CERTIFICATE OF LIABILITY INSURANCE
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8132872498
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......... . . .. . "',.,. ... -. ...,............. . . . . .. ~ 'WI'. .""............ IJAIt:: ~s/:l. .~
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Keystone Risk Managers, LLC CERTIFICATE # ~3 (
1995 Point Township Drive
Northumberland, PA 17867 :3
)f)IfIONAL NAMm INSURED: INSURERS AFFORDING C
COUNTRYf:iI DE: LL INSURER A: LEXINGTON
!:~D ONr.~:y S u I~ RAT T
PO BOX 149~':j5 INSURER B: NATIONAL l
(Non.Uability) COMPANY C
CLEA I:~WATEI~ FI... ~n766 .-.-- ---.
INSURER C: LANDMARK
-'
/O(':!
,9:J.211"'2
O~? 12
OVERAGE:
INSURANCE COMP
NION FIRE INSUAA
F PnTSBURGH, PA
INSURANCE COMP
COVERAGES
-JE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREO NAMED ABOVE FOR THE POLICY PERIOD INDICPfED NOTWITHSTANDI
NY REQUIREMENT, TERM OR CONomON OF ~Y CONTRACT OR OTHER DOCUMENT W~TH RESPECT TO WHICH THIS CERr\f'ICATE I^AY BE ISSUEO OR N
ERTAIN. THE INSURANCE AFFORDED BY THE POlICIES DESCRleED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SU
JLlCIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN AEDUCED BY PAlO CLAIMS.
:s: TYPE OF INSURANCE POuey NUMBER :.::~~
GENERAL LIABILITY
X OCCURRENCE
X INCL. PARTICIPANTS
POLICY EXPIAATION
DATE MMIDDIYY\'Y
LIMITS
EACH LOSS
;!;1 ,()OO ,00
~I;~:.) ,0<}0 ,O(
; 1>:\. ,()()O,<)O
~n I O()O, OC
f-- ,V2 ! 000 I <Ie,
$1,000,000
$1 ,000,000
$35,000
NONE
As in Master
Policy Excess
EACH OCCllRRENCl
x
5098195-01 1/Dl/2006
Property Da e Deductible: $250
j/O i /20<>'1
G~NERALAOOREGAT
X SEXUAL ABUSE
DIRECTORS & OFFICERS
:I. 6 2....()l'iI.l2
:I./01/2()()6
1/01/200'7
I
!.
i
I ><
I
t.
L~~ SPORTS EXCESS ACCIDENT ~; RG9 H)!54a4 'J /0 i 120(){,
'X" INDICATES COVERAGE SELECTED FOR ADDITIONALNANED INSURED
ADDITIONAL INSURED
Vllo is an insured (SECTION II} 01 the General Uabillty polley Is amended to Include as an insured the person Of organization shown in the schedlle, out only witl1 respec
ability arising out 01 the above named Little League's maintenance or lIS9 01 ball flek18, or other premises loaned, donated, or rented to that Little League by such person
,rganizalions and subject to the following additional exclusions:
. Structural alteralions, n~w conslruction, malntenance..repair or demolition operatiqnS pertormed by or on behalf of the person Of organization designilted in the Schedule am
,erforrr,ed trj"\tie above narneQ lit\le leB.~ and
:. That part at the ball field or other prem.SflS not being used by the above named Uttle League
NAME AND ADDRESS OF PERSON OR ORGANIZATION:
AGI3REOATE
CAIME COVERAGE
on09:l09 (H
:l./O:l/:~(>O(.
1/ () t /~:~O~>}
EACH LOSS
Crime Deductible: $250 Propertyl$1,DOO Money
AGGREGATE
1/Ol/2(!(),(
~ ~t1 Master Polk:)!
Mtld. Mo.. $1 00,00<
0.... $1;'.1
CITY OF CLEARWATER 2. PINELLAS COUNTY SCHOOL 80ARD 3, CITY OF LARCO
CITY OF DUNEDIN ~:.:;, CITY OF OU)SMA1~ ,~,. CITY OF SAFE"f'Y HA 1~f3CH< 7. 1:::1 TY OF
UOSDN 8. CITY OF HOLIOAY
~..:".flED
,ittle League Baseball Risk Purchasing Group, Inc.
'l9 U.S. RT.15 HIGHWAY
;outh Williamsport, PA 17702
CANCELLATION
~
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l~SURANCE COMPANY
6101 ANACAPRI BLVD., lANSING, ~I 48911-3999
AaENCY CARLISLE FIELDS & COMPANY INC
12-0025-00 MKT TERR 068
INSURED COUNTRYSIDE LITTLE LEAGUE
8132872498
p. 1
1 54104 (07-87)
Issued 04-04-2005
TAILORED PROTECTION POLIC~ DfClARATIONS
(27) 797-0441
POLICY NUHBER : 90S0:L2-2041SQ73-05
ADDRESS PO BOX 14955
CLEARWATER, Fl 33766-4955
Agency
Bill
Renewal Effective 05-18-2005
POLICY TERM
12:01 a.l1I. 12:01 a.m.
