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CERTIFICATE OF LIABILITY INSURANCE |_ omnes
‘TE
ACORD
a ‘
01/28/2026
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND GONFERS 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 DOFS NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. : ‘
IMPORTANT: 4f the cartificate 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 daes not confer rights to the certificate holder in Iteu_ of such endorsement(s). :
PRODUGER GONTACT
American Speciaity insurance & Risk Services, Inc. PHONG Extt: l Te elope
dba AS Insurance & Risk Services Agency FA ass ’
| 7609 W. Jafferson Bivd., Suite 100 INSURER(S) AFFORDING COVERAGE NAIG#
Fort Wayne IN 46804 msurera: Arch Insurance Company 11150
INSURED : INSURERB :
M&M Youth Sports LLC dba Soccer Shots Buffalo INSURERG:
408 Old Carriage House Rd INSURERDs
: : INSURER E:
Grand Island NY 14072 INSURERF:
COVERAGES CERTIFICATE NUMBER: 1002440387 REVISION NUMBER:
THIS 18 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 |S SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REQUGED BY PAID CLAIMS. :
SR ‘TYPE OF INSURANCE
ADBL|SUBR|
INSD POLICY NUMBER dina donee LIMITS
SC] COMMERGIAL GENERAL LIABILITY EAGH OGGURRENCE s_ 1,000,000
DAMAGE TO RENTED
| cams-wane OGGUR : PREMISES (Ea cecurence) | $__ 1,000,000
[| MED EXP {Any one person) | §
Al Y | SBCGL2232204 06/01/2025 | 06/01/2026 | personal. ADvinJuRY | 8 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: . GENERAL AGGREGATE 35,000,000
[X] roucy[_ ]58% [ue ~~ poy PRODUCTS - coMPIOP AGG | § 5,000,000
OTHER: §
—, COMBREDSNGLELITT [5
AUTOMOBILELIABILITY
ANY AUTO BODILY INJURY (Per person) | $
[
LSP |OwNeD oney SCHEDULED
SCHED . : BODILY INJURY (Fer accident) [ $
RED NON-OWNED PROPERTY DAMAGE $
|__| AUTOS ONLY AUTOS ONLY | {Per agnident)
8
UMBRELLA LIAB OCCUR EACH OCCURRENCE §
EXCESS LIAB CLAIMS. MADE AGGREGATE $
nes | | Revewtions §
WORKERS COMPENSATION , rea CTH
AND EMPLOYERS" LIABILITY YIN [Etawe | [ee
ANYPROPRIETOR/PARTNER/EXECUTIVE ELE
OFFICER/MEMBEREXCLUDED? NIA LEACH ACGIDENT $
(Mandatory in NH) E., DISEASE -EA EMPLOYEE] §
tyes, describe under Et. DISEASE - POLICY LIMIT | $
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS f LOCATIONS / VEHICLES (ASORD 191, Additional Romarka Schedute, may he attached if more spaca ls required)
- Sexual Abuse or Molestation Coverage Is Included on the GL Policy. $1,000,000 Limit each occurrence, $2,000,000 Limit Aggregate.
- Coverage available under policy SR2014PA-P-084014-000 is on file with the policyholder. Accident Medical Coverage, $25,000 per Injury excess of any
othar valld and collactible Insurance (no deductible applies). Accidental Death and Dismemberment $40,000 per person per aceldent.
CERTIFICATE HOLDER CANCELLATION
Town of Aurora Parks & Recreation, New York State SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
575 Oakwood Ave.
AUTHORIZED REPRESENTATIVE
East Aurora NY 14052 tht
i
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