Baseball Player Insurance Certificate Template - Free Download
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Baseball Player Insurance Certificate Template
Baseball Player Insurance Certificate Template
Jones Brown Inc.
435 McNeilly Road
Suite 103
Stoney Creek, ON L8E 5E3
PHONE: 905-575-6809 x.122 FAX:
905-643-8321
Ontario Baseball Association o/a Baseball Ontario
3 - 131 Sheldon Drive
Cambridge, ON N1R 6S2
Canada
Town of Ajax
65 Harwood
Ajax, ON L1S 2H9
X
X
X
X
X
X
X
GAME00459 -
Participant
Liability, Cross
Liability and
Severability of
Interest Included
GAME00459
GameDay Insurance Inc. underwritten by Aviva Insurance
A
A
5,000,000
5,000,000
5,000,000
5,000,000
2,000,000
5,000,000
50,000
Errors & Omissions/
Directors & Officers Liability
2,000,000
05/01/2016 05/01/2017
05/01/2016 05/01/2017
05/13/2016
4Y26SQR5
Sanctioned activities of the named Insured with respect to baseball activities for the Association and its Member Clubs
Town of Ajax is/are added as Additional Insured but only with respect to the Liability which arises out of the operations of the Named Insured Ontario Baseball
Association o/a Baseball Ontario for the following Member Club: Ajax Minor Baseball Association– Use of Facilities.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOUR TO MAIL 30 DAYS WRITTEN NOTICE
TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE
SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS
OR REPRESENTATIVES.
Page 1 of 1
CERTIFICATE OF INSURANCE
ISSUE DATE (MM/DD/YY)
CERTIFICATE OF INSURANCE
This certificate is issued as a matter of information only and confers no
rights upon the certificate holder. This certificate does not amend,extend
or alter the coverage afforded by the policies below.
Company
A
Company
B
BROKER
Company
C
Company
D
INSURED'S FULL NAME AND MAILING ADDRESS
Company
E
COVERAGES
This is to certify that the policies of insurance listed below have been issued to the insured named above for the policy period indicated, not withstanding 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 CO
LTR
POLICY NUMBER POLICY EFFECTIVE
DATE (MM/DD/YY)
POLICY EXPIRATION
DATE (MM/DD/YY)
LIMITS OF LIABILITY
(Canadian dollars unless indicated otherwise)
COMMERCIAL GENERAL LIABILITY
AUTOMOBILE LIABILITY
**ALL AUTOMOBILES LEASED IN EXCESS OF 30
DAYS WHERE THE INSURED IS REQUIRED TO
PROVIDE INSURANCE
EXCESS LIABILITY
OTHER (SPECIFY)
DESCRIPTION OF OPERATIONS/LOCATIONS/AUTOMOBILES/SPECIAL ITEMS/ ADDITIONAL INSURED
CERTIFICATE HOLDER CANCELLATION
AUTHORIZED REPRESENTATIVE
Per:_______________________________________
CLAIMS MADE
OCCURRENCE
PRODUCTS AND/OR
COMPLETED OPERATIONS
PERSONAL INJURY
EMPLOYER'S LIABILITY
TENANT'S LEGAL LIABILITY
NON-OWNED AUTOMOBILE
HIRED AUTOMOBILE
DESCRIBED AUTOMOBILES
ALL OWNED AUTOMOBILES
LEASED AUTOMOBILES **
GARAGE LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
EACH OCCURRENCE $
GENERAL AGGREGATE
$
PRODUCTS - COMP/OP
AGGREGATE
$
PERSONAL INJURY
$
EMPLOYER'S LIABILITY
$
TENANT'S LEGAL LIABILITY
$
NON-OWNED AUTOMOBILE
$
HIRED AUTOMOBILE $
BODILY INJURY
PROPERTY DAMAGE
COMBINED
$
BODILY INJURY
(Per person)
$
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE
$
EACH OCCURRENCE
AGGREGATE
$
$
$
$
$
$
$
Baseball Player Insurance Certificate Template Previous Page
source: ajaxbaseball.com
Baseball Player Insurance Certificate Template
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