CERTIFICATE OF INSURANCE Page 2 of
CERTIFICATE OF Iseult Date-, 10/31/20,16
INSURANCE
TPtI CERTIFICATE IS ISSUED AS A MATTER CIF INFORMATION ONLY AND CONFERS NO RIGHT'S UPON THE CERTIFICATE HOLDER THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND CAF 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,ANC THE CERTIFICATE HO'LOER..
Iportant,It the
the oficat a older is an ma ADDITIONAL INSURED,time pd&6cy1ies1 must be endorsed,if SUBROGATION IS WAIVED,subject to the terms and
P y y require an endorsement,A statement on this certificate does not conifer rights to the certificate holder in lieu of
such endorsement s
Producer: INSURERS AFFORDING COVERAGE
EPIC Brokers INSURER A.National Casualty Company
License No.OB29370 INSURER B:National.Casuafty Company
P.0.13ox 13847 INSURER C:.
INSURER 0:
Sacraiiiento GA 95853 INSURER E:
888-8811-36112
Insured:
United'States Specialty Sports Association
611 tine Drive
Kissimmee,FL.34744
800-741-3014
Coverages:
Thus is to certify that the policies of insurance listed below have been issued to the insured named above for the policy period ind➢rated.Notwlthstand"ang any
requirement,term.,or condition of any contract or other document with respect to which this certiffa ate 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 SUBIR policy Policy
LTR Type of Insurance WSD WVD Policy Number Effective Expiration Limit
Date Date
A Commercial General Liability y N KRO0000006565300 81112016 8//2017 Each Occurrence T2,000,000
occurimnce Basis Damage to Ittnled k"remises(ta oce)I;3iidi,ttoo
tiled Gasp tanY One person i S f:xduded
General Aggresuze s None.
i'c rasuat and Adv lrtbzztry 5"),txIH7,000
t'arulucts-Co n*OP Ap S2,( iI,iNt1iP
f is urcinara LeySal.Lsm&rEPsdy"S7,(101),000
Excess Liability Y N XI40000O00668 5600 811/20161 'i 81"1/2017 F=h Occwra°r"ce$I,4iltwlem
AltErttT,aze'S 1,000,000
DESCRIPTION OF OPERATIONS I LOCATION /VEHICLES(ACORtD 101,Additional Remarks Schedule may be attached It more spade Is
'required)
Coverage inctudes amateur play and practice in the insured sport for:TUP Local Souldiers BKB9w10U-Gr4-C f2f717 5f 7G8dI�B�L98t'
CerV ieatte holder shall be an additional insured but only with respect to lability caused by the negligent acts or omissions of the named Insured and only with
respect to tosses resulting from the learn I league listed and occurring between the coverage effective date listed below and the policy expiration date,
7,;iTc44tc 57-7 Coverage Effective(Date: 10/3IY2016 11:51:00 A
N Greenwood Recreation CANICELLAT'ION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF„NOTICE WILL BE
900 N Martin.Luther King Jr Ave DELIVERED IN ACCORDANCE WITH THE POLICY'PROVISIONS,
Clearwater FL.33755
ertiticate# USSSA-3024 2- 07 51 Authorized Representatives:
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Page 3 of
CERTIFICATE OF lases Date* 10/31/2016
INSURANCE I
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS N7 RIGHTS UPON TI fE CERTIFICATE H017ER.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 pollcy(ies)must be endorsed,If SUBROGATION IS"WAIVED,subject to the terms and
condisfions of the poky,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: INSURERS AFFORDING COVERAGE
EPIC Brokers INSURER A:National Casuafty Company
License No.OB29370 INSURER 8 National Casualty Company
P.O.Box 13847 INSURER C;
INSURER D�
Sacramento CA 95853 INSURER E:
888-880-3602
Insured:
United States Specialty Sports Association
I I Line Drive
Kissimmee,FL 34744
800-741-3014
Coverages,:
,
This is to cenity that the policies of Insurance fisted below have been issued to the insured named above for the policy period indicated Notwithstanding any
requirement,term,or condition of any contract or(Aber 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 SUM Policy p licy
LTR Type of Insurance IN SD VWD Policy Number EffectivelExpoiration Limits
Date Date
A Commercial General Liability y N KRO'0000006585300 8/112016 8/11/2017 Each Occurrence$7,000.007
Occurence Basis Damage to Rented f1rentises(en occ)s3oo,cioo
Nled JExp(airy one persm)5 Excluded
Geneml Aggrepte S None
Pvrsousl and Adv injury S2,000,[l001
llriuluds-ConnpIOP Agg$7,000,000
11 f i I Puticipani LogW Liability S2,000,000
B Excess LjabjI4 565600 81lr 016 2 &112017 Each Occurzewe$],(AD,000
I J I Aglpegale S 1,000,(M -
0 E SCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,A doll III on at Remarks Schedule may be attached If more space Is
requilredl
Coverage Includes amateur play and practice in the Insured sport for:1UP Local Souldiers ftK—ggylQM:gr4:p.g--I'ZDI?-,9176802
fiAg
�Js
Certificate holder shall be an additional insured but only with respect to liability caused by the negligent acts of omissions of the named inured and only with
respect to losses resulting from the team I league listed and occurring Wtween the coverage eff ective date listed below and the policy expiration date.
Certiricate[!older: Coverage E ktcotive Date: 10/31/2016 11.51:61 AM
City of Cleanvater CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POUCfES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF,NOTICE MLL BE
1501 N Belcher Road DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS,
Clearwater FL 33765
Certificate 4 US,SSA-302422-207656 Authorized Representatives:
littp://web,usssa.com/sports/]C.asp'?Seqiio.-.=l fc2d807-58e3-4a5c-9c47-450334a3940e&C... 10/31/2016