CERTIFICATE OF LIABILITY INSURANCE
~M CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDIYYYY)
02/08/2006
PRODUCER 800-526-1379 FAX 973-921-2876 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Bo11inger, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
PO Box 390 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Short Hi 11 s , NJ 07078
INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Harke 1 Insurance Co 38970
Florida Youth Soccer Assn Inc. INSURER B:
8034 Sunport Drive INSURER c:
Suite 404 INSURER D:
Orlando, FL 32809 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 MAYBE 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.
'~M ~~~~ TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
GENERAL LIABILITY 3602AH2430480 06/01/2005 06/01/2006 EACH OCCURRENCE $ 1,000,00l
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100,00l
- ~ CLAIMS MADE 0 OCCUR 5,00e
MED EXP (Anyone person) $
A X Incl Participants PERSONAL & ADV INJURY $ 2, 000, ooe
- 5,000,00e
GENERAL AGGREGATE $
- 2,000,00e
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS. COMP/OP AGG $
I POLICY n j~BT m LOC
AUTOMOBILE LIABILITY 3602AH2430480 06/01/2005 06/01/2006 COMBINED SINGLE LIMIT
- (Ea accident) $ 1,000,00G
ANY AUTO
-
ALL OWNED AUTOS BODILY INJURY
- (Per person) $
SCHEDULED AUTOS
A X
HIRED AUTOS BODILY INJURY
X (Per accident) $
NON-OWNED AUTOS
-
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY. EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
tJ OCCUR D CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS 'COMPENSA TlON AND INCSTATU., I IOl~.
EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? E.L. DISEASE. EA EMPLOYEE $
If yes, describe under E.L. DISEASE. POLICY LIMIT $
SPECIAL PROVISIONS below
OlliER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCUJSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
411 activities sanctioned by Florida Youth Soccer Association for their registered member leagues,
lubs and teams. The Certificate holder is named as an additional insured.
his certificate is issued on behalf of: COUNTRYSIDE YOUTH SOCER ASSOCIATION
C
City of Clearwater Parks & Recreation
'P. O. Box 4748
Clearwater, FL 33758
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
~
John S iotta, CIC/PJT
ACORD 25 (2001/08)
@ACORD CORPORATION 1988