CERTIFICATE OF LIABILITY INSURANCE
'ACORDTM CERTIFICAli
..
OF LIABILITY INSUR NCE
DATE (MM/DDNY)
05/17/2000
P~ODUCER
Bill Bozeman Insurance Agency
6400 Central Avenue
St Petersburg, FL 33707-132
P:727-347-3158 F:727-384-2468
THIS CERTIFICATE IS I~UED 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.
INSURERS AFFORDING COVERAGE
INSURED
Suncoast Youth Football Conference
PO BOX 7377
-"------..----,--..,.-----.--
INSURER A MOUNT VERNON INSURANCE CO
INSURER B
INSURER C
CLEARWATER
FL 33758-
INSURER 0
INSURER E
COVERAGES
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 ..---.-...- -~POllCY.EFFECTlVE . POLICY ExpiRATION' LIMITS
TR TYPE OF INSURANCE POLICY NUMBER 0 E MOTE ID
GENERAL LIABILITY
A IX] COMMERCIAL GENERAL LIABILITY CL 2220134
D CLAIMS MADE ~OCCUR
05/11/2000
05/11/2001
EACH OCCURRENCE
F~RE DAMAGE (A,,-y one fire)
MED EXP_ (Anyone person)
$ 500,000
$ NOT COVERED
--'---'--
$ NOT COVERED
$ NOT COVERED
$ ___ 500 L 000
$
**
D
D
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
AUTOMOBILE LIABILITY
D
D
D
D
D
D
D
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
COMBINED SINGLE LIMIT
, (Ea accident)
$
, BODILY INJURY
(Per person)
$
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
D ANY AUTO
D
OTHER THAN
AUTO ONLY:
AUTO ONLY - EA ACCIDENT $
-'.-----...-----------.----.-----
EA ACC $
AGG $
EXCESS LIABILITY
D OCCUR [] CLAIMS MADE
, EACH OCCURRENCE
r--~---"'--
. AGGREGATE '$
----"_.~-,-_.-.-
$
$
--'.'-."---.----
$
D DEDUCTIBLE
D RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
OTHER
E.L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATlONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
** INCLUDED IN GENERAL AGGREGATE
CERTIFICATE HOLDER
i IX] ADDITIONAL INSURED; INSURER LETTER: A
CANCELLATION
CLEARWATER
FL
3~~li-1 \ l 200(~
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 030 DAYS WRITTEN
NOTICE TO THE CERTlFICA TE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF A
REPRESENTATIVES.
AUTHORIZED REPRESENTATlV
RISK MANAGEMENT
CITY OF CLEARWATER p~EeEtVED
PO BOX 4748
ACORD 25-S (7197)
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InlU'GnCe Ggency. Inc.
NAMED INSURED:
Suncoast Youth Football Conference, Inc Etal
Azelea Jr Football Association
Clearwater Youth Football, Inc
Countryside Jr., Cougars Inc
Dixie Jr Rebels, Inc
Dunedin Jr Falcons, Inc
Nortt"least Bandits Youth Football,-Ifl€-- -~
Seminole Youth Athletic Association
Tarpon Springs North Pinellas Youth Football, Inc
ADDITIONAL NAMED INSUREDS:
School Board Of Pine lias 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
Pinellas County Parks & Recreation
Risk Management
400 S Ft Harrison Ave
Clearwater, FI 33756
City of St Petersburg Athletic
1320 5th St N
St Petersburg, FI 33701
City of Tarpon Springs
Tarpon Springs Community Center
400 S Walton Ave
Tarpon Springs, FI 34689
St Petersburg Catholic High School
6333 9th Ave N
St Petersburg, FI 33710
6400 CENTRAL AVENUE, ST. PETERSBURG, FLORIDA 33707-1393 Phone: (727) 347-3158 WWWBOZEMANINSURANCECOM