CERTIFICATE OF LIABILITY INSURANCE (3) CERTIFICATE OF LIABILITY INSURANCE 61tiL:o1A1O�s'`Y'''
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RtGHT5 UPON THE CERTWICATE HOLDER.THIS
CERTIFICATE DOE S NOT AFFRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICES
BELOW,THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTEA CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
NPORTANT:Wthe certf CM holder Is an ADDITIONAL INSURED,the pDNcy(i")must be endorsed, N SUE1ROGATN)N IS VYAM%subject
to the terms and conditions of the policy,certain policies may require an endorsement.A Statement on this Certificate does not Confer
rights W the certificate holder In lieu of such endorsoment(sy
PRODUCER k It&M: r
+AIe:
BOLLINGER,Ir._ I41CIE 'M
+O Of;FK PARK NAY r—IIO :EOnd46-5311 AR,NP:973-921.2878
SHORT HILLS,N.I 07078 A•KVL
PM>E.1$J.'3448.13it FAti S73.921.2878 AQW31:
IN SURM 21 AFFORDING COVERAGE NAfC><
am MOM A:Na"wounna Coampmy 3111-7
INSURED a'milft a:
LAS Lacrosse:Inc. nlwkdtt;
113 Rest Vnivenitq Padwac
a
Battiamre NM 21210 �
Re:Clearwater You&Laansse vellum e:
wwRelt r:
COVERAGES CERTIFICATE NUMBER; REVISION NUILISER:
THIS IS TO CERTIFY TH.ATTTIE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREO NAMED ABOVE FOR THE POLICY PERIOD INDICATED
NOINVIT)ISTANDING ANY RE011IREUENT.TERM OR CONDITION OFANY CONTRACT OR OTHER DOCuIJF-NT WITH RGSPECT TO WHICH THIS CERTIFICATE MAY BE ISSUEC
OR IAAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIE DESCRIBED KEAElN IS 9ULECT TO ALL THE TERMS.E(CLUSiONS AND CONDITIONS OF SUCH
POLICIES. :,IMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS
IftaR TYPE OF INSURANCE 400E 7MNn POLICY MUTAB£R P61.10ye P poucyro LIMrrs
LTR 16M rm NpN
GENERAL.LiARILItY uc ax ret[�ce Si,066,00G
R x COMMERCIAL aENfRAL IARILITY
R9,L`,�77 -1'E," SiD0,00C
CLAUSJAADf ❑OCCU.R $302AFt221?C9 01101x2015 01'01 2018 p ,I ,g:ty7xrlrrY.
X L l :Mr Ole 55.001)
x Pmrtidpar.uLiab p930O&IIIA,Oy:hJJ?ty 51-0w.046
"L'OdREGATE LIIOITAP?LIE94ER y-A%e4#,LA4'',�eGA�E S:.000.D00
POLICY❑PRO- PgLoc AltWL.C"4-004.IPgPAGO 5=.�:�
JfCr +�
S
ALITOWRILELIAMLITY Covb-.>=MOLE LA ea a=*" 5
ANY AL?0 S
eOCi+.r+r.%Jptr Www
ALL OWNED SCkEOL.LRD 000 r'.+.utr neretciml. 5
AUTOS AUTO$ ptppEgry,y S
kIR£I}ALIrOS k3k•OYVHED Ipwea:teeC
ALTOS g
x UIIBRELLALIA6 x OCCL•R EAC-occ-ttRENIX 51,x,000
A EXCESI LIAR euva s. 4802AN221370 01/0112415 014112018 A±G�E;dLTE 9L000;000
S
DED RETENTION S
YWORNERS COMPENSATION Y i N Nth
Fc q 4
AND EMPLOYERS'LIABILITY � cnr .+-s
AKI'bROPRIC'ORPhn'NEifX:C�:Lt: S
OFRCE4°R'fLIDE+I EXtaJDE_I E L!AC!+ACCtt�
(LterldeterY In NH) eL 3SEASe.EA INIPLOYM 5
'!etawrix-.1ezml$1.010!.C? ELDUEAIf-ppt;,^yu.:- S
OPLI i iONt Omar
A k0ekient MedlLal 4102AIt025220 01/01/2015 01101120tf1 cant Limit 5100.000
kirtaltr icAec 4102AF130SSf12 01/01/2015 101 101!20113 MS!'"nicLimnSl•0,00,000
DESCRIPTION OF OPERATIONS t LOCATIONS J VEHICLES(Anaeh ACORO 101,AdOkionil Rlpta is Sd*dub,V orate spme is MHMS 4
o"r;&W applies to wma+►aaguee to"dead of 10411 US ter,,...mwnbem p ritieipsrtta euring adtadubd artd st"Wisad L a"ba wtivkIw
CERTIFICATE HOLDER CANCELLATION
SIMLO ANY OF THE ABOVE DESCRIBED POLICES BE CAIICELLEO
BEFORE THE DOWATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
Cit Of Cleawater ACCORDANCE WITH THE POLICY PROVISIONS.
1501 N'.Belctler RD
Cle2ma".FL 33 765
AUTHORIZED REPREIENTATWE
6 t98a-2010 ACORD CORPORATION All rights r=stve4
a.CORO 2F,2010:0a1 7h AC:CR01am&Am4 Saga are fag HtbrW Mart;of AC00L'