CERTIFICATE OF INSURANCE (5) Page I of t
CER11FICATE OF Issue Date: 12/18/2015
INSURANCE I
THfS CERTIFICATE IS ISSUED ASA MATTER Or INFORMATION ONLY ANO CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER=THIS
CERTIHCAlfz DOES NO!'AFFIRMATIVELY OR NEGAIIVELY AMEND.EX[END OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
THIS CERTIFICATE OF INSURANCE DOES NoTcoNsTiTUTE A CONTRACT BETWFEN TI IF ISSUING INSURER(s).AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOL,DFR
1 frnpodani:It the certificaTe hatcler is an ADDITIONAL INSURED.the policy(ies)mustbe endorsed-If SUBROGATION IS WAIVED,Subject to the terms and
condistloins of the policy,certain pollcias may require an endorsement A statement on This Certificate does not confer rights to the certifirale holder In lieu of
Such endorsement(s).
Producer: INSURERS AFFORDING COVERAGE
FTIC Brokers INSURER A-.Scoltdale Insurance Company
License No.OB29370 INSURERS Sc0dalaInsurance Company
P.0,Box 13847 INSU :
INSURER RER C D'
Sacramento CA 95853 INSURER E.
888-880-3602
Insured:
United States Specialty Sports Association
611 Line Ildve
K
Kissimmee,FI 34744
800-741-3014
00-741-3014
Coverages:
This,is to certify that the poildias of01'surance listed below have been issued to the insured nairled above for the policy period indicated.NoW7077777g=ny
requirement,term,or condition of any contrad or(Aber document with respeol to which this cedificale maybe Issued or may pertain,the insurance afforded
y flea policies descAbed hereln Is subject to all the leans,excluMons and conditions of Such polldes.Limits shown may have been reduced by paid dalms
INSR ADDL S118RI POHGY POJjCy
LTR Type of Insurance INSD WVD Policy Number Effective Expiration Limits
Date Date
A Commerclaf General Liability y N KRSOOOGOO5901000 11112016 11112017 Each Occuirence$2,000.000,
O,ccu ren ce Be sl s Dantogo I u Rcu trd N coi iscs(c a occ)$31)0,000
Mod Exp(any one person)S Excluded
(zaciall Aggreple S None
ftrsonai aml Adv Injury 52,0W.000
'Ptoduc;s-Corivpr01`Agg$2,000,000
1partectPam Lept Liability 52,000,000
B Excess Liability y J 1XIKS000005071ool 111/204-1 11112017 Each GeculTalou SIA0000
1)ES CH I PTION OF 0 PERATIONS I I-0 CATI 0 INS I VEHICLES(ACOR D 1101.Add I tIonal Rom a rks 8 chedu I a may b a attach ad If more space Is
required)
Coverage includes amalcurplay and practice in the Insured sport lor..City of Clearwater Parks and Recreallon Director
The FIeld/Factity Owner shown as the certificate holder shall be an addificrial insured but only with respects to liability caused by the negligent acts or
omissions of the named Insured and only with resPeds to losses resulting from amateur play and practicedu(ing,USSSA sanctioned acLlvilles op airing r
between the coverage effective date listed below and the policy explration date.
cerlificale Holder. Coverage Effective Date: 1/112016 lV
City of Clearwater Parks and Recreation Director CANCELLATION
Tony Grat SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF.NOTICE WILL BE
PO Box 4748 DELIVERED IN ACCORDANCE VArH THE POI ICY PROVISIONS.
Clearwater FL 33758
Certificate ifir USSSA-274262 Authorized Representatives: �-°441
littp:Hwcb,usssa.coiii/sl)otls/fC.a sip?Seqtio=4SA7A852-C I 34-4A85-9DB I-AOB719A46F2... 7/14/201 IS