CERTIFICATE OF LIABILITY INSURANCE (15)
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ACORDN
CERTIFICATE OF LIABILITY INSURANCE
OP 10 DATE (MM/DDIYYYY)
YOUT-26 11'03 06
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
P ODUCER
Bollinger, Inc.
un JFK Parkway
Short Hills NJ 07078-5000
Dhone:800-526-1379 Fax: 973-921-2876
I"'URED
INSURERS AFFORDING COVERAGE
Markel Insurance Co
an
NAIC#
38970
Youth Basketball of America
10325 Orangewood Blvd.
Orlando FL 32821
INSURER A:
INSURER B:
INSURER C:
INSURER D:
INSURER E:
QOVERAGES
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.
'LTR !"NsRl TYPE OF INSURANCE POLICY NUMBER DATEiMWD"'D~E I P8k~CEY,~J;h'r~~N LIMITS
GENERAL LIABILITY EACH OCCURRENCE $1,000,000
t-- ~~~~S(EaO~Uffin~)
A- X COMMERCIAL GENERAL LIABILITY 3602AH024190 09/01/06 09/01/07 $100,000
t-- :=J CLAIMS MADE [i] OCCUR
MED EXP (Anyone person) $ 5,000
t--
X Incl Participants PERSONAL & ADV INJURY $ 1,000 000
GENERAL AGGREGATE $3 000 000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS. COMP/OP AGG $ 1 000 000
I POLICY n ~~8r [Xl LOC Abuse/Mol 1 000 000
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- (Ea accident) $
ANY AUTO
-
ALL OWNED AUTOS BODILY INJURY
- (Per person) $
SCHEDULED AUTOS
-
HIRED AUTOS BODILY INJURY
- (Per accident) $
NON-OWNED AUTOS
-
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY. EA ACCIDENT $
=1 ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $1,000,000
A ~ OCCUR D CLAIMS MADE 4602AH024191 09/01/06 09/01/07 AGGREGATE $1,000,000
$
~ DEDUCTIBLE $
X RETENTION $10 000 $
WORKERS COMPENSATION AND I TORY LIMITS. I IUEft
I EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $
J
i ANY PROPRIETOR/PARTNER/EXECUTIVE
, OFFICER/MEMBER EXCLUDED? E.L. DISEASE. EA EMPLOYEI $
If yes, describe under E.L. DISEASE. POLICY LIMIT $
SPECIAL PROVISIONS below
OTHER
A Accident Insurance 4102AH024189 09/01/06 09/01/07 Med Max: $250,000
Full Excess Oed: $50
I DlESCRIPTlON OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
The certificate holder is named as an additional insured. Coverage is
provided under this policy for sponsored/supervised activities of the named
insured. Not valid for tournaments. Issued on behalf of Suncoast Youth
Foundation.
CERTIFICATE HOLDER CANCELLATION
PCSOCLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRmEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
PCSB/City of Clearwater IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
1500 N. Belcher Road
Clearwater FL 33765 REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
ACORD 25 2001/08 @ ACORD CORPORATION 1