CERTIFICATE OF LIABILITY INSURANCE
MaY, 22, 2006
1 : 53 PM
KING-GREENP01NT INSURANCE GROUP
No,1346
P, 1/1
ACORD CERTIFICA TE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY)
TM OS/22/2006
PRODUCER Phone: (336) 852-7703 Fax. 336-294-0886 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
GREEN POINT INSURANCE GROUP ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
711 GALLIMORE DAIRY RD BOX 1 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
HIGH POINT NC 27265 AI T",a T"'" D.V T"'" ani ""I"'''' BEL IW_
INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: MAKSIN
PINELLAS YOUTH FOOTBALL CONFERENCE INSURER B: MAKSIN
PO BOX 71 INSURER c:
LARGO FL 33779
INSURER D:
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 ADD'L TYPE OF INSURANCE POLICY NUMBER POUCY EFFECTIVE POUCY EXPIRATION LIMITS
LTR INSRD DATE MMlDD/YY DATE IMMlDD/YY'
GENERAL LIABILITY GLS2200588 05/14/06 05/14/07 EACH OCCURRENCE $ 1,000,000
-
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 50,000
PREMISES (Ea occurence)
I CLAIMS MADE 0 OCCUR MED. EXP (Anyone person) $
A PERSONAL & ADV INJURY $ 1,000,000
f--
GENERAL AGGREGATE $ 2,000,000
f--
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG_ $ 2,000,000
II n PRO- nLOC
POLICY JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
f---
ANY AUTO (Ea accident) $
f--
ALL OWNED AUTOS BODIL Y INJURY
f--- (Per person) $
SCHEDULED AUTOS
f---
HIRED AUTOS BODIL Y INJURY
f--- $
NON-OWNED AUTOS (Per accident)
f--
f--- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONL Y AGG $
EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $
~ OCCUR D CLAIMS MADE AGGREGATE $
$
~ DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND IWCSTATU- T I OTHER
EMPLOYERS' LIABILITY TORY LIMITS
EL EACH ACCIDENT $
ANY PROPRIETOR/PARTNER/EXECUTIVE
DFFICER/MEMBER EXCLUDED? EL DISEASE-EA EMPLOYEE $
If Ves, describe under EL DISEASE-POLICY LIMIT $
SPECIAL PROVISIONS below
OTHER: ACCIDENT HEALTH SRG91 00271 OS/29/06 12/31/06
A
DE SCRIPTION OF OPERATlONS/LOCA IONSNEHICLES/EXCLU SIONS ADDED BY I NDORSEMENT/ SPECIAL PROVISIONS
CERTIFICATE HOLDER IS SHOWN AS ADDITIONAL INSURED IN RESPECTS TO GENERAL LIABILITY.
MEMBERS OF PINELLAS YOUTH FOOTBALL CONFERENCE INCLUDE CHILDS PARK, GIBBS, GREENWOOD, LARGO, ST PETE AND SILVER
RAIDERS PQt'l,*l~
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS
WRITIEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO
CITY OF CLEARWATER DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, IT'S
CLEARWATER FL 33755 AGENTS OR REPRESENTATIVES
AUTHORIZED REPRESENTATIVE ~lL QD-~cJ~nt4-
Attention: ~ Barbra M Abrahams
ACORD 25 (2001/08)
Certificate #
18667
@ACORD CORPORATION 1988