VERIFICATION OF INSURANCE FOR THE AMATEUR ATHLETIC UNION OF THE US INC AND ITS MEMBER CLUBS VRRIMI(CpTEON OF INSURANCE
FOR T1119 AMATEM ATIMETIC VNION OF THE U,S,,INC.AND ITS MEMBER CLU&5
GEMERAL INPORMATION I1tl5 snag Verifies iftPone t pryvorals fartW Atwmw AtHedc
Union oftbe Unked Stated Ina Mknbaelebs 11%v coverer ss sh0wa COVERAC£DATM
below Fmm rite dat;ofearcAnct"aadaceopm ee In the AAU. €or"14-WUNTS
CxplFapan dale K Attgpsi Sitl agn pally.
TWs vcciftmlon rs issued v a Inaaer oTiOlbnttiuim only vtd ctxtfen It*rit)riu><This variFieralott doesnot xHlrttn�vnly or aetativaiy amend txtmd or
okcrilw eovcral t aflonkrl by$*polkks Wow,This veri6eatim of kK1xat194 dnet not cotntilok a contract between the Eioilapi krsenar(11 uatlwaizeii
esenhtivcoi producer
PRODIICtOt lxBUktEi MEMBER CLUB ENSURED CLUB CODIL lVW789F
Payinsutanea AmatewAdilci;aUnienofthgV,S„Inc. CMARWATERRASIUMALLCLUU L'P
64 Pwanowlt A,c Walt Disney World Etesori 2025 ROUNTREE COURT
PO Box 1030 P.O.Hoc 10000 CLEARWATEK TL 3.3763
Exeter,HK MS-1030 Lahc Bo nctc Visa,FL 32830.1000 Par:alltntrtt'37dt«€91248014 1,14:9DI'M
(407)934-7206
€NBURER(S)A�MADM Q COVj0%A -.
Cantpnay A thNtcd Swo Fite IntmnnceCompam NAlCd121113
Company a Everett Natiaul lntu rmu c tpwptgty NAI C N 10120 •For box below,[NSR LTR
re'terf tc ewnpapy A or 13.
MRRAGL3-This is I comfy lbal the 'M1.3 a tnsruanet:l smcl below have btto tube
to ilia kssotad tw tied abavo tbq Oro polity yer e.
NotwilIvOo rl:og pay n gotrcasrtN,cettn,or owtdkim ofaoy con pact orother doo icrit wkb rewel so vAilch dtis aatideycd ioea be issued or Ipay pcitm,the
insurance atrorded b-v4M policy(lets)deocri kcd ller6n is wWcct to an the terl1w v*D)d ioar,aril up"tions of suds poG 6146 sho%11 taay have be=
:copier d by paid ciah of
Veit TYPE OF POLICY 71CAMOX COVERAGXJ*'&P COVERAGES LIMITS
LTR INSURANCE NUiV BER #D/Y1t) DATE�A Portioiptatt UStS11711'- U3•AM.ir 1f2bLS 42'•01 :� :Apc'Aortk cn1 AW(kht y y 'try i; k' L.,1 s +� *MAC JBtt4tlgeplIt and Dismeotbemuai 10,000
B Excess SIEEX401f2-_€dt •91Ultzpl4._12:01/AM,,•�.,�3tf033•��T`AJy7'•.1 '�aci(�pptrrte�PerCk,b b
9,OPD,000
labilay �` ry.l \ =i ''\•= �'.��'t,.`lbliry\Ap regtite.hkrClu RDW,OOU
8 Gwrrsl 5t8M100t7�I41 91tl11Lgt4.�2�1` k4 "ti •9yS/10 IdQI Aii4 R
CkcwieacaLinal 1,000,000
Lmbilky �'1.` \ ` :t t '� tC feral ASE Mue L'unit FW C7ub 3.000.0DG
•1�r,L � �4��,.�Put€cSpmetLCEalUabil€ly 1.p00,U0D
\ t•l.•a Personal ptdAdvertsil%[1).ry U09T 109D,OD0
t.y1e \� Ptodnets-Complctrrl Qperatierd AgtyeptaEa 3,OfNi,000
'•, •+.`•�,'.ti•I�'' '�� 1 't__\.,�J S J Fire,baaaax+a ytrenti kented to
4';s,�tiv .\''..',,,��,z+k',"`�•� +til'`�`"'"�' Yast(AayOaaPrentiaes) I.UDC,900
• �'•' : - MedicalExprnsesLimit(Any Or*€Vron) 5.000
Sexual Allwe UsHlby 1,001,000
Sexual Abnse Agts 3,006900
ADDITIONALINFORMA7I0N1RESFRI NA 41,-Nr tS
Far sa€d claU to Irova tx+vlxa&4.al I meriilssci§hip nv lvira"ts in 0*AAU most bcmeL
FOrsa tt t lub Eo liars Extwsdad Coyfrage(A13}progratry au It►ambctsisip requiremeros is rte AAEI AD program mm I c met.
CANCBLLATlOP1-Skoukl a ry ofll ealtova ticmrt�esl pnJieks be cmcelkdbeSme tJte axpltadml date tlkroof,attrico will be ddivered its aocordwe wick:be
pdtey pronGCen-H}a,13iblre t0 malE utek pallcea II{al1 entpose a6 0bl l$a11Dn for Nobility*fogy kind upon Ike mstav,€tn ngtatls or up n.t.*W;vas
NttVOCA'C[UY OF AiFittB$RSEItP•will nosuh Ia cancelintiop of coverage.
A1lhoritedit<praeutetive
Vtrificallan No. WW789F
Event Sanction Application Page 1 of t
JOINAWT INS~CEt GOVERNANCEr
Cuax:roer S2rVkX
CL.EARWATER 3ASX9T$ALLCt-IJ81TUP
��01 V40t PMCtkW{LIARWATRR 3ASKMALL CLUB(TUP Dates 2112312014-088"12015
�� M. X)CXX
C.0 t 3snoM a Wl1am (nt 499--SM Type: BA.PrKWs
FVeRt FieNltles eeiMn _
OLy or Gbornelw G1Ba HAer FL
C%W WBtd'BarkelbaA f3lb.Owmater FL
P'MON[gamy O*xJ BaoE,Lugo FL
PLEASE NOTE:AN aFJderes end IM-81hletes befongfnO to your Plab must be AAV IntlhMdrral raembers
for our fnswanes bamOls to be In three.
i:1•,:'rt� l:;1:R;:Y-F:" f.,vA:tt�.]tui,r i�?i al�,:!Y�:nn of loft USA.II-w- -Rwacy5latemm Term5of t,ke
littps://application.aausports.org/clubapp/ClubSanctionO4,asp?Type=PIS 1 OP-412014