CERTIFICATE OF LIABILITY INSURANCE (2) CERTIFICATE OF LIABILITY INSURANCE DATE 12:/22/14
Keystone Risk Managers,LLC IFICATE# 3091211-1
1995 Point Township Drive � 09 1
Northumberland,PA 17867
ADDITIONAL NAMED INSURED INSURERS AFFORDING COVERAGE:
COUNTRYSIDE LL INSURER A: LEXINGTON INSURANCE COMPANY
MATT WERNER
3052 ASHLAND TERRACE INSURER B: NATIONAL UNION FIRE INSURANCE
(Non-Liability) COMPANY OF PITTSBURGH,PA
C.!_IrfiFtlw�-^,TER T=L. 33?suI
INSURER C: CHARTIS SPECIALTY
INSURANCE COMPANY
COVERAGES
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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _
INSR ADVL POLICY EFFECTIVE POLICY EXPIRATION
LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YYYY DATE MM/DD/YYYY LIMITS
GENERAL LIABILITY EACH OCCURRENCE $1 1 000, 000
A X X OCCURRENCE 011225810 1/01/201S 1/01./20 d6 GENERALAGGREGATE $2, 000, 000
PRODUCTS/COMP OPS $1; 0001 OOU
X INCL.PARTICIPANTS Property Damage Deductible:$250 AGGREGATE
SEXUALABUSE $1 1 000� ('BOO
X SEXUALABUSE OCCURREN E
SEXUALABUSE $2, 000, 000
AGGREGATE
NY
MEDICAL PAYMENTS PEONE
PER ONE
EACH LOSS ! $1,000,000
A x DIRECTORS&OFFICERS 17602157 1/01/2015 2/01/2016
AGGREGATE $1,000,000
A X 011406714 1/01/201S 1/01/20 ib EACH LOSS $35,000
CRIME COVERAGE
Crime Deductible:$250 Property/$1,000 Money AGGREGATE NONE
i
B SPORTS EXCESS ACCIDENT As in Master Polity As in Master
X I SR G91054�34 1/01/2015 1/O 1/2016 Med.Ded.$50'000 Policy Excess
"X"INDICATES COVERAGE SELECTED FOR ADDITIONAL NAMED INSURED '
ADDITIONAL INSURED
Who is an insured(SECTION II)of the General Liability policy is amended to include as an insured the person or organization shown in the schedule, but only with respect to
liability arising out of the above named Little League's maintenance or use of ball fields,or other premises loaned,donated, or rented to that Little League by such person or
organizations and subject to the following additional exclusions:
1. Structural alterations,new construction,maintenance,repair or demolition operations performed by or on behalf of the person or organization designated in the Schedule unless
performed by the above named Little League and
2. That part of the ball field or other premises not being used by the above named Little League
NAME AND ADDRESS OF PERSON OR ORGANIZATION:
a. CITY OF CLEARWATER 2. P INEI. LAS COUNTY SCHOOL BOARD
INSURED CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES TO THE ABOVE NAMED LITTLE LEAGUE BE CANCELED BEFORE THE
Little League Baseball Risk Purchasing Group,Inc. EXPIRATION DATE THEREOF,THE ISSUING INSURER OR THEIR REPRESENTATIVE WILL MAIL 30 DAYS WRITTEN NOTICE
TO THE DESIGNATED PERSON OR ORGANIZATION AT THEIR LA&T,KNowN `ADDRESS TO US.
539 U.S_ RT.15 HIGHWAY
South Williamsport,PA 17702
AUTHORIZED REPRESENTATIVE