CERTIFICATE OF LIABILITY INSURANCE (17) '- -W
CERTIFICATE OF LIABILITY INSURANCE 10/02/2015
T-ls CLIRTIRCA"E R V A-1,:)!, Y
C,P,
YDIES, O" AP,`1 I -TIV
"M -,.E COVERAGE AFFORDED BY-1-- A C
NEOATVELY S 5; C'A' IIS CER-IFICA-E OF IINSURANCm DO` -,ONTRI�CT
ISSUINGINSJRLR($� -,!IATI -E CERTI�I" -C..
S'' VII)IRPRODUCER AND T1
IMPORTANT I'S,A:TOGA-1014 IS WAIVED $ub,qct to e tern S ol,Cies er re
,y cert,11,, I yr ju
oner,dQrsemen',Asirl!r- or S (:a:c Cans n.D`;0,11F0'riglls to the cehifta�e nolde,I,,I o, &
PRODUCER Y.,()NTACT NAME
Bollinger, Inc, PHONE Zc
101 JFK Parkway No E xt) 800 526-1379 0: 973.921.2a76
ShortHills, NJ 07078-5000 EMAIL ADDRESS
Phone: 800-526-1379 Fax: 973-921-2876 INSURERS,AFFORDING COVERAGE NAIC#
INSURED INSURER A: Markel Insurance Company
38970
Amateur Softball Association and Members of the J0 INSURER 9:
FL - Florida ASA Individual Registration Program
Carlton Benton INSURERCi
1643 Bedivere INSURER D:
Lakeland, FL 33813 INSURER E:
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,01'ANY CONTRACT OR OTHER DOCUMENT WITH RESPLci TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY
THE POLICIES DESCRIBED HEREIN 8S SUBJFCT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
NS. TYPE Of INSURANCE An DL sIJBR I POLICY NUMBER POLICY EFF POLICY EXP I IMITS INS. '. D
IMMIDDan iMM.DaNyk
,GENERAL LIABILITY V 3602AN230069 09/01✓15 09/01✓lis EACH OCCURRENCE $2,000,000
A . . COMMERCIAL G P NE (M
LIAL�-y DAMAGE 10 RENTED
CIAWSMADE v OCCUR PREMISES(Ea occu_rence) $3001000
MED EXP(Any one person) $10,000
only
A, Is/ Participant Liabil1-,ty PERSONAI &ADV INJURY $2,000,000
Sexual Abuse&Mole5mIio�'I-iac oei accirrence:$i1J00,000
AGf`IREG 7E LIMIT'APPLIES PER: Sexual Apuse&Moles"a'io-Al greg@le I rrit 52,00,000 GENERAL AGGREGATE $5,000,000
POLICY PRo.1ECI LOO
PRODUCTS-COMPIOP AGG $2,000,000
AUTOMOBILE UABILITY
COMBINED SINGLE LIMIT S
ANY AUTO (Ea accklenl)
ALL OWNED AUTOS
BODILY INJURY $
SCHEDIJI.E0 AUTOS (Per Derson)
HIRED AUTOS BODILY INJURY
IL__'NON-OWNED A U I OS (Per accidenty $
PROPERTY DAMAGE
(Per accident)
UMBRELLA EACH OCCURRENCE
IAR OCCUR
AGGREGATE
EXCESS
LIAR E J 01 AN$MADE. $
DED 1 7 $
RETENTION $
WORKERS COMPENSATION,AND "".WCSTAIUTORY --1
EMPLOYER'S LIABILI TY OTHER
A14Y PROPRIETOR PARTNER EX, ,,'Iv'-
OPP I CE PUM r KI 8---R EXCL 1,DLLI N/A
i E.L.EACH ACCIDENT S
(Mandatory In NH) E,L,DISEASE-EA EMPLOYEE $
If yes,deserbe under DESCRIP7 1v1,OF
nPERATIC-NS below I E.I.,DISEASE-POLICY LIMIT $
A
ZOciden4iifim t Medical
Excess Period. Deductible may apply
DESCRlPTI0N OF OPERATIONS i LOCATIONS r VEHICLES Attach ACORD 01,Additional Renriaeks 50edwIv,if more space is required)
COVERAGE UNDER THIS POLICY SHALL APPLY TO LIABILITY OF THE INSURED ARISING OUT OF THE ADMINISTRATION, PLAY OR
PRACTICE OF AMATEUR SOFTBALL✓BASEBALL, BUT ONLY FOR INCIDENTS INVOLVING BODILY INJURY OR PROPERTY DAMAGE.
CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED. THIS CERTIFICATE IS ISSUED ON BEHALF OF: Clearwater Bullets 16U -
Sharpe
CERTIFICATE HOLDER CANCELLATION
City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
112 S. Osceola Avenue AUTHORIZED REPRESENTATIVE
Clearwater, FL 33756
ACORD,25(20 10105) Cr 1988-2010 ACORD CORPORATION,All rights reserved.
The ACORD name and logo are registered marks of ACORD
THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY
ADDITIONAL INSURED-DESIGNATED PERSON OR ORGANIZATION FOR
AMATEUR SOFTBALL ASSOCIATION OF AMERICA ACTIVITIES
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
With respect to coverage provided by this endorsement,the provisions of the Coverage Form apply unless
modified by the endorsement.
Narnod a%unf& Amateiar Softball Association and Members of the 70 FL - Flozida ASA
Individual Registration Program
City of Clearwater
Policy Number PokV Period :We
3602AH230069 09101,115 - 09101116 As shown o.r,me aftaCtWd Certificate of Insurance
Issued Sy T11 utnorizecl Reprosentative
Markel Insurance Company
The above information is required only when this endoMSenlelit IS prepared altar the polity is issued.
SCHEDULE
Name of Person or Organization:
As Shown on the Attached Certificate of Insurance
A. The following is added to Section 11-WHO IS AN INSURED:
The person or organization shown in the above SCHEDULE but only with respect to liability arising out
of the organization,promotion,administration and conduct of amateur softball activities. including
games,practices,tournaments,and fund-raising activities, under the rules of the Amateur Softball
Association of America,provided:
a. That if the person or organization is designated as a Team,the person or organization so designated
shall be deemed to include team members.manager,coaches,assistants,batboys. registered
scorekeepers,sponsors,any other individual participating in the official functions of the team,and if
so indicated,a Field Owner,but only for liability arising out of the designated Team's amateur
softball activities covered under this policy,
b. That if the person or organization is designated as a League,the interest of the League shall not be
included unless all team members in the League purchase this insurance.
When the interest of the League is so included,the person or organization designated as a League
shall be deemed to include all teams in the league and team members, managers,coaches.
assistants, batboys,registered scorekeepers,sponsors,any other individual participating in the
official functions of the League or of any such teams,and if so indicated,a Field Owner, but only for
liability arising out of the designated League's amateur softball activities covered under this policy.
All other terms and conditions of this policy remain unchanged.
19 69 GL 09 98 includes copyrighted material of Insurance Services Off Ice,Inc.with Its permission Page I of 1
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