05-18-2005"to 05-18-2IHl6
In COl"lsider-atian 0'" PilY-.n't 0-1 the P....i~ shotm below, this. policy ill I"enewed. Pl.... attach t 'is
DeclaraUons and attBChllents to )lour- policy. If YOU ha.,. Ilnlt questions, p1__ consult with YOUI"' agent.
COMMERCIAL PROPERTY COVERAGE
COVERAGES PROVIDED
INSURANCE AT THE DESCRIIED PREMISES APPLIES ONLY FOR COVERAGES FOR WHICH A LIMIT OF
INSURANCE IS SHOWN.
LOCATION 001
ADDITIONAL FORMS THIS LOCATION: None
LOC 601 SLDG 001 Misty Sp~ings Park 51" 580
Clearwater, Fl 34619
OCCUPIED AS: Storage 81dg
COVERAGE: Building
CAUSES OF lOSS
Basic Gr-oup I
Basic Group II
Special
Theft
OPTIONAL COVERAGE:
COINSURANCE
80X
80~
8D~
80A:
Replacement Cost
Inflation Guard Factor
Building
1.029
COVERAGE: Personal Prop.
CAUSES OF LOSS
Basic Group I
Basic Group II
Special
Special Including Theft
OPTIONAL COVERAGE:
CO! NSURANCE
"84%_
8ij7.
BOY.
807.
Replacement Cost
limit of Insurance
DEDUCTIBLE
$250
250
250
250
Limit OT Insurance
DEDUCTIBLE
--$250
250
250
250
RATE'
0.660
0.304
0.078
$39,8110
PREMIUM
$263.00
121. DO
'31.00
Included
RATE
IL-632-
0.306
0.135
2.316
$35,000
PREMIUM
. $239;'1)0
107.00
47.00
,-~.J,.:..'!!lJ
ADDITIONAL FORHS THIS BUILDING: n0017 (11-85) 55081 (08-88> IL0003. (11-85)
!LOl7S (09-93> lL0255 (07-94) 59246 (05-00) 59350 (02-03) CP0090 (Ol-lI8)
CP0125 (10-90) CPOOIO (10-91) CPI030 (10-91)
SECURED INTERESTED PARTIES: None
RATING INFORMATION
Ter-ritory: 525
Cl~ss Ra~e - Building,
Coun~y: Pine lIas
Construction: Frame
pc: 03 Class Code:
Class Ra~e - Contents: 0.489
0.473
0756
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81328724S8
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eAuto-Owners
p...
2 5itl04 (07-87)
[ssued 04-04-2
'IULORED PROTECTION Pt)UCV Df.CLARATl'
INSURANCE C~PANV
6101 ANACAPRI BLVD., lANSING, "1 48917-3999
AGH.JCY CARLISLE FIELDS & COMPANY INe
12-0025-00 HKT TERR 068
INSUREO COUNTRVSIDE LITTlE LEA6UE
(727) 797-0441
Renewal Ef.Feci:i ve 15-18- 2
POLICY NUMBER I~OSO 12- 2t4olS073
""-....
AOO~YS PO BOX 14955
CLEARWATER, Fl 33766-4955
Agency
Bill
~~~I,~
POltCY TUft
12:01 iil,m. 12:01 "".m,
OS-lS-20ll51:D 05-18-2006
I., consideration of pa~t of the Pre.Ua __ below, this policy is nlneweid. Please .tiach this
Decl_tions ~ .i*-,-t. to ~ClUr policy. If you ..". any <<aftastions, Please consult wUh )t1Nr agen-t.
COMMERCIAL PROPERTY COVERAGE
SLUG 002 Misty Springs Park Sr 580
Clearwa~er, Fl 34619
OCCUPIED AS: Batting Cages & Net
COVERAGE: A~use Equip
LOC OQl
Li.it at Insurance
CAUSES OF LOSS
Basic Group I
Basic Group II
Special
Theft
OPTIONAL COVERAGE:
COINSURANCE
au
80X
80X
SIX
DEDUCTIBLE
$250
250
250
o
RATE
0.453
0.304
0.000
no ,000
PREMIUM
$45. (
30.!
1.(
Inclod~
Replace~n~ Cost
Infla~iQn Guard Factor
Building
1.029
ADDITIONAL FORMS THIS BUILDING:
IlD175 (09-93) IL0255 (07-94)
CP0125 nO-90J CPOOID nO-9l)
IL0017 (11-85) 55981 (08-S8) IlD003 (11-85)
59246 (05-80) 59350 (02-03) CP0090 (01-88)
CPI030 <l0-9ll
SECURED INTERESTED PARTIES: None
RATING INfORMATION
Territol'Y: 525
County: Pinellas
Construction, N/A
Spcl Class Rate - AMuse Equip
PC, 03 Class Code.
0.530
1190
FDREIGN TERRORIsM - CERTIFIED ACTS
SEE FORM 59350
$17. (
LOCATION Den
PREMIUM
$1,712.: