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6.3.B. - Page 7 <br /> ACCORD CERTIFICATE OF LIABILITY INSURANCE VN I c 4mMIUMPT rnl <br /> fir" 08/07/2017 <br /> THIS CERTIFICATEI ISSUED A A MATTER OF INFORMATION N CONFER NO RIGHTS UPON THE CERTIFICATE HOLDER, THISI <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE <br /> OR PRODUCER AND THE CERTIFICATE HOLDER, <br /> IMPORTANT: the certificate holder Is an ADDITIONAL INSURED,t e policy(los)must have ADDITIONAL INSURED provisions or be endorsed. I <br /> SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this <br /> certificate does not confer rights to the certificate holder In lieu of such endorsement(s). <br /> PRODUCER CONTACT NAME: Masa Merchandising Underwriting <br /> K&K Insurance Group,Inc. PHA <br /> 1712 Magnavox Way Alo No Ext): 800-426.2889 (AIC,No): 260.459.5105 <br /> Fort Wayne IN 46804 AODREss: into@sportsinsurance-kk.com <br /> CUSTOMER to: <br /> INSURERS)AFFORDING COVERAGE NAIC# <br /> INSURED INSURER A: Nationwide Mutual Insurance Company 23787 <br /> Sequoia High School Sport and Spirit Boosters INSURER B: <br /> 1201 Brewster Ave -- -- <br /> Redwood City,CA 94062 INSURER C: <br /> A Member of the Sports,Leisure&Entertainment RPG INSURER D: <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: W01077781 REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. <br /> NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE <br /> ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF. <br /> I <br /> SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> LTR TYPE OF INSURANCE INSD UB POLICY NUMBER MM/DD MMIDD/YYYY LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY 6BRPG0000006055900 09/16/2017 09/18/2017 EACH OCCURRENCE $2,000,000 <br /> pES' X�OCCUR 12:01 AM EDT 12:01 AM <br /> PREMISES Ea Occurrence $1,000,000 <br /> MED EXP(Any one person) $5,000 <br /> PERSONAL&ADV INJURY $2,000,000 <br /> GENERAL AGGREGATE $5,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $2,000,404 <br /> PRO-POLICY ❑JECT LOC PROFESSIONAL LIABILITY <br /> OTHER LEGAL LIAB TO PARTICIPANTS $2,000,000 <br /> AUTOMOBILE LIABILITYN <br /> Ea accident <br /> CE LIMIT <br /> ANY AUTO BODILY INJURY(Per person) <br /> OWNED AUTOS SCHEDULED BODILY INJURY Peraazdont <br /> ONLY 8 AUTOS ( ) <br /> HIRED NON-OWNED PROPERTY DAMAGE <br /> AUTOS ONLY AUTOS ONLY Per aceldent <br /> NOT PROVIDED WHILE IN HAWAII <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE <br /> DED RETENTION <br /> WORKERS COMPENSATION ANDN/A OTHER <br /> EMPLOYERS'LIABILITY STATUTE Li <br /> ANY PROPRIETOR/PARTNERI Y/N E L EACH ACCIDENT <br /> EXECUTIVE (Mandatory <br /> MBER <br /> In NH) ❑ E L.DISEASE-EA EMPLOYEE <br /> EXCLUDED?(Mandatory In NH) <br /> If yes,describe under DESCRIPTION <br /> OF OPERATIONS below E L DISEASE-POLICY LIMIT <br /> A MEDICAL PAYMENTS FOR PARTICIPANTS BBRPGOOOOOO605590009/16/2017 09!1812017 PRIMARY MEDICAL <br /> 12 01 AM EDT 12:01 AM EXCESS MEDICAL $25,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) <br /> Legal Liability to Participants(LLP)limit is a per Occurrence limit. <br /> Event Name:Sequoia Stampede Type of Event:Walk and Run Distance:5K <br /> Event Date(including ancillary events and set-up/tear-dawn):9/16/2017 to 9/17/2017 Number of Participants:600 Event Location:Sequoia High School <br /> CERTIFICATE HOLDER CANCELLATION <br /> Evidence of Coverage SH ULD ANY OF TRE ABOVE 5ESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> Coverage is only extended to U.S.events and activities <br /> 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 <br /> ACORD 26(2016/03) O 1988.2016 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />