CERTIFICATE OF LIABILITY INSURANCE (16)
"I
-ACORDru CERTIFICATE OF LIABILITY INSURANCE
1/16/2007
PRODUCER
Bollinger, Inc.
101 JFK Parkway
Short Hills, NJ 07078-5000
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
Phone No. 800-526-1379 Fax No. 973-921-2876
INSURED
Amateur Softball Association and Members of West
Central FL ASA JO Indiv Reg Program
Carlton Benton
1843 Bedivere
Lake1and FL 33813
INSURER A: Markel Insurance Company
INSURERB: Markel Insurance Company
INSURER C:
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.
IN~: TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE P~~!fJ EXPIRATION LIMITS
~NERAL LIABILITY 3602AH230069 01/01/07 01/01/08 EACH OCCURRENCE $ 2,000,000
A X 3MMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire) $ 300,000
f-- CLAIMS MADE ~ OCCUR
f-- MED EXP (Anv one person) $ 10,000
PERSONAL & ADV INJURY $ 2,000,000
A X Participant Liabi GENERAL AGGREGATE $ 5,000,000
GEN'L AGGREAE LIMIT APnS PER: PRODUCTS - COMP/OP AGG $ 2,000,000
n POLICY p'~g: LOC
~OMOBILE LIABILITY COMBINED SINGLE LIMIT $
i---'- ANY AUTO (Ea accident)
f--- ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS (Per person)
-
- HIRED AUTOS BODILY INJURY
(Per accident) $
- NON-QWNED AUTOS
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
=i ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
::]"OCCUR D CLAIMS MADE AGGREGATE $
Umbrella Form $
=i DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I ~~~,~T~T.lt-" I IOJ~-
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYEE $
E.L. DISEASE - POLICY LIMIT $
OTHER
Accident Medical 4l02AH2203l7 01/01/07 01/01/08 Med Max. $250,000
B
Full Excess
DESCRIPTION OF OPERATlONSlLOCATlONSNEHICLESlEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
Coverage applies to liability of the named insured arising out of the administration, play or
practice of amateur softball. Certificate holder is named as an additional insured. This
certificate is issued on behalf of: Clearwater Lady Bombers 18 Gold
CERTIFICATE HOLDER I I ADDmONAL INSURED; INSURER LETTER: CANCELLATION
City of Clearwater 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 DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Clearwater FL ~~A~ ~
AUTHORIZED REPRESENTATIVE
I
ACORD 25-8 (7/97) '...J Y@ACORDCORPORATION 1988
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
ADDITIONAL INSURED . DESIGNATED PERSON OR ORGANIZATION FOR
AMATEUR SOFTBALL ASSOCIATION OF AMERICA ACTIVITIES
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
With respectto coverage provided by this endorsement, the provisions of the Coverage Form apply unless
modified b the endorsement.
ame Insured: Amateur Boftba11 Association and ~ers of West Centra1 FL ABA JO Ind1v Reg
~f€ir~ C1earwater
ocyumr
3602AH230069
01/01/07 - 01/01/08
Issued ~
MARKEL INSURANCE COMPANY
The above Informetlon Is required only when this endorsement Is prepared after
Name of Person or Organization:
As Show on the Attached Certificate of Insurance
A. The following is added to Section 11- WH 0 IS AN INSURED:
The person or organization shown in the above SCHEDULE but only with respect to liability arising out
of the organization, promotion, administration and conduct of amateur softball activities, including
games, practices, tournaments, and fund-raising activities, under the rules of the Amateur Softball
Association of America, provided:
a. That if the person or organization is designated as a Team, the person or organization so designated
shall be deemed to include team members, managers, coaches, assistants, batboys, registered
scorekeepers, sponsors, any other individual participating in the official functions of the team, and if
so indicated, a Field Owner, but only for liability arising out of the designated Team's amateur
softball activities covered under this policy;
b. That if the person or organization is designated as a League, the interest of the League shall not be
included unless all teams in the League purchase this insurance.
When the interest of the League is so included, the person or organization designated as a League
shall be deemed to include all teams in the league and team members, managers, coaches,
assistants, batboys, registered scorekeepers, sponsors, any other individual participating in the
official functions of the League or of any such teams, and if so indicated, a Field Owner, but only for
liability arising out of the designated League's amateur softball activities covered under this policy;
All other terms and conditions of this policy remain unchanged.
1959 GL 0998
Includes copyrighted material of Insuranc:eServlces OfIlce, Inc. wtlh Its permlssIon
Copyright, Insurance ServIces OfIlce, Inc.
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