CERTIFICATE OF LIABILITY INSURANCE F—DATE IMMfDo,-Y-yYyj
CERTIFICATE OF LIABILITY INSURANCE 1 03;2512014
THIS CERTIFICATE ISIS SUED 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)l.
PRODUCER CONTACT
NAME:
BOLLINGER,Inc, PKGNE
FAX
101 JFK PARKWAY jAic,No Exti: SH-526-1379 3T3-R21-2976
SHORT HILLS,W1 070 7-8 E-MML
PHONE:1-800-52e--1379 FAY,:57-24-C-21-2971f� ADDRESS:
I N SU RER(St AFFORDING CoVERAGE NAIL#
INSURER A:Markel Insurance Company 39�71111
INSURED INSURER 5:
Amateur Softball Association and Members of Florida ASA JO
Indiv Reg Program INSURER G:
Chris Wirth INSURER D:
1843 Bedivere INWRIERE:
Lakeland, FL 33813 INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER.
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TC 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 POLICIE DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. LIMITS SHOWN MAY HA%T BEEN REDUCED BY PAID CLAIMS.
NSR TYPE OF INSURANCE ADDL SUM POLICYNUM13ER LIMITS
R M311 vvvo
LTR vswDwffyy�
GENERAL LIABILITY Ssxwd Abuse Liablity per mcurrsn-*Ir,1-S2.�XO,OM
A_I x
X COLAFERCIAL GENERAL LIABILITY Sexual Abuse Liabdity aggregate firr.4-SZ CX),,aD0 DAMAZIETOREINTED
CLAI MS-MADE FX]OCCUR 3602-AH230069-13 01'Di,2A14 01 «l wli PREMSES JEA O=Telx*�
tM,DEX-fArqawmrwn
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Padidpants Liab *Non-pafticipants only FEF-4()NAL&ADV MURY
GENERAL AGGREGATE ss;000;000
GEN1 AGGREGATE LIMIT APPLIES PER Geraral Am�rajzxta
7 pft=UuT -COG VQp AGG
POLICY JECT PRC- LCC apph-P-T-1
F]
AUTOMOBILE LIABILITY COWNED&W L"rr'U amom
ANY AUTO 5001Y INJURY Fu remm"
ALL OWNED- AL SCHEDULEC
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AUTOS DS PRDPERTY DALAGE
HIREDAUTOS NON-aVVNED
AUTOS
UMBRELLA LIAB 01-CUR EACH 01DCLRRENM
EXCESS LIAB -CLAA� AGGREGATE
I
IAL
DED F]RETENTION
WORKERS COMPENSATION � -A-- I kT-
AND EMPLOYERS'LIABU-tTY CIRYLDATS
ANY PROPR�Tf.4 PARTNEREXEC;j7VE Y I N
0fFICERAwk%ERExCLi=r N f A El-EACH ACCCENT
(Mandatory in NH) ❑ El,DSEASE-EA E*%1LQYEE
,r.yn.Oncribe ursZer DESCRPT,10N 0-- El,DISEASE-PCLZY LAVT
OPER ATOM beft
OTHER 01 ICA 2014 01012,015
A Accident Medical
Full Acce-%s 52-w-1-Beodt Pe-dod.D-ductibis applizs.
DESCRIPTION OF OPERATIONS i LOCATIONS!VEHICLES(Attach ACORD 1011.Additional Remarks Schedule,if more space is requireq*
VE E THIS POLICY SHALL APPLY TO LIABILITY OF THE INSURED ARISING OUT OF THE ADMINISTRATION.PLAY OR PRACTICE OF AMATEUR SOF7RALLJBASEBALL.
BUTONLY NLj
4L F�NRD[ENRCIDENTS INVOLVING BODILY INJURY,PERSONAL INJURY OR PROPERTY DAMAGE. CERTIFICATE HOLDER IS NAMED AS AN ADDITIONAL INSURED.THIS
ERTIFICATE IS ISSUED ON BEHALF OF:Clearwater Bullets ISu
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
City of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE SF
I
0 1588-2010 ACORDCORPORATION. All rights rc-se-vs-d.
ACORC 25(2013!35? TheACDRD name and lcgc srE registF--Ted cJAC-ORD