INSURANCE CERTIFICATE
s
ACaRDIA EAST . TAMPA BAY
P.O. Box 31666
Tampa, FL 33631-3666
727.796-6666
DATE {MM/DD/YYI
03/14/01
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.
PRODUCER
INSURERS AFFORDING COVERAGE
INSURED
Clearwater Chargers Soccer
% Cathy Weatherilt
880 Bay Esplanade
Clearwater FL 33767
COVERAGES
INSURER A:
!INSURER B:
i INSURER c:
: INSURER D:
Scottsdale Insurance Company
INSURER E:
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING
ANY REOUIREMENT, 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, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
I~~: TYPE OF INSURANCE POLICY NUMBER ~~~~Y';~6%T~~~ Pgk!fEY,~~I~~W~ LIMITS
-~._- ., ,~ , '- . I ... ........
A GENERAL LIABILITY BIND428308 2/19/01 2/19/02 EACH OCCURRENCE $ 1000000
-
.x COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone firel $ 50000
~ CLAIMS MADE W OCCUR MED EXP IAny one person) $ 5000
-
PERSONAL & ADV INJURY $ 1000000
-
GENERAL AGGREGATE $ 1000000
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS, COMP/OP AGG $ 1000000
I POLICY n ~~;?T n LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- $
ANY AUTO lEa accidenll
-
ALL OWNED AUTOS 1 BODILY INJURY
- $
I (Per person)
SCHEDULED AUTOS 1
-
HIRED AUTOS I I
- BODILY INJURY $
NON,OWNED AUTOS (Per accident)
-
-- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY, EA ACCIDENT $
==1 ANY AUTO I EA ACC $
I OTHER THAN
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
~ OCCUR D CLAIMS MADE AGGREGA TE $
I $
1 DEDUCTIBLE I $
i
RETENTION $ $
_. WORKERS COIVIPENSArioNAND ' ---- -- -- "' - - --- -. - - " __-u_ __"_ "_.____:"_'-___"__ ,I WC STATU, I :Ol~' , .... -
EMPLOYERS' LIABILITY e-:.::J:.TORYllMITS f' .
E,L. EACH ACCIDENT $
E,L. DISEASE, EA EMPLOYEE $
E,L. DISEASE, POLICY LIMIT $
OTHER I
,
I
I I
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS REGEl l::.U
MAR 1 ~ 2001
I\I'I"\J f\11:01.( ll-I-'AH I Mt::i\lT
CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION v..-
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITY OF CLEARWATER DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
POBOX 4748 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
CLEARWATER, FL 33757 IMPOSE NO 01 ,-IGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATI ES, /)
I AUTH~ ~ ~ ~/M
ACORD 25,S (7/97)
45.41
@ ACORD CORPORATION 1988
.(
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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),
__~ _c""--
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s). authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25.S (7/97)