CERTIFICATE OF LIABILITY INSURANCE (835) a
ACC>RV DATE(MMi
CERTIFICATE OF LIABILITY INSURANCE 9/23/2016
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. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
FM_PORTANT: If the—certificate holder-Is—anADDITIONAL INSURE I D, the policy(ics) must be endorsed. If SUBROGATION IS WAIVED,—subject t—o-
the terms and Conditions of the policy,Certain polli imay require an endorsernent, A Statement on this certificate does not conifer rights to the
—certificate hallider In lieu Of such endorsement(s),
PRODUCER CONTACT
Westpoint Insurance Group, Ltd. PHONFLE4, (8001)318-77019
� 5920 W. 111th St 708)636,, 915
Chicago Ridge IL 60415, ........... IM RER@jAFFORDING COVERAGE... NAIL rl.
............... ................ INSURER A U,s ton Casual apy
INSURED INSURER B:
!kS
Shihan School of Survival, Inc. . URER C ......
P.O. Box 213 IN U RER D
Clearwater FL 33757 INSURER F,
COVERAGES CERTIFICATENUM R:CL1692303648 REVISION NUMBER:
THIS IS TO CERTIFY THAT"THE' POLIMES OF INSURANCE LISTIED BELOW HAVE BEEN ISSUED TO T'HEI INSURED NAMED ABOVE FOR THE POLICY TE—RIOT
INDICATED, NOTNTHSTAN'DtNGi ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUIVEN'T 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
W SUBF4 POLICY EFF PoLi EXP
199k A yVn
TYPE OF INSURANCE A=V POLICY NUMBER IMMIDIDYYYY1 flNM1DDNY5"Y1 LIMITS
A GENERAL LIABILITY 16/7003967 9/21,/201609/21/'2017
EACH OCCURRENCE $ 1,000,000
..........
X COMMERGAL GENERAL LIA3lI-1 fY A A,
300,000
CLAIMS MADE li] OCCUR
ME D EXP(Any one person) $
X INCLUDES ATHLETIC 1,0010,000
PEI RSO NAL&ADV I NJ ij RY $
PAEIGI SLANTS ...... 2111EIRIAL AGGREGATE 3,000,000
GENI AGGREGATE LINIff APPLIES PER; 2, 2DYC1'SCOMP/0PAGG S 1,000,000
7 PO PRO [��LOC.
LICY F I
AUTOMOBILE LIABILITY COM SINE 0 S I NGL _IMJT
Eat aqqjtn
BODILY INJURY kPerperbon)
ALL OWNED SCHEDULED ... ..ANY AUTO
AUTOS ALTOS BODILY INJURY(Per accident) S
NON-OWNED
WRF,D AUTOS AUTOS
UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESS LIAS aAWS4A E 'REC�AII"
$
DED RETENTIO S $
WORKERS COMPENSATION 4AC ST A TU, OTH
AND EMPLOYERS'LIABILITY YiiN .........
hr`IY PROPRCt-"TORrP,kRTNERiEXIF.,CUT'IVE[ ]
OFIRCERIMEMSER EXCLUDED? IN RA
1111J��__._,I — _...........
(Mandatory In NH) _t DISEASE. EA EMPLOYE, 5
derlicrii under ............
CTI SC RIPTION OF OPERATIONS bakm POI ICY LIMIT 3
El, DISEASE
DESCRIPTION€YFOPERATIONS F OCATIONSIVEHICLES (Attach ACORD 104,Addftnal Remarks Schodi If more space Is requlrradl
114SURED, Sports & Specia,1 Risk Group Liability Insurance Trust and it's Member Organizations by
Certificate.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Shihan School of Survival, Inc. ACCORDANCE WITH THE POLICY PROVISIONS.
P.O., Box 213
Clearwater, FL 33757 AUTHORIZED REPRESENTATIvE
Terri "fie masik/HAH
ACORD 25(2010/05) @ 1988,-2010 ACORD CORPORATION, All rights,reserved
IN r1'7I r9r)i rgil,s n i Tha brinon r%2m= net Inn^nr�irx nvcfororil miark a^f hr.nOn