CERTIFICATE OF LIABILITY INSURANCE
A~ORDTM
CERTIFICATE OF LIABILITY INSURANCE
DATE
06/05/2001
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
Bill Bozeman Insurance Agency Inc
6400 Central Avenue
St Petersburg
FL 33707-1329
INSURERS AFFORDING COVERAGE
INSURED
Suncoast Youth Football Conference
PO BOX 60782
INSURER A MOUNT VERNON FIRE CO
St Petersubur
COVERAGES
FL 33784-
INSURER B:
INSURER C
INSURER D:
INSURER E:
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.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE Pgk~JI~~6~~N LIMITS
LTR DATE (MMIDDIYV)
A GENERAL LIABILITY / / / / EACH OCCURRENCE $ 1,000,000
-
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire) $
I CLAIMS MADE 0 OCCUR CL2233437 OS/22/2001 OS/22/2002 MED EXP (Anyone person) $
PERSONAL & ADV INJURY $
-
- / / / / GENERAL AGGREGATE $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $
!Xl POLICY n j~8i n LOC / / / /
r_~.UTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMIT
ANY AUTO (Ea accident) $
I--
f-- ALL OWNED AUTOS / / / / BODILY INJURY
SCHEDULED AUTOS (Per person) $
I--
- HIRED AUTOS / / / / BODILY INJURY
NON,OWNED AUTOS (Per accident) $
- / / / /
- PROPERTY DAMAGE
(Per accident) $
~RAGE LIABILITY AUTO ONLY, EA ACCIDENT $
ANY AUTO / / / / OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY / / / / EACH OCCURRENCE $
D OCCUR D CLAIMS MADE AGGREGATE $
$
',', ~ DEDUCTIBLE_ - ~ '- -- / I I / - '.-, --- - '--, $ -- ---
RETENTION $ $
WORKERS COMPENSATION AND / / / / I T~~nfJNs I 10TH,
EMPLOYERS' LIABILITY ER
E.L. EACH ACCIDENT $
/ / / / EL DISEASE - EA EMPLOYEE $
E.L DISEASE - POLICY LIMIT $
OTHER
/ / / /
DESCRIPTION OF OPERATIONS/LOCATlONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CERTIFICATE HOLDER ALS NAMED AS ADDITIONAL INSURED
CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER: CANCELLA TION
CITY OF CLEARWATER PARKS & RECREATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
RISK MANAGEMENT EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
PO BOX 4748 030 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
-
CLEARWATER FL 33758- FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR L~ ITY OF ANY KIND UPON THE
INSURER, ITS AGENTS oR'Bel'~jSENTATIVES... U
AUTHORIZED RnT_AJP1' J, C::' "" .I.~. , ~
nttr I .......... J >1'
ACORD 25-S7l91) , " <t?CORD CORPORATION'1988
(
fieTM-INS025S (9910) Off (],.
Cc tRfj~ (
C 1771 c! t ~RONIC LASER FORMS, INC - (800)327,0545
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Page 1 of2
~
bill
bozeman
i",ulaftce Ggency. inc.
NAMED INSURED:
Suncoast Youth Football Conference, Inc. Etal
Azelea JI' Football Association
Clearwater Youth Football, Inc
Countryside Jr., Cougars Inc
Dixie Jr Rebels, Inc
Dunedin Jr Falcons, Inc
Northeast Bandits Youth Football, Inc
Seminole Youth Athletic Association'
Tarpon Springs North Pinellas Youth Footballlnc
Pine lias Park Thundel'birds
ADDITIONAL NAMED INSUREDS:
School Board Of Pinellas County
Real Property
Walter Pownall Service Center
11111 S Belcher Rd
Largo, FI 33773
City Of Clearwater Parks & Recreation
Risk Management
PO Box 4748
Clearwater, FI 33758
Pine lias County Parks & Recreation
Risk Management
49.Q~ ~ Ft HarL[~_Qf} A~IQ~__ '___~_~
Clearwater, FI 33756
City Of St Petersburg Athletic
1320 5th St N
St Petersburg, Fl 33701
City Of Tarpon Springs
Tarpon Spl'ings Community Center
400 S Walton Ave
Tarpon Springs, FI 34689
St Petersburg Catholic High School
6333 gill Ave N
St Petersburg, FI 337'10
City of Pinellas Park
5'14 '1 78111 Ave N
Pinellas Parl<:, FI 3378'1
G'\OO CENTRAL AVi::NUE, ST. PETERSBURG, FLORIDA 33707-1393 Phono: (727) 3'17:3150
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WWW.GOZEMANINSURANCEO.COM