CERTIFICATE OF LIABILITY INSURANCE (18) A-,c LP CERTIFICATE OF LIABILITY INSURANCE 1 09/20/2016
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.TH1S CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE
ISSUINGINSURER(S),AUTHORIZED REPRESENTATIVER PRODUCER.AND THE CERTIFICATEHOLDER.
IMPORTANT:It the certificato holder is an AD01TICNAL INSURED,the poricy(es)must he endomed.if SUBROGATION IS WAIVED,subject to the terms and Condihons of the policy,certain policies may require
an endorsementA statementen this cattificate does not co rifer righte to the certiCcate holder in lieu of such endvrsem and(s).
PRODUCER CONTACT NAME.
Bollinger, Inc. PHONE(AIC, FAX(AlC,
150 ,TFK Parkway Na.E#): 800.526-7379 No); 973-921-2876
ShortAills, NT 07078-5000 EMAILADDRESS:
Phone: 800-446-5311 Fax: 973-921-8236 INSURERS AFFORDING COVERAGE NAIC ff
INSURW INSURER A: Markel Insurance Company 38970
Amateur Softball Association and Members of the JO INSURER B:
FL — Florida ASA Individual. P-Agistration Program INSURER C;
Carlton Benton
1843 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 OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED eY
THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL 114E TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE Amy suaR POLICY NIJMSER POLICY EfF POLICY ExP
LTR wsa nvo LIMITS
G=NERALLIABILITY 3602AH230069 08/01/16 09/01/17 EACH OCCURRENCE $2,000,000
A [V]CON MERGIAL GENERAL LIA SILIFY
DAMAGE TO RENTED
CLAIMS MADE 2OCCUR PREMISES(Ea occure nce) $300,000
❑ 'Non-paficipants only MED EXP(Anyone persona $I0,000 "
A ❑d.Participant I iability Sexual Abuse&Molestation Lied per occu rer ce:52,000,00q PERSONAL,&ADV INJURY $2,000,000
GEITL AGGREGATE LIMIT APPLIES PER; Sexual Abuse 6 Molestation Aggregate Ilmii S2.000,ODO GENERAL AGGREGATE $5,000,000
❑POLICY ❑PROJECT LOC PRODUCTS-COMPIOP AGG $2,000,000
AUTOMOBILE UASIGTY COMBINED SINGLE LIMIT
S
ANY AUTO JEa accident)
❑ALL OWNED AUTOS BODILY INJURY❑SCIiEDUL.EI]AUTOS (Perperson) ;
❑HIRED AUTOS
BODILY INJURY
❑NON-OW NED AUTOS (Pei accident)
❑ PROPERTY DAMAGE S
(Per a ccident)
UMBRELLA EACH OCCURRENCE
OCCUR
❑UAB ❑
AGGREGATE
EXCESS CLAIMS MARK
UAB ❑ $
DED RETENTION $
$
S
WORKERS COMPENSATION AND WC OTHER
EMPLOYER'S UASILITY YIN UNITS
ANY PROPRIETORMARTNERIEXECLPr{VE ❑ N!A EL EACH ACCIDENT S
OfFICE?IMEMBER F=-UDEP7
(Mandatory uribe Irl under DESCRIPTION DISEASE-]EA EMPLOYEE S
If yes,deseti6�under DESCRIPTION OF
OPERATIONS below E.L.DISEASE.POLICY LIMIT
OTHER
Accident 4102AH220317 08/01/16 09/01/17 Med Max. $25D,000 52-Week Benefit
py Accident Modica] Full Period. Deductible may apply
Excess
DEEMPTION OF OPERATIONS LOCATIONS I VEHICLES(Attacti ACORD 101,AddNohal Remarks Schedule,if mom sp=co Is mquln d)
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 19SURED. THIS CERTIFICATE IS ISSUED ON BEHALF OF: Clearwater Bullets I8U —
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 26(2010f05) 41988-2010 ACORD CORPORATION.All rights reserved.
The ACORD name and logo are registered marks of ACORD