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Insurance Certificate - NBC/Sunflower Collegiate League
DATE(MM/DD/YYYY) CERTIFICATEOFLIABILITYINSURANCE 5/24/2017 THISCERTIFICATEISISSUEDASAMATTEROFINFORMATIONONLYANDCONFERSNORIGHTSUPONTHECERTIFICATEHOLDER.THIS CERTIFICATEDOESNOTAFFIRMATIVELYORNEGATIVELYAMEND,EXTENDORALTERTHECOVERAGEAFFORDEDBYTHEPOLICIES BELOW.THISCERTIFICATEOFINSURANCEDOESNOTCONSTITUTEACONTRACTBETWEENTHEISSUINGINSURER(S),AUTHORIZED REPRESENTATIVEORPRODUCER,ANDTHECERTIFICATEHOLDER. IMPORTANT:IfthecertificateholderisanADDITIONALINSURED,thepolicy(ies)mustbeendorsed.IfSUBROGATIONISWAIVED,subjectto thetermsandconditionsofthepolicy,certainpoliciesmayrequireanendorsement.Astatementonthiscertificatedoesnotconferrightstothe certificateholderinlieuofsuchendorsement(s). CONTACT PRODUCER JackieAraiza NAME: FAX PHONE (210)524-7113(210)524-7193 MonarchManagementCorporation (A/C,No): (A/C,No,Ext): E-MAIL 3201CherryRidgeDrive ADDRESS: SuiteD405 INSURER(S)AFFORDINGCOVERAGENAIC# SanAntonioTX78230 StarrInternationalCompany INSURERA:38318 INSURED INSURERB: NBC/SunflowerCollegiateLeague INSURERC: POBox262 INSURERD: INSURERE: ViolaKS67149 INSURERF: CL1752410204 COVERAGESCERTIFICATENUMBER:REVISIONNUMBER: THISISTOCERTIFYTHATTHEPOLICIESOFINSURANCELISTEDBELOWHAVEBEENISSUEDTOTHEINSUREDNAMEDABOVEFORTHEPOLICYPERIOD INDICATED.NOTWITHSTANDINGANYREQUIREMENT,TERMORCONDITIONOFANYCONTRACTOROTHERDOCUMENTWITHRESPECTTOWHICHTHIS CERTIFICATEMAYBEISSUEDORMAYPERTAIN,THEINSURANCEAFFORDEDBYTHEPOLICIESDESCRIBEDHEREINISSUBJECTTOALLTHETERMS, EXCLUSIONSANDCONDITIONSOFSUCHPOLICIES.LIMITSSHOWNMAYHAVEBEENREDUCEDBYPAIDCLAIMS. ADDLSUBR INSR POLICYEFFPOLICYEXP TYPEOFINSURANCELIMITS LTRPOLICYNUMBER (MM/DD/YYYY)(MM/DD/YYYY) INSRWVD GENERALLIABILITY 1,000,000 EACHOCCURRENCE$ DAMAGETORENTED 300,000 X COMMERCIALGENERALLIABILITY$ PREMISES(Eaoccurrence) 5/23/20171/15/2018 1000107639-1 5,000 A CLAIMS-MADEOCCURMEDEXP(Anyoneperson)$ X 1,000,000 PERSONAL&ADVINJURY$ 2,000,000 GENERALAGGREGATE$ 2,000,000 GEN'LAGGREGATELIMITAPPLIESPER:PRODUCTS-COMP/OPAGG$ PRO- $ X POLICYLOC JECT COMBINEDSINGLELIMIT AUTOMOBILELIABILITY (Eaaccident)$ BODILYINJURY(Perperson)$ ANYAUTO ALLOWNEDSCHEDULED BODILYINJURY(Peraccident)$ AUTOSAUTOS NON-OWNED PROPERTYDAMAGE $ HIREDAUTOS (Peraccident) AUTOS $ UMBRELLALIAB EACHOCCURRENCE$ OCCUR EXCESSLIAB CLAIMS-MADEAGGREGATE$ $ DEDRETENTION$ WCSTATU-OTH- WORKERSCOMPENSATION TORYLIMITSER ANDEMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACHACCIDENT$ N/A OFFICER/MEMBEREXCLUDED? (MandatoryinNH) E.L.DISEASE-EAEMPLOYEE$ Ifyes,describeunder E.L.DISEASE-POLICYLIMIT$ DESCRIPTIONOFOPERATIONSbelow DESCRIPTIONOFOPERATIONS/LOCATIONS/VEHICLES(AttachACORD101,AdditionalRemarksSchedule,ifmorespaceisrequired) Thecertificateholderlistedbelowisaddedasanadditionalinsuredasrequeredbywrittencontract, butonlywithrespecttoliabilityarisingoutoftheoperationsofthenamedinsuredduringthepolicy term. CERTIFICATEHOLDERCANCELLATION SHOULDANYOFTHEABOVEDESCRIBEDPOLICIESBECANCELLEDBEFORE THEEXPIRATIONDATETHEREOF,NOTICEWILLBEDELIVEREDIN ACCORDANCEWITHTHEPOLICYPROVISIONS. CityofSalina P.O.Box736 AUTHORIZEDREPRESENTATIVE Salina,KS67402-0736 WayneMalzone/ARAIZA ACORD25(2010/05)©1988-2010ACORDCORPORATION.Allrightsreserved. INS025(201005).01 TheACORDnameandlogoareregisteredmarksofACORD