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CERTIFICATE OF LIABILITY INSURANCE A`°R°® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 5/31/2013 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 OW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED ,RESENTATIVE 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 PH: 800-526-1379 FAX: 973-921-2876 CONTACT Cathy Wilson Bollinger, Inc. PHONE (813)229-8021 F� N (813)229-2795 PO Box 390 ADDRESS,cwi 1 son@mewi 1 son.com INSURERS AFFORDING COVERAGE NAIC# Short Hills NJ 07078 INSURERA:Markel Insurance Co 38970 INSURED INSURER B: Florida Youth Soccer Association, Inc. INSURER C: INSURER D: 2828 Lake Myrtle Park Road INSURER E: Auburndale FL 33823 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1352803169 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. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YY MM/DD/Y LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 300,000 A CLAIMS-MADE OCCUR 3602AH243048 6/1/2013 6/1/2014 MED EXP(Any one person) $ 5,000 X Participant Legal Liab. Sexual Abuse and PERSONAL&ADV INJURY $ 1,000,000 X Sexual Abuse & Moles. olestation: GENERAL AGGREGATE $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: $1,000,000 Per occurrence PRODUCTS-COMP/OPAGG $ 2,000,000 POLICY PRO X LOC $2,000,000 Aggregate $ )TOMOBILE LIABILITY COs aBINED SINGLE LIMIT E 1,000,000 A ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 3602AH243048 6/1/2013 6/1/2014 BODILY INJURY Per accident $ AUTOS AUTOS ( ) X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per accident) $ 10 $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 1,000,000 A X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED X RETENTION$ 10,000 4602AH029104 6/1/2013 6/1/2014 $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N I ER ANY PROPRIETOR/PARTNER/EXECUTIVE $ OFFICER/MEMBER EXCLUDED? ❑ NIA E.L.EACH ACCIDENT (f Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ I yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ A Participant Accident 4102AR243046 6/1/2013 6/1/2014 $50,000 Excess Accident Max per Claim Medical Expense Limit $2,000 Deductible Per Claim DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) All operations of the Florida Youth Soccer Assn, its teams, leagues & clubs. Coverage applies only to official, sanctioned and supervised activities of FYSA. CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED. This certificate is issued on behalf of: CHARGERS SOCCER CLUB 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. City of Clearwater Athletics Office Jere Gunderman AUTHORIZED REPRESENTATIVE 706 N. Missouri Avenue Clearwater, FL 33755 A.J. Morgan/PJT 4CORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved.