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2021/07/01 California State Soccer Association - South (Cal South)WILLIS TOWERS WATSON 26 CENTURY BLVD. 6TH FL NASHVILLE, TN 37214 6368 1 MB 0.447 CITY OF MENIFEE 6368 29844 HAUN RD MENIFEE, CA 92586-6539 ****NOTICE**** We attempted to deliver this certificate to you electronically using the information we have currently in our system. However, our email has been rejected as undeliverable to the email address/fax number provided. In order to continue receiving certificates electronically, please provide Willis Towers Watson Certificate Center with an updated email address or fax number using the contact information below. If you do not wish to receive electronic copies in the future or no longer require a certificate for this Insured, please note as such below. Please complete this form and submit with a copy of your current certificate to the contact information below: Do you wish to receive renewal certificates: Yes [ ] No [ ] Certificate Holder Name and Address: Email Address or Fax Number: Certificate Number: If you require additional information or have further questions, please feel free to contact: Willis Towers Watson Global Certificate Center Email: EDPCERTS@willistowerswatson.com Fax: 888-467-2378 Phone: 877-945-7378 Please note that it is your responsibility to provide up-to-date contact information to assure correct distribution of any future renewal certificates. 1 of 3 6368 Page 1 of 1 ACaRhr CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD(YYYY) L__- 06/30/2021 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(les) 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). PRODUCER CONTACT Willis Towers Watson Certificate Center NAME Willis Towers Watson Southeast, inc- PHONE 1-877-945-7378 1-888-467-2378 c/o 26 Century Blvd - NC P.O. Box 305191 E-MAILoertilicateagwillis.com Nashville, TN 372305191 USA INSURERS AFFORDING COVERAGE NAIC# INSURER A: Everest National Insurance Company 1012.0 INSURED CALIFORNIA STATE SOCCER ASSOCIATION - SOUTH (CAL SOUTH) 1029 S. Placentia Avenue Fullerton, CA 92831 IINSURER B: HDI Global Insurance Company 1 41343 I INSURER D : INSURER E : COVERAGES CERTIFICATE NUMBER: W21485764 RFVISIAN NI IMRFR- 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 TYPE ADi]LSUi3R� - rPOLICYEFF - POLSgqYEXP �- LIMITS POLICY NUMBER WD YY M+DtuYYYY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE L""J OCCUR EACHOCCURRENCE $ 1,000,000 DAMAGE TO-AFITTI717— PREM! ESLE3Locr�{n{gig] $_ 1,000,000 A X Participant 6 Legal rAabiliE MCD EXP (An one person) $ 5,000 y SIBML01152-211 1 07/01/2021 07/01/2022 X Abuse 5 molestation PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY L PRO- JECT [] LOC GENERAL AGGREGATE PRODUCTS -COMP/OP AGG $ 3,000,000 $ 3,000,000 X. OTHER, For Team (15M Pal Agg) $ AUTOMOBILE LIABILITY f COMWNEDSINGLELIMIT _� �acciclontJ--_ $ BODILY INJURY (Per person) ANY AUTO $ OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY BODILY INJURY (Per aceldenl) $ $ pFK]PERTYDAMAGE 1Pgr OCgldenl) EACH OCCURRENCE $ $ 4,000,000 H UMBRELLA LIAB X 1 OCCUR )( X AGGREGATE $ 4,000,000 $ EXCESS LIAB CLAIMS -MADE DED 1 RETENTIONS D 07/01/2021 07/01/2022 WORKERSCOMPENSATION PER AND EMPLOYERS' LIABILITY ANYPRYIN PRIETOR PARTNER/EXECUTIVE OFFICE OFFICER/MEMBEREXCLUDED? NIA; T E F-L.EACH ACCIDENT $ (Mandatory In NH) II yes, describe under DESCRIPTION OF OPERATION b low E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) LEAGUE; 0574 LEAGUE NAME: Menifee youth Soccer League ADDRESS: 29682 Coll Meadow Drive Menifee CA 92584 *Mod Pay applies for spectators only. Certificate Holder in an additional insured as respects CalSouth youth soccer sanctioned events only where required by written contract and per attached endorsement. Practice and games Facilities throughout Menifee 29714 Haun Road Menifee 92586 CE11 I IFICATE HOLDER CANCELLATION City of Menifee 29844 Haun Road Menifee, CA 92586 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 QQ r]� 01988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SR In: 21296159 eATcH: 2150372 2 of 3 6368 Page 1 of 1 �� CERTIFICATE OF LIABILITY INSURANCE °06/30/2021Y' 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(les) 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 endorsements . PRODUCER CONTACT Willis Towers Watson Certificate Center Willis Towers Watson Southeast, Inc. NAME: PHONE 1-877-945-7378 FAQ 1-888-467-2378 c/o 26 Century Blvd P.O. Box 305191 E • certiiicataa�willie.00m Nashville, TN 372305191 USA INSURERS AFFORDINGCOVERAOE NAICIF INSURED CALIFORNIA STATE SOCCER ASSOCIATION - SOUTH (CAL SOUTH) 1029 S. Placentia Avenue Fullerton, CA 92831 UN INSURER A: Everest National Insurance Company 10120 INSURERB: HDI Global Insurance Company 42343 INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE 1111MAFR: W21485766 1= rVIR11.7N IJIIMRFR- 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. (LSR TYPEOFINSURANCE AODLSUBR rOLICrr�uen6lR POLIC°/YYYYY MMIL010Y.E Y LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR EACHOCCURRENCE 8 1,000,000 _ _PREp�{I$�AO ,� --] $ 1,000,000 A X Participant & Legal LiabilitN MED EXP (Any one person) $ 5,000 X Abuse & molestation Y SIBML01152-211 07/01/2021 01/01/2022 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY u jR� a LOG Hx GENERAL AGGREGATE PRODUCTS - COMP/OP AGO $ _ 3,000,000 $ 3,000,000 OTHER:Per Team (15M Rol Agg) $ AUTOMOBILE LIABILITY QOMElI1,1EDSINGLE LIMIT $ } ANY AUTO BODILY INJURY (Per person) $� OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTYDAMKO „jPer.agCi{fei�l}. _ $ _ B UMBRELLA LIAB X OCCUR EACHOCCURRENCE $ 4,000,000 X AGGREGATE $ 4,000,000 EXCESS LIAO CLAIMS,MADE 18EX2269 07/01/2021 07/01/2022 X i DED RETENTIONS 0 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A I PER Lk1lkiv.1a E.L. EACH ACCIDENT $ (Mandatory In NH) E.L.OISEASE - EA EMPLOYEE $ II yes, descnkie under DESCRIPTION OF OPERATIONS below E.L. DISEASE • POLICY LIMIT 5 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) LEAGUE: 0574 LEAGUE NAME: Menifee youth Soccer League ADDRESS: 29682 Coll Meadow Drive Menifee CA 92584 *Mad Pay applies for spectators only. Certificate Holder is an additional insured as respects CalSouth youth soccer sanctioned events only where required by written contract and per attached endorsement. Practice and games Facilities throughout Menifee 29714 Haun Road Menifee 92586 CERTIFICATE HOLDER City of Menifee 29844 Haun Road Menifee, CA 92586 CANCELLATION 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 (��-44 ® 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SR — 21296159 BATCH: 2150372 3 of 3 6368