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CERTIFICATE OF LIABILITY INSURANCE (800)ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 9/6/2016 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 Lancaster Insurance 510 Druid Rd E., Ste. #C P O Box 2856 Clearwater FL 33757 CONTACT Sherry Wilt NAME: y (A/C.NNo. Extl: (727) 461 -3704 AC No): (727) 441 -3298 E- MAIL S :Sherry.Wilt @lancasterinsur.com ADDRE INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Scottsdale Ins. Co. LIABILITY COMMERCIAL GENERAL LIABILITY INSURED Make A Difference Fishing Tournament, Inc. P 0 Box 16535 Clearwater FL 33766 INSURER B : CPS2066495 .. , INSURER C : 8/13/2017 INSURER D : $ 1,000,000 INSURER E : $ 100,000 INSURERF: I CLAIMS - MADE X OCCUR COVERAGES CERTIFICATE NUMBER:CL153608394 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 CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY . CPS2066495 .. , 8/13/2016 8/13/2017 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence) $ 100,000 I CLAIMS - MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 PRODUCTS - COMP /OP AGG $ 1 , 000 , 000 GEN'L AGGREGATE POLICY LIMIT APPLIES PFT — I PER: LOC $ AUTOMOBILE _ LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ _ SCHEDULED AUTOS NON -OWNED AUTOS .- - • - ' - .. COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A I WCY I STATU- I 10TH- FR E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Additional Insured is the City of Clearwater, Parks & Recreation Deptartment applicable to Kids Tournament Saturday October 1st. CERTIFICATE HOLDER CANCELLATION City of Clearwater 100 S Murtle SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Ave AUTHORIZED R ENTATIVE Clearwater, FL 33750 . .a--gd? ',-;:-.-:/(_-.1 Ca---11---6—. / ACORD 25 (2010/05) INS025 (201005).01 ©1988 -2010 AO:5RD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORD® �- CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 9/6/2016 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 Lancaster Insurance 510 Druid Rd E., Ste. #C P 0 Box 2856 Clearwater FL 33757 CONTACT Sher Wilt NAME: MM. o. Ext): (727) 461 -3704 I A/C. NO): (727) 441 -3298 Vaess: Sherry . Wilt@ lancasterinsur . com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Scottsdale Ins. Co. LIABILITY COMMERCIAL GENERAL LIABILITY INSURED Make A Difference Fishing Tournament, Inc. P 0 Box 16535 Clearwater FL 33766 INSURER B CPS2066495 c INSURERC: 8/13/2017 INSURER D : $ 1,000,000 INSURER E : $ 100 000 INSURERF: $ 5,000 COVERAGES CERTIFICATE NUMBER:CL153608394 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 CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDS INSR SUBR WVD POLICY NUMBER POLICY EFF IMM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS _. A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY CPS2066495 c 8/13/2016 8/13/2017 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100 000 MED EXP (Any one person) $ 5,000 I CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 PRODUCTS - COMP /OP AGG $ 1 , 000, 000 GEN'L AGGREGATE LIMIT APPLIES PER POLICY n IF� n LOC $ AUTOMOBILE — _ LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ SCHEDULED AUTOS NON -OWNED AUTOS ;i _ - Al t:,' COMBINED SINGLE LIMIT (Ea accident) j $ BODILY INJURY (Per person) BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB _OCCUR CLAIMS -MADE ' -,' "' ' `- � EACH OCCURRENCE $ AGGREGATE $ $ DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A WC STATU- I TORY I IMITS OTH- FR E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Additional Insured is the City of Clearwater Parks & Recreation Department applicable to The Adult Tournament Saturday Sept 10, 2016. CERTIFICATE HOLDER CANCELLATION City of Clearwater 100 S Myrtle Ave Clearwater„ FL 33750 I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED RE RE TATIVE 4 jai AOF n ACORD 25 (2010/05) INS025 (201005)01 1988 -2010 ACORD CORPC(RATION. All rights reserved. The ACORD name and logo are registered marks of ACORD