CERTIFICATE OF LIABILITY INSURANCE
ACORDru CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDIYY)
02/02/06
PRODUCER 1-800-777-4930 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Risk Management Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
- '>. Box 32712 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
."oenix, AZ 85064-2712 INSURERS AFFORDING COVERAGE
INSURED INSURERA:Lexington Insurance Company
CLEARWATER AQUATIC TEAM
USA Swimming eta1 Incl Local Swimming Committees INSURERB:llutual of Omaha Insurance Company
IfiU YEARWOOD INSURER C:
1501 N BELCHER ROAD, SUITE 229
CLEARWATER, FL 33765-1339 INSURER D:
I 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 a.AJMS.
I~ TYPE OF INSURANCE POLICY NUllBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
A ~NERAL LIABILITY 1638683 12/31/05 01/01/07 EACH OCCURRENCE S 2,000,000
X COMMERCIAL GENERAL LIABILITY ARE DAMAGE (Anyone r....) S100,000
1 ClAIMS MADE 0 OCCUR MED EX? (Anyone person) S EXCLUDED
X Participant Legal PERSONAl & ADV INJURY Sl, 000, 000
-
~ Liability Included GENERAL AGGREGATE S 4,000,000
GEN'L AGGREGATE LIMIT APPUES PER: PRODUCTS - COMPIOP AGG S 2,000,000
Xl POUCY rl ~ n LOC
~OMOBIl.E LIABILITY COMBINED SINGLE LIMIT $
ANY AUTO (Ea accident)
-
ALL OWNED AUTOS BOOIL Y INJURY
- (Per person) $
SCHEDULED AUTOS
-
t-- HIRED AUTOS BOOIL Y INJURY
(Per accident) $
f-- NON-OWNEO AUTOS
- PROPERTY DAMAGE $
(Per accident)
~RAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EAACC $
AUTO ONLY: AGG $
A EXCESS LIABILITY 0352672 12/31/05 01/01/07 EACH OCCURRENCE $ 3,000,000
~OCCUR 0 ClAIMS MADE AGGREGATE $ 8,000,000
$
=1 DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I ~~T~~ I .IOJ~-
EMPLOYERS' LIABILITY E.L EACH ACCIDENT $
EL DISEASE - EA EMPLOYEE $
EL DISEASE - POUCY LIMIT $
OTHER
B XS ACC KED/DENTAL AD" D T5MPSP35054 01/01/06 01/01/07 MaximWII $ 25,000
B AD" D T5MPSP35054 01/01/06 01/01/07 Maximum. $ 5,000
$
DESCRI'TION OF OPERATIONSlLOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEIlENTISPECIAL PROVISIONS
Verification of General/Excess Liability for INSURED ACTrvITIES per attached. The Certificate Bolder is included
as Additional Insured per attached ADDITIONAL INSURED ENDORSBMBNT EFFECTIVE CERTIFICATE ISSUE DATE.
CERTIACA TE HOLDER I I ADDITIONAL INSURED; INSURER LETTER: CANCELLA T10N
SHOULD ANY OF THE ABOVE DESCRBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Mike Yearwood DATE THEREOF, THE ISSUING INSURER WILL ~MAIL ~ CAYS WRITTEN
NOTICE TO THE CERTIFICATE HOlDER NAMED TO THE LEFT,
1501 N. Belcher Road
'lifiJPfiIIiV~UYYYYYYYYYY1CXXJOCYyyyyyyyyyyyyYlaCXXXXXXXXXXX
arwater, FL 33765 AUTHORIZED REPRESENTATIVE .', ~, ". ~.> ~ ., \
I I USA ,.~~ ~y~' ...?\. ~~, ~1'
''-i --
ACORD 25-8 (7197) FL-CAT
3947706
@ACORDCORPORATION19M
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