CERTIFICATE OF LIABILITY INSURANCE (4) �R RNr CERTIFICATE OF LIABILITY INSURANCE �DAI (MWDD1rYYY)
X2016
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 INSU'RER(5), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE,HOLDER.
IMPORTANT. If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must the 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 Beau of such endorsement(s.
PRODUCER CONTACT
NAME:
WILSON SPORTS INSURANCE SERVICES, LLC PRONE ;FAX
iAb Ira,EkTI _ IAIR,wql.
43 CROWN RD, ADORE-MAIL
AESS.
WILLOW PARK, TX 76087 INSURER
pSI AFFORDING-COVERAGE NAIL 9
INSURER A: S OTTS D ALE,I N . CO'.
INSURED INSURER 6 1 NATIONWIDE LIFE INS. CO.-
L)NI'TI D YOUTH FOOTBALL$�CHEER LEAGUE INSURERC• 1
y,. Hy� gyp.
1060 SUS'SE WY.,#B INSURER D:
PARK RIDGE, IL 60068 INSURER E.
Attn: TONY ARENA I INSURER .
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER,
THIS IS TO CERTIFY'THAT THE POLICIES OF INSURANCE LISTED BELOW HA VF BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, rERM'OR CONDITION OF ANY CONTRACT OR 07 HER DOCUMENT VWI rH 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 PAINT CLAIMS.
INSR I
�ADOL SWefE''J ... _ POLICY EFF f'OR.IcY EXP _. _...... .......
LTR I`YPE Or INSURANCE ! POLICY NUMBER IMMfDDNYYY1 fMMt1DD1YYYYJ, LIMITS
,j COMMERCIAL Ms-MAC GENERAL J cr l�r I -
A EACH $ 1 070,000
..... �� PREMISES,IE;a,wxurrunuej. 300,000
A(hl _tiC Pa"3I"t:Icippnt_. _... , M €7 EXP{Arry„Nxmu picrsuni _,5,0470 .
Legal-LIU IIity __ KRS-64133-00 � s13UJts� � 6/30/17 Pnr��aNNAL�ADU NraJURr �� N,L�,QQ�[DQt�y_
GEN'L AGGREGATE L.IRutitlT.A3 PLIES.PER:, ' c,FNERAL AGG5REGAT£ .. s5,000,000
,000,000
J
,.
POLICY POLICY JLC'T
PRODUCTS R Cc )ObJCTS raOrMPrIIP AGG r 1,000,000_
a ,
OTHER: � S.A.M. S1,000,000
AUTOMOBILE LIABILITY' r'COMBINED SWGLE LIMIT, $
....
ALL LOW OWNED SCHEDULED � � i BODILY INJURY(per person) J$
AiWTO,S' AUTOS - I ) $
NON,OWWNED F^dsY amr,n rdelrryl
... - PROPERTY LR VAGE
HIRED �—_.m......._.._.. . _ ...... 4Pra:a ci i mrr4 $
.... AUTO
i 1 UMBRELR.,ALIAEt...... ..._ ,_..... ....�.._, .. __.e...... .., .... �. .e,...m. .. .. ,..,�.,,.....�..,_._.... ,....
W
OCCUR 1 EACH OCCURRENCE $
EXCESS LIAR CLAIMS pMADE r
AGGREGATE
m. $
DED RETENTION$
RISE 1 T OTH-
RS COMPENSATION I PER
AND EMPLOYERS LBABTLn'Y YIN 1 t `,_STATUTE_ FR
OI-HC1-R(MRaETOR(I,WWNNL,L XN:CU”#tl1JL > EL..EACH ACCIDENT $
ANY PROFrr
,(Mandatory In NH) — .r .........
I E I�.DISEASE-EA EMPLOYEE,$
LMr3�LFR L kC"LLrDLI]'� 1 N FA
I If yus rla sudb€.under r _ _ _
B Excess Accident iedica�l
OTHIER(secondary) � l _....� SP}C- 7615 00 6J3CNrIS .., E.L.
imit: SE ROL ICY
25,LNRrMRT ..5... ....... m._,_,..
. L�IrN"All X5,000
6I30M 7 Deductible: 500
I
t R i
DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES IACO�RD 101,,Additional Remarks S-chedule,may be attached if mare space,is required)
FOR COI FERER*NCEIA SOCIATIONITEAM' Greenwood Panthers 15U
CONTACT:
CERTIFICATE HOLDER IS NAMED AS AN ADDITIONAL INSURED WITH RESPECT TO THE OPERATIONS OF THIS NAMED INSURED,
Certific-ate speeifiCally relates to practices&Barnes of registered&mastered players of UYFL.
CERTIFICATE HOLDER CANCELLATION
City Of Clearwater/Parks&Rec.Dept. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
RO.Box 4748 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Ctearwater„Florida 33758 AUTHORIZED REPdRES,kN IATIMfE
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