2015-615 DEAPR - Hillsborough Youth Athletic Association Lease Agreement

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ACORD CERTIFICATE OF LIABILITY INSURANCE DATE D/YYYY) 1/30/20 15 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 K&K INSURANCE GROUP,INC. CONTACT Cheryl Pettibone 1712 MAGNAVOX WAY PHONE 800.736-7368 FAX PO BOX 2338 A/C No.Ezt: A/C,No): FORT WAYNE IN 46801 ADDRESS: Cheryl.Pettlbone @kandklnsurance.com INSURED INSURERS AFFORDING COVERAGE NAIC# MEMBER NO: INSURER A: Nationwide Life Insurance Co. INSURER B: Nationwide Mutual Insurance Co. HILLSBOROUGH YOUTH A.A.BABE RUTH LG INSURER C: DBA.HILLSBOROUGH YOUTH A.A.BABE RUTH LG INSURER D: P.0 Box 577 INSURER E: Hillsborough, NC, 27278 INSURER F: COVERAGES CERTIFICATE NUMBER: 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. TYPE OF INSURANCE POLICY NUMBER P LI LIMITS LTR INSD WVD MMI /YDDYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 B CLAIMS-MADE ❑X OCCUR 02/01/2015 02/01/2016 PREMISES Ea occurrence $ 300,000 X RPG-266488-00 12:01 AM 12:01 AM MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $5,000,000 POLICY E7 PROJECT F7 LOC PRODUCTS-COMP/OP AGG $1,000,000 OTHER: PARTICIPANT LEGAL LIABILITY $1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 Ea Accident ANY AUTO BODILY INJURY(Per person) 02/01/ 02/01/2016 B ALL OWNED AUTOS ISCHEDULED AUTOS RPG-286488-00 1201 A AM M 1201 AM BODILY INJURY(Per accident) X HIREDAUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE DED I I RETENTION WORKERS COMPENSATION Y/N STATUTE OTHER AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE—EA EMPLOYEE If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE—POLICY LIMIT A PARTICIPANT ACCIDENT SPP-266488-00 02/01/2015 02/01/2016 AD&D $ 10,000 12:01 AM 12.01 AM PRIMARY MEDICAL $ 250,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space Is required) THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED,BUT SOLELY WITH RESPECT TO THE OPERATIONS OF THE NAMED INSURED. RE: Owner,manager or lessor of the premises where you conduct practices or games SEXUAL ABUSE/MOLESTATION:$1,000,000 PER OCCURRENCE/$2,000,000 AGGREGATE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Orange County DEAPR ACCORDANCE WITH THE POLICY PROVISIONS. 302 West Tryon Street Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE ACORD 25(2014/01) ©1998-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD