CERTIFICATE OF LIABILITY INSURANCE (3) Sadler Sports:AYF Insurance Plan
PATE(M Ml DOf YYYY)
ACRD_ CERTIFICATE OF LIABILITY INSURANCE 0712D12014
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AN CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMAMATNELY OR
NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFOROED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN
THE ISSUING INSURER(S),AUTHOR12P0 REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER,
IMPORTANT':tithe certificate holder Is an ADDIT1011AL INSURED,the pelky(wc)m.st be endorsed.If SUBROGATION 11 WAIVED,aab)tet is the(ermc a w mrvliMns e u b policy.oaAain polities may
roquire an endoraenlerll.A stelernent on ids mr1ire to does not confer fthLs to the odificate holler in Neu of such andonannent(s)-
PRODUCER CONTACT NAME Sports Dept
WLER&COMPANY.INC. PHONE(Al C.No,Erdl:W&622.7370 1 FAX(AlC,Nol:605.256J0i7
P.Q.BOX 5866 E.MAILADOR64.9:ayf®sad arspods cum
COLUMBIA,SOUTH CAROLINA 29250-5866 PRODUCER CUSTOMER IDe:
INSURED
AMERICAN YOUTH FOOTBALL,INC.AND
AMERICAN YOUTH CHEER AS MEMBERS OF
FRS RISK PURCHASING GROUP ASSOC..INC.
Gre.nmod Parilhers Culture and Sports Organization
d G Joseph Marshall
1380 S Madison Avenue INBURERISI AFFORDING COVERAGE NAIL 6
1380 S Madison Avenue INSURER A:NATIONAL CASUALTY COMPANY
CIeammiler,FL 33756 INSURER B:NATIONWIDE UPE INSRAiANCE
INSURER C:
Appilcallon ID:113144 INSURER D:
COVERAGES CERTIFICATE NUMBER REVISION NUMBER
THIS IS TO CERIWY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED"NIEA A96VE FOR THE POLICY PERIOD INDICATED,
NOTMRTHSTANDRI6 ANY REQLMEMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUM ENTYMN RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR RAY
PERTAIN.THE PIBURANCEAFFORDED BV IHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.Lima SHOWN
MAY HAVE BEEN REDUCED BY PAD CLAIMS.
INSR TYPEOFIMORANCE ADDL SUER POLICY NUMBER POLICYEFF POLJCVE)tA LIMITS
LTR INSR WVD (MW DDf YYYY) (mWDG7YYYY)
A GENERAL LIABILITY X EACH OCCURRENCE 6L000:000
®COMMERCIALGENFAALUADILITY DAMAGE TO PREMISES RENTED Si 000000
❑C(AIMSMADE 2OCCUR TO YOU(Ea otxsaesrne)
PREMISES MEDICAL PAYMENTS $5,000
KR00000004478300 D9:57PM ET 12:01AM ET PERSONAL S ADV INJURY 31,000,600
❑ 07/20/2014 0W3W201'5 GENERAL AGGREGATE none
GENLAGGRECATE LIMIT APPLIES
PRODUCTS•COMPl OP AGG 31,000000
PER. LEGAL LIAR TO PARTICIPANTS S1,0w.mo
❑POLICY ❑PROJECT []LOC
AUTOMOBILELIASILITY COMBINED SINGLE LIMIT(E. 3$000,000
❑ANY AUTO Ahem
[]ALL OWNED AUroe BODILY INJURY(Par peraeni
L]SCHEDULED AUTOS BODILY INJURY 1Paf Agomm)
®HIRED AUTOS PROPERTY DAMAGE iPaf ao idard)
®NON.OMMED AUTO$
A ®SEXUALABUSE l MOLWATION 09.57PM ET 1tH
2' AM ET EACH COCURRENCE 11,000,000
KR0000000d478300 0712012014 06130/2015
AGGREGATE 32,000A DD
QUMBRELLALUI6 ❑OCCUR EACH OCCURRENCE NA
L3EXCE85LLAB ❑CLAIMS-MADE
NIA NIA NIA AGGREGATE N1 A
[]DEDUCTIBLE
[]RETENTION -
WORKERS COMPENSAMOIN []M STATUTORY LIMITS
AND EMPLOYERS'LIABILITY
ANY PROPRIETOR t ❑OTHER
PARTNER 1EXECU IVE YI N
OFFICER l MEMBER ❑ NIA E.L.EACH ACCIDENT
EXCLUDED?
(MandmiW in NH) II DISEASE-EA EOMPLOYEE
Ifyas,QKnfiee under DESCRIPTFON OF
OPERATIONS below E.L.DISEASE-POLICY LIMIT
6 PARTICI PANT ACCIOENT FJ(CESSMEDICAL 1100,00a
JXSOD00026398300 09'57PM ET 12:01AM ET DEATFItsPECI FIC LOSS 510.600
07/2012014 06!3012015
DEDUCTIBLE 5250
DESCRIPTION OF OPER1A�TtONBs I LOCATIONS f VEHICLES(A UGh ACORD 101,Addamnal Realarks Schedule,Nmore space is required)
RE.COVERED SPORTS Tackle Football-Agaa 161Under11 teams},Flag Football-Arf"647(t Mams),Chaae(Danes lSUp l Ma)anotta squads f CoMeader-Clean 2(1
Meets)
NOTE The Participant Accident policy,H inCluaed above,is not a part of the ERE Risk purchasing Group Association,Im.
The ceaNrale holder h added as an addkiahal Insured,Sul only wah respect to the Sabahy arh.log oul of Ina opem600s of ON insured abovs-
CERflFICATE HOLorm CANCELLATION
RELATIONSHIP: SHOULD ANY Of THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE
Property Owners Lessor THEREOF,NOTICE WILL BE DELIVERED ON ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE(company A)
City of Clearwater u
P.Q.Box 4746
Cloamter,FL 33768 AUTHORIZED REPRESENTATIVE(b mpery 8)
coverage is only axtendecl to U5.averts and atliilles �+
'-NOTICE TO TEXAS INSUREDS.The Insurer Wthe purchasing group may not be sobjed to all the insurance lows and regulations ofthe Slate of Texas.
ACORD 25(2009109) 01968,2009 ACORD CORPORATION.All fights reserved.
Tne ACORD name and logo are regNtered marks al ACORD