, CA 92704(Owner/Lessor of Premises)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE WITH THE POLICY PROVISIONS.AUTHORIZED REPRESENTATIVE
Coverage is only extended to U.S. events and activities.** NOTICE TO TEXAS INSUREDS: The Insurer for the purchasing group may not be subject to all the insurance laws and regulations of the State of Texas
ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
01/15/2019THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE 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 REPRESENTATIVEOR 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. IfSUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on thiscertificate does not confer rights to the certificate holder in lieu of such endorsement(s).PRODUCER CONTACT NAME: Mass Merchandising UnderwritingK&K Insurance Group, Inc.1712 Magnavox WayFort Wayne IN 46804
PHONE(A/C, No, Ext): 1-800-426-2889 FAX
(A/C, No): 1-260-459-5105E-MAILADDRESS: [email protected] ID:
INSURER(S) AFFORDING COVERAGE NAIC #
INSURED INSURER A: Nationwide Mutual Insurance Company 23787Fountain Valley Youth BaseballDBA: Fountain Valley Pony BaseballP.O. Box 8218Fountain Valley, CA 92728A Member of the Sports, Leisure & Entertainment RPG
INSURER B: INSURER C: INSURER D: INSURER E: INSURER F:
COVERAGES CERTIFICATE NUMBER: W01369842 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 BEISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OFSUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.INSRLTR TYPE OF INSURANCE ADDL
INSDSUBRWVD POLICY NUMBER POLICY EFF
(MM/DD/YYYY)POLICY EXP
(MM/DD/YYYY) LIMITS
A X COMMERCIAL GENERAL LIABILITY X 6BRPG0000006430100 02/01/201912:01 AM EDT
02/01/202012:01 AM
EACH OCCURRENCE $1,000,000 CLAIMS-
MADE X OCCUR DAMAGE TO RENTEDPREMISES (Ea Occurrence) $1,000,000
MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE $5,000,000GEN’L AGGREGATE LIMIT APPLIES PER: PRODUCTS – COMP/OP AGG $1,000,000 POLICY PRO-
JECT LOC PROFESSIONAL LIABILITY $1,000,000 OTHER: LEGAL LIAB TO PARTICIPANTS $1,000,000
A AUTOMOBILE LIABILITY 6BRPG0000006430100 02/01/201912:01 AM EDT
02/01/202012:01 AM
COMBINED SINGLE LIMIT(Ea accident) $1,000,000
ANY AUTO BODILY INJURY (Per person) OWNED AUTOS
ONLY SCHEDULEDAUTOS BODILY INJURY (Per accident)
X HIREDAUTOS ONLY X NON-OWNED
AUTOS ONLYPROPERTY DAMAGE(Per accident)
X NOT PROVIDED WHILE IN HAWAII UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION
WORKERS COMPENSATION ANDEMPLOYERS’ LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory in NH)
If yes, describe under DESCRIPTIONOF OPERATIONS below
N/A PERSTATUTE OTHER
Y / N E.L. EACH ACCIDENT E.L. DISEASE – EA EMPLOYEE E.L. DISEASE – POLICY LIMIT
A MEDICAL PAYMENTS FOR PARTICIPANTS 6BRPG0000006430100 02/01/201912:01 AM EDT
02/01/202012:01 AM
PRIMARY MEDICAL EXCESS MEDICAL $25,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)Sexual Abuse or Sexual Molestation Liability - $1,000,000 each occurrence (included above)/$1,000,000 aggregate (included above)Legal Liability to Participants (LLP) limit is a per occurrence limit.Sport(s): Baseball Age(s): 12 and under, 13-15The certificate holder is added as an additional insured, but only for liability caused, in whole or in part, by the acts or omissions of the named insured.
CERTIFICATE HOLDER CANCELLATIONCity of Huntington Beach2000 Main StreetHuntington Beach, CA 92648(Owner/Lessor of Premises)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE WITH THE POLICY PROVISIONS.AUTHORIZED REPRESENTATIVE
Coverage is only extended to U.S. events and activities.** NOTICE TO TEXAS INSUREDS: The Insurer for the purchasing group may not be subject to all the insurance laws and regulations of the State of Texas