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CERTIFICATE OF LIABILITY INSURANCE (4) }4ZIAN1]KrN12 " � CERTIFICATE OF LIABILITY INSURANCE 06/Dl/20 6 Y' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES HOT 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 r+ 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 Ileu of such endorsement(s). PROOOCER 1-813-229-8021 CONTACT NAME: Amber Richards rn H_ R. Wilson Co., Inc. PHONE 813-349-2220 FAx 813-229-2795 � INC.No.E?EQ1 (Pic Nei): > E-MAIL charde@mewilsan.com LU ari 300 W. Platt St. ADDRESS: UU Ste 200 INSURER(S)AFFORDING COVERAGE HAIC# Tampa, FL 33606 INSURERA: SCOTTSDALE INS CO 41297 INSURED INSURER e: NATIONAL CAS CO 11991 Florida Youth Soccer Aean Inc. INSURER C 2828 Lake Myrtle Park Road INSURER D: INSURER E Auburndale, Pb 33823 INSURER F: COVERAGES CERTIFICATE NUMBER:47000358 REVISION NUMBER: TEAS ES 10 GERTIFY THAT THE POLICIES OF 1143URANCE LISTED BELOW HAVE BEE 1%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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIDMYYy AlMODIYYYY LIMITS INSO A X COMMERCIAL GENERAL LJA81LITY ILKRSO0000063739-00 061Q11i6 06/01/17 EACH OCCURRENCE 5 1,000,000 CLAIMS-MADE X OCCUR DAP,IAGE TO RENTED 300,000 PREMISES(Ea occurrence) $ X Participant Legal Liao MED EXP{Anyone pelsonl $ 5,000 X Sexual Abuse & Moles. PERSONAL BADVINJURY 5 1,000,000 GEN-LAGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2,000,000 POLICY PRO- X SECT LOCI PRODUCTS-COMPADPAGE $ 2,090,000 OTHER. $ 13 AUTOMOBILE LIABILITY 6LKK000000063740-00 06/01/16 06/01/17 COMBINED SINGLE LIMIT g 1,000,000 (Ea acadeal) ANY AUTO BODILY INJURY IPer fine n} $ ALL OWNED SCHEDULED BODILY INJURY Per accrdenl $ AUTOS AUTOS [ } X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE 5 AUTOS {Per a�ident) 8 A UMBRELLA UAB x OCCUR ILXKSOOODO063742-00 06/01/16 06/01/17 EACH OCCURRENCE $ 1,000,000 H EXCESS LIAR CLAIMS-MADE AGGREGATE S 1,000,000 DED RETENTIONS S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNERIE(ECUTIVE E L EACH ACCIDENT $ OFFIC E RW E MBER E XCLUDED? -�k!A (Mandalnry In NHJ E L DISEASE-EA EMPLOYEE S kf yS6 descnbe under DESCRIPTION OF OPERATIONS below E L.DISEASE•POLICY LIMIT 5 8 Participant Accident 6ASPXDOGO0275662-00 06/01/16 06/01/17 Max Per Claim 501000 .Medical Expense Limit Ded Per Claim 2,000 DESCRIPTION of OPERATIONS)LOCATIONS!VEHICLES(ACORD 101,AddMianal Remarks Schedule,may 4e attached it more space Is requirod) All operations of the Florida Youth Soccer Assn, its teams, leagues & clubs. Coverage applies only to official, sanctioned and supervised activities of PYEA. .CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED. This certificate is issued on behalf Of: CHARGERS SOCCER CLUB (CLUB COM: C2-CSC) EDDIE C. MOORE COMPLEX - 3050 DREW ST. CLEARWATER FL 33759 - COUNTRYSIDE SPORTS FLEX 3060 MCMDURN BOOTH RD CLEARWATER FL 33761 - SOB DIMAGGIO FIELDS 2450 DREW ST CLEARWATER FL 33765 - GLEN OAKS PARR/DAVID MARTIN FIELDS 1345 COURT ST CLMWATER FL 33756 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 8E CANCELLED BEFORE City of Clearwater Athletics Office THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE-WITH THE POLICY PROVISIONS- 706 N. Hissouri Avenue AUTHORIZED REPRESENTATIVE Clearwater, FL 33755 USA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACID RD name and logo are registered marks of ACORD MS004 47000358