CERTIFICATE OF INSURANCE (3) Page I of I
Issue Dole:
CERTIFICATE OF INSURANCE 1/4/2013
Producer: THIS CERTIFICATE IS iSSUED AS A MATTER OF INFORMATION ONLY ANC?
James C Jenkins ins Srvc Concd CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS
CEPTIPICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
License No. 0545478 AFFORDED BY THE POLICIES BELOW.
P,O,Box 5668
Concord CA 94524
888-880-3602 INSURERS AFFORDING COVERAGE
miured, INSURER A- National Casualty Company
.............
United States Specialty Sports Association INSURER 6:
611 Line Drive INSURER C!
Kissimmee, FL 34744 INSURER D�
80(1-741-3014 IINSURER L,
COVERAGES
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 Mrs certificate may be issued or may pertain,the
insurance afforded by the policies described herehi is subject to all the terms,exclusions and conditions of such policies.Aggregate 4111its
shown may have been reduced by paid claims,
L's' Type of Insurance P o I I c y-N-um t;;-r-- Policy Policy Limits
TR
Effective t ate Expiration Date
A General Liability KR00000003114700 1/1/2013 111/2014 Ealh 1111,11, $2,000,000
omreroal Gviera!LabNv oamegf,,je Rrrted occ) $3001000
Orcurrence Basis Mad Exp 1 n or.e persont S Excluded
Genorr,)!Aggregate $ None
Pe,sona€ard Adv lrpr; $2,000,000
Prr,dtjc,ts-Coml-,!0P Agg $2,000,000
Partdpani Legg,Uabdity $2,000,000
Description of operations 1 vehicles /exclusions added by endorsements d special provisions:
Coverage induces amateur play and practice in the Insured sport for, City of CleaRtvater/ Lady Bombers
The Field/Facility Owner shown as the certificate holder shall be an additional insured but only with respects to liability
caused by the negligent acts or emissions of the named insured and only with respects to losses resulting from amateur
play and practice during USSSA sanctioned activities occurring between the coverage effective date listed below and the
policy expiration date,
-—------------------------------
Certificate Holder: Coveram Effective Date:
Cancellation: Should any of the above described policies be
City of Clearwater/ Lady Bombers cancelled before the expiration date thereof, the issuing insurer
Tony Graf will endeavor to rnail 30 days written notice to the certificate
1900 Gilbert Street holder named to the left, under Certificate Holder, but failure to do
so shall Impose no obligation or liability of any kind upon the
Clearwater FL 33765 insurer, its agents or represenatives,
Certificate USSSA-181550 Authorized Represen@tives:
C,asp?SecIlio-.408ab I e-0f2e-488d-baa1-'-b3)9501 7-M&C'er.- 1r` 12t)13