Loading...
CERTIFICATE OF LIABILITY INSURANCE (2) ,� - �► ,. CERTIF. ATE OF LIABILITY II�BURP 4CE QAT0115DDIYYYYj 02:'1:1:01 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 IN 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 CONTACT BOLLIJGER.Inc. 11WIC F.Lx 101.IFK PAP,K0iAY (.a'C.No.Gat):800-328.1379 SHORT HILLS,k 070?5 u ,t+a.):973 521.2876 I;•N.aIL PHONE: 1500-52??37° FA K: ADD.36: INSURE AFFORDING COVERAGE NAIC 1E 00141WRA:Aixrksl Insurance Company INSURED II+SUR2R B: Lis LaCrosse;Inc. IN3urexc: 113 West t:niversi y patk-way Bakitnore ifs]211-10 n+su n D: Re:Clearwater Youth Lacrosse II+sulti R°: at+sul�lt F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CeRTIFY THAT THE POLICIES CF INSURANCE LISTED SELO'N HAVE BEEN ISSUED TO THE INSURED NAMED ASOI E FOR THE P^v I Y PERIOC INDICATED. NOTIWITHSTANDIN3 AIRY REQUIRE>tENT,T EERU OR CONDITION OF ANY CON R,&rCT OR wi HER DCCUMENT-ArlH RESPECT TO WHICH Tils CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSUP.ANCE AFFORDED BY THE POLICE:DESCRIBED HEREIN i;SUIEIECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIL31T5 SHVJVN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE AODL UOR POLICY NUMBER POLICY 9" OOLICY27W LIMITS LTR INSR VW0 fkWoOryyyyl fmMourml GENERAL LIABILITY x E3^t?OL4 ti4.vL SL 000 000 A X COI,{IAERCIAL 3ENERAL LIABILITY X16 R£ L S300"m CLAIII-04 AD OCCUR SE02AH221?.a8 01/0112014 0110112015 aft-mmsfzawa rretw �vr4 l D :M;+a^Ie uersc-r S5.0 5D X Panic(pann List PERSON,&&ADvN---Tf S1:0o4.wo GEN`L A33REGATE LIMIT APPLIES PER: 409Ii4:A lwtewATc S=: . POLICY RO- LOC a�ODLL:iS-COtv4pA�cc S •00�4.OW 13ECT © S AUTOMOBILE LIABILITY SN--iRUXT;eaa:elx-t S ANY AUTO $03AY IIVJU.RY rlsermrw, S ALLD'VVNEO SCHEDULED SODLY;,W:JRYIperw--m-C S AUTOS AUTOS PAUP R C C4:i^u S Hi RED AU T CS NON-OUVNED r a tx AUTOS Is X UMBRELLA LMB x I OCCUR, OCCLARMENCE SI.000;I3D0 A EXCESS LIAB C- SAd, 4&02AH2211_70 09/01/2014 01101/2015 A o wnT€ 51,000.000 S DEC RETENTION WORKERS COMPENSATION YIN NIA 0%10 STA.r� _z S AND EMPLOYERS'LIABILriY tORYULVIT3 AN Ei.eAC ACCT S (Mandatary in NH) ELDt-A--EA_mp-OYSE S ?'^*mrtx;,mrceSL`,pr?okOF £i.MWE-PMCyU;fq;• S c�n/iTkYt35.M1.`I6Y1 A Accident Medical 4102AI102S�e0 0110112014 01f011201S 'dent Limit:5100.000 tastrophicACc 4102At1305&12 01101120141 011o11201s patestrophic Limit:81,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(Attach ACORD 141,Additian:l Remarks Schedule,N More space Is required) Coverage applies only to team sileagues comprised of 100' US Lacrosse meMicier participants during scheduled&supervised lacrosse activites.Certificate Holder is named"Additional Insured"with respect to Clearwater Youth Lacrosse. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Gift-of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS. 1501\_Belcher Rd. Clearwater,FL 33 76 AUTHORIZED REPRESENTATIVE rs 1955.213 10 ACCORD CORPORATION. All rights reserved. ACCORD 28 201J'Oc?' The ACCORD ram_arc tc-0e a,e.sginsrea maflo of ACORD