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COI - Audax Soccer Club - Expires 2024-04-18 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/ DD/ YYYY) 04/12/2023 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 SADLER & COMPANY, INC. P.O. BOX 5866 COLUMBIA, SOUTH CAROLINA 29250-5866 CONTACT NAME: Sports Dept PHONE (A/ C, No. Ext): 800-622-7370   |   FAX (A/ C, No): 803-256-4017 E- MAIL ADDRESS: soda@sadlersports.com PRODUCER CUSTOMER ID#: INSURED D/ B/ A SPORTSPLEX OPERATORS AND DEVELOPERS ASSOCIATION Audax Soccer Club 203 windsong way gilroy, CA 95020 Club #: C.85338 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: State National Insurance Company 12831 INSURER B: Sirius America Insurance 38776 INSURER C: INSURER D: 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. INSD LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/ DD/ YYYY) POLICY EXP (MM/ DD/ YYYY) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY    CLAIMS MADE   OCCUR ____________________ ____________________ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY  PROJECT  LOC OTHER X   OVE-0000286-00 12:01AM ET 04/18/2023 12:01AM ET 04/18/2024 EACH OCCURRENCE $2,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence)$1,000,000 MEDICAL EXPENSES (other than participants)$5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $3,000,000 PRODUCTS- COMP/ OP AGG $1,000,000 LEGAL LIAB TO PARTICIPANTS $2,000,000 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON- OWNED AUTOS    n/ a n/ a n/ a COMBINED SINGLE LIMIT (Ea Accident)$1,000,000 BODILY INJURY (Per person)  BODILY INJURY (Per accident)  PROPERTY DAMAGE (Per accident)  A SEXUAL ABUSE / MOLESTATION    OVE-0000286-00 12:01AM ET 04/18/2023 12:01AM ET 04/18/2024 EACH OCCURRENCE $1,000,000 AGGREGATE $2,000,000   UMBRELLA LIAB   OCCUR EXCESS LIAB   CLAIMS- MADE DEDUCTIBLE RETENTION    n/ a n/ a n/ a EACH OCCURRENCE n/ a AGGREGATE n/ a      WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below    N/ A PER STATUE OTHER   E.L. EACH ACCIDENT   E.L. DISEASE - EA EOMPLOYEE   E.L. DISEASE - POLICY LIMIT   B PARTICIPANT ACCIDENT    PHSA- BAM-10089- C.85338 12:01AM ET 04/18/2023 12:01AM ET 04/18/2024 EXCESS MEDICAL $100,000 AD&D $10,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: COVERED Team(s) - Youth - Accident & General Liability Soccer - 6 Team(s) - [Maximum 18 players per team] Team Names: Soccer Teams: Rec League 5-6, Rec League 7-8, Rec League 9-13, U8- U9 Boys, U9 Girls, Mini- Junior- Dax (Accident Package Youth Team: $100,000 Excess Medical; $10,000 Accidental Death or Dismemberment; $250 per claim deductible) (General Liability Package Youth Team: $2,000,000 Each Occurrence; $1,000,000 Participant Legal Liability Sublimit; $1,000,000 Neurodegenerative Sublimit; Waiver/ Release Recommended) The certificate holder is added as an additional insured, but only with respect to the liability arising out of the operations of the insured above. CERTIFICATE HOLDER CANCELLATION RELATIONSHIP: Property Owner/ Lessor City of Gilroy, Its Officers, Officals and employees 7351 Rosanna Street Gilroy, CA 95020 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 (company A) Y/ N Sadler Sports: SODA DocuSign Envelope ID: 7E8880D7-4B3F-4AB3-B820-9C41CA14F1F3 AUTHORIZED REPRESENTATIVE (company B) 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 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD With respects to CG- GL- CW-0025, Sexual Abuse Endorsement, it is agreed that no coverage shall apply for any insured who does not meet the following risk management guidelines. Have a system in place to perform and running criminal background checks on paid staff and volunteers.1. Have written procedures that include sexual abuse & molestation prevention.2. NOTEPAD: INSURED NAME: Audax Soccer Club ISSUE DATE (MM/ DD/ YY) 04/12/2023 09:52:31 AM ET Member Leagues: Soccer Teams: Rec League 5-6, Rec League 7-8, Rec League 9-13, U8- U9 Boys, U9 Girls, Mini- Junior- Dax --- Sadler Sports: SODA DocuSign Envelope ID: 7E8880D7-4B3F-4AB3-B820-9C41CA14F1F3 --- ENDORSEMENT NO. 0000 ATTACHED TO AND FORMING A PART OF POLICY NUMBER ENDORSEMENT EFFECTIVE DATE (12:01 A.M. STANDARD TIME)NAMED INSURED AGENT NO. OVE-0000286-00 04/12/2023 Audax Soccer Club THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSUREDS OWNERS AND/ OR LESSORS OF PREMISES, SPONSORS OR CO- PROMOTERS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART A. SECTION II — WHO IS AN INSURED is amended to include as an additional insured any per- son(s) or organization(s) of the types indicated by an “x” in any boxes shown below, but only with respect to liability for “bodily injury,” “property damage” or “personal and advertising injury” caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: In the performance of your ongoing operations; or1. In connection with your premises owned by or rented to you. However: 2. The insurance afforded to such additional insured only applies to the extent permitted by law; and 1. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. With respect to an additional insured owner and/ or lessor of premises, this insurance does not apply to: 2. An “occurrence” or offense which takes place while you are not a tenant in possession of the subject premises. 1. “Bodily injury” or “property damage” arising out of:2. Structural alterations, new construction or demolition operations performed by or on behalf of the owner and/ or lessor of premises; 1. Any design defect or structural maintenance of the premises; or 2. Any premises defect.3. B. With respect to the insurance afforded to these additional insureds, the following is added to SECTION III — LIMITS OF INSURANCE: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: Required by the contract or agreement; or1. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. 2. This endorsement shall not increase the applicable Limits of insurance shown in the declarations. Schedule of Additional Insureds: [X] Owners and/ or Lessors of the premises leased, rented or loaned to you [X] Sponsors [X] Co- Promoters [ ] Any individual person(s) or organization(s) listed below COACHES, OFFICIALS AND VOLUNTEERS WHILE ACTING WITHIN THE SCOPE OF THEIR DUTIES FOR THE INSURED. KR- GL-56 (7-18) Page 1 of 1 Sadler Sports: SODA DocuSign Envelope ID: 7E8880D7-4B3F-4AB3-B820-9C41CA14F1F3 AUDAX SOCCER CLUB Gilroy, CA T0: City of Gilroy | Recreation Division Att: Monica Sendejas | Recreation Coordinator August 16th, 2021 Re: Audax Soccer Club Workers’ Compensation Insurance Worker ’s Compensation Insurance Exemption Currently,all Audax Soccer Club coaches and administrative staff are independent contractors. All staff payments are reported by filing Form 1099 (Nonemployee Compensation). Audax Soccer Club currently does not run payroll;therefore,it is not required by the IRS to carry workers’ compensation insurance. Audax Soccer Club’s current liability and general insurance covers the coaching and administrative staff, as well as club’s officers. Sincerely, ________________________________________________________________ Rafael Soares (Audax Soccer Club Director)Date 08/16/2021 DocuSign Envelope ID: 7E8880D7-4B3F-4AB3-B820-9C41CA14F1F3