CERTIFICATE OF INSURANCE (2)
I ISSUE CATE (MMIDDIY'() I
CERTIFICATE OF INSURANCE 1251252
D 5/19/06 i
PROCXJCEA ,
THIS CERTIFICATE IS ISSUED AS A MATTER 01: INFORMATION i
K &: K Insurance Group, Inc. I
ONLY AND CONFERS NO RIGHlS UPON THE CERTIFICATE i
1712 Magnavox Way HOLDER. THIS CERTIFICATE DOES Nor AMHiD. EXTEND OR ,
I
P.O. Box 2338 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. !
Fort Wayne, In 46801 I
COMPANIES AFFORDING COVERAGE i
i
INSUREIJ i
COM PANY . I
UNITED STATES DIVING, INC. LETTER ANATIONWIDE LIFE IN~:URANCE I
COM
PAN AMERICAN PLAZA COM PAHY I
201 SOUTH CAPITOL, SUITE 430 LETTER B GREAT AMERICAN ASSlJRANCE COMP
INDIANAPOLIS, IN 46225 COMPANY C i
o. LElTER I
- I
COVERAGES
THIS IS 10 CER'TlFY THKr THE POLICIES OF INSURANCE LISTED BElOW HAVE BEEN ISSUED 10 T~E INSUREO NAMED ABOVE FOFi THE POLICY PERIOD IN- I
DICArED. NonMTHsv.NDING ANV REQUIREUENT. TERM OR CONDmON OF AIolY COmRACT OR OTHER IX)CUMEi'IT WITH RESPECT 10 WHICH THIS CERTlFICArE
p
~.
MAY BE: I$$I.IEDOR MAY PERTAIN, THE INSURANCE AFFORDED BVTHt: fIOllCIES DESCRIBED HEREIN IS SUBJECT mAll THE TERMS, EXClUlaaNS AND CONDI-
TIONS OF SUCH POLICIES. LIMITS SHOWN UAY HAVE BEEN REDUCED BY PAID CLAIMS.
co. TYPE OF INSURANCE POLICY NUMBER POliCY EFFECTlVE POLICY EXPIRATION LIMITS (ill trolJsands) I
lTR DATE (MMI DDIYY) Df\TE ~MJOD/YY)
General L1abDlty General A!lgrega1e S NONEl
B OOComll1srcial General Uabilit,o GL00568996201 12:01AM 12:01AM ProdllCts-Comlll00s Aoorela!e :s 1000!
o Claims Made ~ Occur. 12/31/05 12/31/06 Personal & Adver1isino Iniurv S 10001
D Own9l"S & Contractors Prot. Each OCClJrrenCB S 1000
0 A Ie Oamaae IAllV one lire) $ 10001
Me\lil;al Exoense(Anv one person) $ 5
Porli;ipant u:calLiability $ 10001
Automobile Llablity Combined
o Any auto 5in~8 $
lillllt
D All owned autos Bodifti
D Scheduled autos Injury $
(ptr personl
D Hired autos Ilodilv
D Non.owned autos kljury
~, aCCide11t) $
D Garage LiaDillty Prooerty
D Dam loe $
Exeess Liability Each
D Occurre no 8 Aggregam
D Other Ulan Umbralla form $ $
Wortels' Compensation St!lltut;)ry
i and $ Eact Accident
I Employers' liability $ DiselSe-Policy Limit
i $ Diseise-Each Employee
12:01AM 12:01AM AD&D ~; 25
A Participant SPXOOO1706500 12/31/05 12/31/06 Primary Medical " NONE
..
Accklent Excess Medical c. 25
"
Weekly Indemnity ,. X NONE
"
DESCRIPTION OF ()PEflATI~SI LOCAIlONS I VEHICLESJ RESTAlCrIONS I SPECIAL ITEMS
'CLUB: CLEARWATER AQUATIC TEAM EFF. DATE: 5/17/06
LOCl'rTION: CLEARWATER HIGH SCHOOL &: THE LONG CENTER *CERTIFICATE HOLDER IS AN
ADDITIONAL INSURED AS RESPECTS TO THE LIABILITY ARISING FROM THE N~lED INSURED
CEATlFICATE HOlDEn CANCELLATION
CLEARWATER HIGH SCHOOL, CITY OF
CLEARWATER, AND THE LONG CENTER.
MAIL TO: KATIE LINTON
12001 BELCHER RD S, APT E76
LARGO, FL 33773
SHOULD ANY OF THE ....aOvE. DESCRIBE[' POLICIES BE
CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE
ISSUING COMPANY WILL ENDEAVOR TO ~IAIL ~ DAYS
WRITTEN NOTICE 10 THE CERTIFtCATE HOLDEF: NAIItlED TO THE
lEFT. BUT FAILURE TO MAIL SUCH NOTICE SHA.lLlMPOSE NO
OBLIGATION OR LIABILITY OF ~y KIND UPON THE COMPANY,
ITS AGENTS OR REPRESEN'[l).TIV ,
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