CERTIFICATE OF LIABILITY INSURANCE (5)
ACORQM CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDIYYYY)
5/23/2006
PRODUCER 9149229248 FAX 9149229282 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
The Allen J. Flood Companies, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
4614 Main Street, Suite 2 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Lisle, IL 60532
INSURERS AFFORDING COVERAGE NAIC#
INSURED Youth Basketball of America INSURER A: Lexington Insurance Company
10325 Orangewood Blvd. INSURER B'
Orlando, FL 32821 INSURER C:
INSURER 0:
Member Suncoast Youth Foundation INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICA TED. 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.
I~~: ~9,9;~ TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
GENERAL LIABILITY 0424073 09/01/2005 09/01/2006 EACH OCCURRENCE $ 2,000,000
- DAMAGE TO RENTED
X COMMERCIAL GENERAL LIABILITY -, $ 100,000
- ~ CLAIMS MADE 00 OCCUR
MED EXP (Anyone person) $ Excl uded
-
A X PERSONAL & ADV INJURY $ 2,000,000
-
GENERAL AGGREGATE $ 4,000,000
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000
Xl POLICY n j~8T n LOG
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- (Ea accident). $
ANY AUTO
-
ALL OWNED AUTOS BODILY INJURY
- (Per person) S
SCHEDULED AUTOS
-
HIRED AUTOS BODILY INJURY
- (Per accident) $
NON-OWNED AUTOS
-
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
~ ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
~ OCCUR D CLAIMS MADE AGGREGATE $
S
~ DEDUCTIBLE S
RETENTION $ $
WORKERS COMPENSATION AND WCSTATU-, IOJ~-
EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? E.L. DiSEASE - EA EMPLOYE S
If yes, describe under E. L. DISEASE. POLICY LIMIT $
SPECIAL PROVISIONS below
~O~~~Ra 1 0424073 09/01/2005 09/01/2006 $1,000,000 each occurrence
A ~buse/Molestation $1,000,000 aggregate
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
This certificate holder is named as an additional insured under the liability policy. Coverage is provided under the policy for
sponsored/supervised activities of the named insured for which a premium has been paid. Certificate is not valid for
tou rnam ents.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
PCSB/City of Clearwater EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
1500 Belcher Road ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
Clearwater FL 33765 OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE ~P'~
William Flinker/BILL
ACORD 25 (2001/08)
@ACORDCORPORATION 1988
ACORD TM CERTIFICA TE OF LIABILITY INSURANC I Oat. (mm/dd/yy)
1/5/2006
-----
IPRODUCER (- 1-804-733-20~ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
CHAPPELL INSURANCE AGENCY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
25807-A COX ROAD ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PETERSBURG, VA 23803 INSURERS AFFORDING COVERAGE
INSURED INSURER A: UNITED STATES FIDELITY & GUARANTY COMPANY
INSURER B:
UNITED STATES SPECIALTY SPORTS ASSOC. INC. INSURER C:
215 CELEBRATION PLACE, SUITE 180 INSURER 0:
CELEBRATION, FL 34747
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, EXCLUSION AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
TYPE OF INSURANCE
POLICY NUMBER
POLICY POLICY
EFFECTIVE EXPIRATION
DATE (MMlDDIYY) DATE (MMIDDIYY)
LIMITS
INSR
LTR
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
= '=:J CLAIMS MADE 0 OCCUR
D064L00984
08/01/05
08/01/06
EACH OCCURRENCE $
FIRE DAMAGE(any one fire) $
MED EXP (anyone person) $
GENERAL AGGREGATE $
PERSONAL, ADV INJURY $
PROOUCTS - COMP/OP AGG $
1,000,000
50,000
EXCLUDED
2,000,000
1,000,000
2,000,000
-
GEN'L AGGREGATE LIMIT APPLIES:
~~OLlC CPROJECT C1LOC
---
OTHER
EXCESS L1ABIL TY
EACH OCCURRENCE
AGGREGATE
$ 1,000,000
$ 1,000,000
I
~
A :J CLAIMS MAOE 0 OCCUR
D064Y00561
08/01/05
08/01/06
IDESCRIPTION OF OPERATlONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTS/SPECIAL PROVISIONS On ~ I eOJv.... <:...1r\ I '1
COVERAGE INCLUDES AMATEUR PLAY AND PRACTICE IN THE INSURED SPORT FOR:~F~Rln~Rk' -:;-:::;"'~HE
CERTIFICATEHOLDER SHALL BE AN ADDITIONAL INSURED BUT ONLY WITH RESPECT TO LIABILITY CAUSED BY THE NEGLIGENT ACTS
OR OMISSIONS OF THE NAMED INSURED AND ONLY WITH RESPECT TO LOSSES RESULTING FROM THE TEAM/LEAGUE AND DATES
LISTED, PARTICPANT LEGAL L1ABLlTY LIMIT IS $2,000,000.
I
L_
COVERAGE IS EFFECTIVE 1/5/2006.
~
CERTIFICATE HOLDER
I
I
I
I
PCSB/CITY OF CLEARWATER
1500 BELCHER ROAD
CLEARWATER, FL 33765
ADDITIONAL INSURED; INSURER LETTER _ CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER
WILL ENDEAVOR TO MAIL 30 DAYS WRITIEN 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 REPRESENTATIVES.
L____
reproduced from ACORD 25S (7/97). Used with permission.
~Cl~
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:ERTIFICATE #:
BK-1-244
AUTHORIZED REPRESENTATIVE
(LIABILITY ONLY) l
i
.....J
COPYRIGHT ACORD COPRPORATlON 1988