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CERTIFICATE OF LIABILITY INSURANCE (4)
CERTIFICATE OF LIABILITY INSURANCE 1 DATE(M 090r_D16 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 Pohcy4les)must be endorsed. If SUBROGATIOf!IS WAIVED,subject to the terms and conditions of the policy,certain pOcies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu Of Stich endorsernent(s). PRODUCER CUNTACY I3pLLINGER,Inc A PHOria:tt: FA7C 150,FFK PARKWAY,4TH FLOOR (GEC-tin.iW),.804-446.5311 PD SOX 390 [ .Hai:973-921-2876 SHORT BILLS,N1 07078 E-MAJL AsS: PRONE:1-800-446-5311 FAX 973-921-2276 INSURERS AFFORDING COVERAGE NxC g INSLFRERA:Clarke!Insurance Company 38570 fit SURE O INSURER S: 'US Lacrosse,Inc. trrsuaEltc: 2 Laveton Circle Spa&.s,NI[7 2113-2 ut auRfx o: Re.Gleafwater Youth Lacrosse ItiaurWRE: v4 stIRER F., COVERAGES CERTIFICATE.NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO O THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDINO ANY REQUIREMENT,TcRU OR CONDITION OF ANY CONTRACT OR OTHER DOCUJAENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY 6E ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIE D=ESCRIBED HEKJN IS SUBJECT TO ALL THE TERM.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIIATS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAI645. INSA TYPE OF INSURANCE ADM MR I POLICY NUMBER PO—Y-F FOUCYE1w LTR WSR %im MwD A"!lYf7 LlH.1rrS 16tIVWOptYrYYI GENERAL LMLFTY x EACcr=1 - i tam Sipo.:ray A X COMMERCIAL GENERAL LIABILITY oAmseTOR Yl'� 5300,Of.IQ CLALIMS-1lADE OCCUR 8502AH221369 01F0112016 0110112017 P-emrc p x=rum1 k' VP Ar rcre Ss,Lt7v X Parkidpanffi sY Llab SExtia?Abuse x estatao wev :$1,,700,4p gS-Aw "ur%Y GEN'L AGGREGATE LIMIT APPLIES PER: SemW Atwse&Morastauan Agg rega tslat$2,ikFO1 rEhEkAC--iEGkTE FRO- POLICY❑JECT ©LOC 5SS!_C044F0O.,4W00 3 5:,007,006 5 RllTOINY AUTO LIABILITY mwai�S<JWAZUAT(a 11 i S ANY tiIITO ECOLLY iTu6MY(Per OuElw) S ALL OSYNED J-13CHEDULE11 AUTO 5OD Y Y I a AUTOS AUTO5 PROPERTY rafu�HIREDAUiOS AUTOS NEC1 � f AUTOS S UMBRELLA LIAR OCCUR x X x EACH C7CCIlR9� S1,0e0,060 A EXCESS L.IA9 Ct!§MC, 4602AH221370 01/01/2016 01101/2017 �c Si,LXlO,Oiip DM FRETENTIONS INORKERS COMPE14 SATIOH YIN NIA Try S AND EMPLOYERS'LIAIRLI TY srA1 u h.Yi?3 TC?L11Ah'Tt,�R. CtrrFlE �10RYL%tITS OFFiCErs8J.1�R EXC.Llk7F_D? (Mandatory in NH) EL.EACH ACCCENT s tfy2S.0.6-*l�eutYrDE6C.�L�17g7df7P ELDSEASE-EAEI.:Koy=- b (PERATXY.iz b3bw EL.a-%E&9E-P0UM LWEi r S A Accident Medical 4102AH025220 01101C2016 01101/2017 dent Limes:5100,000 te strophic Acc 4102AH305882 01{01i201S 01101CL017 �testrophicLimit 51.000,000 DESCRIPTION OF OPERATIONS/LOCATIONS f VEHICLES{Rttarh!CORD 101.Additiaml Remarks Schedule,if more space is required) Coverage applies only toteamsfleagues comprised 0100%US Lacrosse member participants during scheduled&supervised lacrosse activates.Cerfiftcate Holder is named"Additional Insured'with respect to Clearwater-Yotith Lacrosse. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,140TICE VALL BE DELIVERED III City Orclearwater ACCORDANCE WITH THE POLICY PROVISIONS. 1501 N-Helciier RD) Clearwater FL 33756 AUTHORIZED REFRESENTATIVE 0 1988.2010 ACORD r-OPPORATION. All rights reserved. AGORD 25(2010105) The ACORD name and logo are mgi;iered marks of ACORD