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CERTIFICATE OF LIABILITY INSURANCE (2) ® DATE(MM/DD/YYYY) aco�zo CERTIFICATE OF LIABILITY INSURANCE ��• 10/15/2014 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). CONTACT PRODUCER NAME: Debra Williams Risk Management Services, Inc. PHONE FAX P.O. BOX 32712 C No Ext: (602) 840-3234 AIC No:(602) 274-9138 E-MAIL ADDRESS: info@theriskpeople.com Phoenix AZ 85064-2712 INSURERS AFFORDING COVERAGE NAIC# INSURER A:National Casualty 11991 INSURED (1/7/2015-12/31/2015) INSURER B:Mutual of Omaha Insurance CO 71412 Clearwater Aquatic Team INSURERC: Randy Reese INSURER D: _ 1501 N Belcher Rd Ste 229 INSURER E: _ Clearwater,FL 33765-1339 INSURER F: COVERAGES CERTIFICATE NUMBER:Cert ID 15703 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 LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MWDDIYYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE OCCUR ( KKO04856600 1/1/2015 1/1/2016 PREMISES(Ea occurrence') i$ 1,000,000 • Participant Liab MEDEXP(Any one person) $ 5,000 • Sexual Molestation PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ No Limit POLICY PRO X LOC PRODUCTS-COMP/OP AGG $ 2,000,000 JECT OTHER: I Abuse/Molestation* $ 1,000,000 COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY Ea accident _ ANY AUTO j BODILY INJURY(Per person) $ ALL OWNED SCHEDULED i BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED ! PROPERTY DAMAGE $ — AUTOS Per accident � I$ i A UMBRELLA LIAB X OCCUR Y XK04856700 1/1/2015 1/1/2016 EACH OCCURRENCE j$_4,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 4,000,000 DED I I RETENTION$ WORKERS COMPENSATION PER STATUTE EMPLOYERS'LIABILITY STATUTE ER YIN I ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ /M OFFICEREMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYES S If yes,describe under --i- DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLIC-Y LIMIT $ B XS Medical/Dental Acc TSMPSP35054 1/1/2015 1/1/2016 Maximum Limit 25,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Verification of General Liability, Excess Liability & Abuse/Molestation coverage for COVERED ACTIVITES. *Abuse/Molestation Aggregate on the General Liability Policy is $5,000,000. Abuse/Molestation is excluded in the Excess Liability Policy. Excess Medical/Dental Accident coverage provided for participants only. 30 DAY CANCELLATION PER POLICY PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. To Whom It May Concern AUTHORIZED REPRESENTATIVE I �J — ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Page 1 of 1