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CERTIFICATE OF LIABILITY INSURANCE
,+' EC'y MH CERTIFICATE OF LIABILITY INSURANCE 4/28/201/5 D/YYYY) 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 CONTACT Gagliardi Insurance Services, Inc. PHONE (408) 414-8100 1 FAX N (408) 414-8199 2380 S. Bascom Ave. Suite 100 E-MARL .sales @gsportsinsurance.com ADDESS Campbell, CA 95008 INSURERS AFFORDING COVERAGE NAIC# 0791300 New York Marine & General Ins. 16608 INSURED Suncoast Youth Football Conference, Inc. INSURER B: Federal Insurance Company 20281 1921 Blueheron Way INSURER C: Palm Harbor, FL 34683 INSURER D: 727-458-8995 INSURER F INSURER F COVERAGES CERTIFICATE NUMBER: 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 CONDITIONSOF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BYPAID CLAIMS. INSR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE NSD VWD POLICY NUMBER / / LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1 000,000 CLAIMS-MADE � -- OCCUR c>•-rs>a ngrE $ 300 000 X Abuse & Molestation PK201500006054 4/20/2015 /20/2016 MEDEXP An one rson $ 0 A PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,0 0 0 X POLICY D PRO- F-1 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: JECT Part c pant Legal Lab $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANYAUTO PK201500006054 4/20/2015 4/20/2016 BODILY INJURY(Per person) $ ALLOWNED SCHEDULED A AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS .(Per accident) PAND UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ KERS COMPENSATION PER OTH- EMPLOY ERS'LIABI LITY TAT T YIN PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ CERIMEMBE R EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ Ifyes,describe under DFSCRIPTION LIMIT B Accident Medical 9907-1406 4/20/2015 /20/2016 Limit $100K / $250 DED AD&D $25K DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) The Certificate holder is included as an additional insured, but only with respect to the liability arising out of the negligence of the named insured. All policy terms and conditions apply. ft %earw'L er "4r Tornad©.s; Countryside Jr Cougars.= CFRTlFlQATF HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 47 E-t, THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. P.O.Box 4748 Clearwater, FL 33758 AUTHORIZED REPRESENTATIVE ©1988-2014 ACO ORPORATION.A ights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD