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CERTIFICATE OF LIABILITY INSURANCE (355)A` CC)R�® ' `u.....' CERTIFICATE OF LIABILITY INSURANCE DATE (MWDD/YYYY) 4/16/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Stahl & Associates Insurance, Inc. 110 Carillon Parkway St. Petersburg FL 33716 CONTACT Susan Andrews, PIAM NAME: PHONE (727)391 -9791 FAX HO No. Extl: IA/C. Not: (727)393 -5623 Ai ss: susan .andrews @stahlinsurance.corn INSURER(S) AFFORDING COVERAGE NAIC # INSURER AAutO Owners Insurance Co 18988 INSURED Largo United Soccer Club P 0 Box 952 Largo FL 33779 INSURER B: 20560596 INSURER C: 4/24/2015 INSURERD: $ 1,000,000 INSURER E : $ 50,000 INSURER F : $ 5,000 :CL1441621363 REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF IMM /DI YYYY) POLICY EXP IMM /DDNYYY) LIMITS A . GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY X 20560596 4/24/2014 4/24/2015 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 50,000 MED EXP (Any one person) $ 5,000 CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY n PFC fl LOC $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A WC STATU- TORY I IMITS OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS/VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate Holder is listed as additional insured with respects to general liabi ;e14,ses operations only ` ',i( CANCELLATION - - - - - -- - - - - -- - - - - - -- City of Clearwater 100 S Myrtle Ave Clearwater, FL 33756 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Kelly Petzold /ANDREW '---L� X P "� -— ACORD 25 (2010/05) NS025 (201005).01 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD “y�ggvy v-uV A. . 0000 -UU Policy Number 982312 - 20560596 COMMERCIAL GENERAL LIABILITY 55202 (12 -04) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED EXCLUSION - PRODUCTS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization (Additional Insured): CITY OF LARGO CITY OF ST PETERSBURG CITY OF CLEARWATER CITY OF PINELLAS PARK CITY OF DUNEDIN (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Under SECTION I - COVERAGES, COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABIL- ITY, 2. Exclusions, the following exclusion is added: 2. Exclusions This insurance does not apply to: The Additional Insured for the "products -com- pleted operations hazard ". B. Under SECTION II - WHO IS AN INSURED, the fol- lowing is added: The person or organization shown in the above Schedule is an Additional Insured, but only with re- spect to liability arising out of "your work" for that insured by or for you. C. Under SECTION III - LIMITS OF INSURANCE, the following is added: D. The limits of liability for the Additional Insured are those specified in the written contract or agreement between the insured and the owner, lessee or con- tractor, not to exceed the limits provided in this policy. These limits are inclusive of and not in ad- dition to the limits of insurance shown in the Decla- rations. Under SECTION IV - COMMERCIAL GENERAL LI- ABILITY CONDITIONS, 4. Other Insurance, the fol- lowing is added: This insurance is primary for the person or organ- ization shown in the Schedule, but only with respect to liability arising out of "your work” for that person or organization by or for you. Other insurance available to the person or organization shown in the Schedule will apply as excess insurance and not contribute as primary insurance to the insurance provided by this endorsement. Includes copyrighted material of Insurance Services Office., ifpit °uw Copyright, Insurance Services Office, Inc., 198.47'2 i'tn 5sron. Page 1 of 1