CERTIFICATE OF INSURANCE (4) Page I of 1
CERTIFICATE OF INSURANCE Issue bate: 4/17/2015
THIS CERTIFICATE IS IS 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(),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER,
Important:If the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and
eondistfons of the policy,certafn policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of
such endorsement(s).
I
Producer: INSURERS AFFORDING COVERAGE
EPIC Brokers INSURER A:Scottdale Insurance Company
License No.OB29370 INSURER B:Scottdale insurance Company
P.O.Box 13847 INSURER c:
INSURER D.
Sacramento CA 95853 INSURER E:
888-880-3602
Insured:
United States Specialty Sports Association
611 Line Drive
Kissimmee,FL 34744
800-741-3014
Coverages:
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 contractor other document with respect to which[his 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 SUER Policy Policy
LTR Type of Insurance INSR WVD Policy Number Effective Expiration Limits
Date Date
A Commercial General Liability y N KR80000004617500 1/112015 1/1/2016 EachOccurre $2,0%000
Oecurance,Basis Dange to Rented Aemises(ea me)S300,000
Med Exp(any one person)S Excluded
General Aggregate S None
Personal and Adv Injury$2,000,000
Products-Comp/OP Agg$2,000,000
Participant Legal Liability$2,000,000
B Excess Liability I y I N XKS0000004917600 1/1/2015 i/1/2016 Eachoccu---s1,000000
Aggregale SIAW,000
t
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule may be attached It more space Is required)
Coverage includes amataur play and practice in the Insured sport for:City of Clearwater
The Fteld/Facillly Owner shown as the certificate holder shall be an additional Insured but only with respects to liability caused by the negligent acts or
omissions of the named insured and only with respects to losses resulting from amateur play and practice during USSSA sanctioned activities occurring
between the coverage effective date listed below and the policy expiration date.
Certificate Holder: Coverage Effective Date:4/17/2015 11:36:00 Atli
City of Clearwater CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
Anthony Grant BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE
1900 Gilbert St DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
Clearwater FL 33765
Certificate# USSSA-256389 Authorized Representatives:
http://web.usssa.com/sports/IC.asp?Cert=O&Segno=28B5BE9B-8BB0-4AAO-92DO-D 121... 4/17/2015