CERTIFICATE OF LIABILITY INSURANCE (3)
I
ACORQ. CERTIFICATE OF LIABILITY INSURANCE 13/29/2006
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Bollinger, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
101 JFK Parkway HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Short Hills, NJ 07078-5000 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Phone No. 800-526-1379 INSURERS AFFORDING COVERAGE
Fax No. 973-921-2876
INSURED INSURER A: Markel Insurance Company
Ameteur Softball Association and Members of West Markel Insurance Company
Central FL ASA JO Indiv Reg Program INSURER B:
Carlton Benton INSURER C:
1843 Bedivere INSURER D:
Lakeland I FL 33813 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 II\IITH 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.
IN~ TYPE OF INSURANCE POLICY NUMBER POUCY EFFECTIVE POUCY EXPIRATION LIMITS
~NERAL LIABILITY EACH OCCURRENCE $ 2,000,000
A X COMMERCIAL GENERAL LIABILITY FI RE DAMAGE (Anyone fire) $ 300,000
U CLAIMS MADE ~ OCCUR 3602AH230069 01/01/06 01/01/07 5,000
f--- MED EXP (Anyone person) $
r-- PERSONAL & ADV INJURY $ 2,000,000
A X Participant Liabi ity GENERAL AGGREGATE $ 5,000,000
n.L AGGREnE LIMIT APnS PER: PRODUCTS - COM PlOP AGG $ 2,000,000
POLICY P,~;: LOC ,
~OMOBILE LIABILITY COMBINED SINGLE LIMIT $
ANY AUTO (Ea accident)
f--
f-- ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS (Per person)
f--
f-- HIRED AUTOS BODILY INJURY
(Per accident) $
f-- NON-OWNED AUTOS
PROPERTY DAMAGE $
(Per accident)
~RAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
::J~OCCUR 0 CLAIMS MADE AGGREGATE $
Umbrella Form $
=1" DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I T~JT~T.\h I 1OJbi-
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYEE $
E.L. DISEASE - POLICY LIMIT $
OTHER
B Accident Medical Med Max. $250,000
I 4102AH220317 01/01/06 01/01/07
Full Excess 52-Week Benefit Period
DESCRIPTION OF OPERA TIONSlLOCATIONSNEHICLESlEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
Coverage applies to liability of the named insured arising out of the administration, play or
practice of amateur softball. Certificate holder is named as an additional insured. This
certificate is issued on behalf of: TEAM FLA
CERTIFICATE HOLDER I I AoomONAL INSURED: INSURER LETTER: CANCELLA nON
City of Clearwater, Florida SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WlLlL ENDEAVOR TO MAIL ~ DAYS WRITTEN
O. Box 4748 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Clearwater FL 33758 """"""M.- ~
AUTHORIZED REPRESENTATIVE
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ACORD 25-S (7/97) '..J Y@ACORD CORPORATION 1988
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION FOR
AMATEUR SOFTBALL ASSOCIATION OF AMERICA ACTIVITIES
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless
modified by the endorsement.
Named Insured: Ameteur Softball Associat on and Members of West Central PL ASA JO Indiv Reg
P+ogr~ .
C1ty ot Clearwater, Plor1da
Policy Period
01/01/06 - 01/01/07 As shown on the attached Certificate of Insurance
Authorized Representative
SCHEDULE
Policy Number
3602AH230069
Issued S'J
MARKEL INSURANCE COMPANY
Name of Person or Organization: .
As Show on the Attached Certificate of Insurance
A. The following is added to Section II-WHO ISAN INSURED:
The person or organization shown in the above SCHEDULE but only with respect to liability arising out
of the organization, promotion, administration and conduct of amateur softball activities, including
games, practices, tournaments, and fund-raising activities, under the rules of the Amateur Softball
Association of America, provided: T
a. That if the person or organization is designated as a Team, the person or organization so designated
shall be deemed to include team members, managers, coaches, assistants, batboys, registered
scorekeepers, sponsors, any other individual participating in the official functions of the team, and if
so indicated, a Field Owner, but only for liability arising out of the designated Team's amateur
softball activities covered under this policy;
b. That if the person or organization is designated as a League, the interest of the League shall not be
included unless all teams in the League purchase this insurance.
When the interest of the League is so included, the person or organization designated as a League
shall be deemed to include all teams in the league and team members, managers, coaches,
assistants, batboys, registered scorekeepers, sponsors, any other individual participating in the
official functions of the League or of any such teams, and if so indicated, a Field Owner, but only for
liability arising out of the designated League's amateur softball activities covered under this policy;
1959 GL 09 98
Includes copyrighted material of Insurance Services Office, Inc. with its pennission
Copyright, Insurance Services Office, Inc.
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