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CERTIFICATE OF LIABILITY INSURANCE (2) CERTIFICATE OF LIABILITY INSURANCE DATE 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). PRODUCER PH: 800-526-1379 FAX: 973-921-2876 CONTACT NAME: Stan Driskell Bollinger, Inc PHONE (813)229-8021 �CNo:(813)229-2795 P O Box 390 EDMAIE :sdriskell @mewilson.com INSURER(S)AFFORDING COVERAGE NAIC# Short Hills NJ 33823 INSURERA:Markel Insurance Cc 38970 INSURED INSURER B: Florida Youth Soccer Association, Inc. INSURERC: 2828 Lake Myrtle Park Road INSURERD: INSURER E: Auburndale FL 33823 INSURER F: COVERAGES CERTIFICATE NUMBER:14/15 All Lines 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 300,000 A CLAIMS-MADE 7 OCCUR X 3602AH243048 6/1/2014 6/1/2015 MED EXP(Any one person) $ 5,000 • Participant Legal Liab. Sexual Abuse and PERSONAL&ADV INJURY $ 1,000,000 • Sexual Abuse & Moles. olestationi: GENERAL AGGREGATE $ 5,000,000 GEN'LAGGREGATELIMIT APPLIES PER: 1,000,000 per Occurrence PRODUCTS-COMP/OPAGG $ 2,000,000 X POLICY PRO LOC 2,000,000 Aggregate $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ A ALLOWNED SCHEDULED 3602AH243048 6/1/2014 6/1/2015 BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 A X EXCESS UAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED I X I RETENTION$ 10,000 602AH029104 6/1/2014 6/1/2015 $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? F NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Participant Accident 102AH243046 6/1/2014 6/1/2015 $50,000 Excess Accident Max per Claim Medical Expense Limit $2,000 Deductible Per Claim DESCRIPTION OF OPERATIONS I LOCATIONS I 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. Athletics Office 706 N. Missouri Avenue AUTHORIZED REPRESENTATIVE Clearwater, FL 33755 A_J. Morgan/PJT �� ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 nninns m The Ar.np 1 namc­1 Innn arc rcnicfcrnrl m Lr of a(r1Rr1