CERTIFICATE OF LIABILITY INSURANCE (2) A�to CERTIFICATE OF LIABILITY INSURANCE DATE D1�7
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 policy(ies)must have ADDITIONAL INSURED provisions or 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 Neu of such endorsemen s.
PRODUCER
American Specialty Insurance&Risk Services,Inc. PHOHtS . 260-969-5203 Fox No, 260-969-4729
EMAIL
ADDRESS*
7609 W.Jefferson Blvd.,Sub 100 INSUREn AFFORDING COVERAGE NAIC IF
Fart Wayne IN 46804 INSURER A: Arch Insurance Company 11150
INSURED INSURER B:
Florida Sports Foundation,Inc. INSURER C:
Uo Enterpries Florida Inc. INSURER D,
800 North Magnolia Avenue,Suite 1100 INSURER E
Orlando FL 32803 INSURER F,
COVERAGES CERTIFICATE NUMBER: 1001383617 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 BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCEDAY PAIL]CLAIMS.
INSR TYPE OF INSURANCE ADD SUBR POLY NUMBER POLICY EPF POLICY EXP L"Arrs
X cOMMERCIALGENERAL uAB&r Y EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTEff--
CLAIMS-MADE FX7 OCCUR PREMISES a oocurmnce $ 1,000,000
MED EXP(Any one person) S Excluded
A Y SBCGLOO456DO 01/23/2017 01/23/2018 PERSONAL&ADV INJURY $ 1,000,000
GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000
POLICY PRO-
JECT D LOC PRODUCTS-COMPMPAGG i 5,000,000
X OTHER: EVENT i
AUTOMOBILE LIABILITY COMBINED SINGLE U M r r i
ANY AUTO BODILY INJURY(Per person) S
A OWNED SCHEDULED N N SBAUTDO27000 0112312017 01/2312018 BODILY INJURY(Per accident) S
AUTOS ONLY AUTOS
Ix
HIRED X NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY
NON-OWNEDIHIREDAUTO S 1,000,000
UMBRELLA LuLa X OCCUR EACH OCCURRENCE S 4,000,000
A X EXCESS LIAB CLAIMS-MADE N N SBFXS0028100 01!2312017 01/23/2018 AGGREGATE $ 4,000,000
OED I I RETENTION $
WORKERS COMPENSATION PER OTH-
ANDEMPLOYERS'LIAGUTY YIN STATUTE ER
ANYPROPRIETDRIPARTNERIEXECUr[VE ❑ NIA E.L.EACH ACCIDENT $
OFRCERIMEMSEREXCLUDED7
IMandAmy M NH) E.L.DISEASE-EA EMPLOYEE $
r desalt under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(ACORD 161,Additional Ramarhs Schedule,may be attachad N more space Is mquirad)
-The Certificate Holder shall be an Additional Insured,but only with respect to the operations of the Named Insured,and subject to the provisions and
limitations of Form DOS GLOO2900 Additional Insured-Designated Person or Organization Written Contract or Written Agreement,but only with respect to
OFFICE SPACE.
CERTIFICATE HOLDER CANCELLATION
CITY OF CLEARWATER,FLORIDA
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
PO BOX 4748
AUTHORIZED REPRESENTATIVE
CLEARWATER FL 33758
®1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD