CERTIFICATE OF LIABILITY INSURANCE (865) ...........__
D"TE(MMIDDPYYYYti
CERTIFICATE OF LIABILITY INSURANCE
10/12/201 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(les) Wiu't—beondorsed, If SUBROGATFONI—S !AiA-1VED, Subject to,
the terms and conditions of the prAicy, certain policies may require an ondorsernent, A statement on this certificate does not confer rights to the
certificate holder in lieu of Such endorspment(s),
PRODUCER
w.
------ -
Westpoint Insurance Group, Ltd. PHONE (800)318-77709 jFA'
5920 W. 1,11th St E-MAIL
INSURE 5 5 AFFORDINGO
CVE RAGE NAIC Y
RL
Chicago Ridge IL 60415 iNS1JRrSRA,Houst on Casual:i;y_rka ani
i-
I INSURED
INSURER C',:
___.......... ............
Shihan School of Survival, Inc. NSURERL
P.O. Box 213 INSURER E
Clearwater FL 33757 INSURER F;
COVERAGES CERTIFICATE NUMBER:CL17101H5319 REVISION NUMBER:
HIS IS TO CERTIFY "THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE" INSURED NAMED ABOVE' FOR THE POLICY PE 14;31:T
!NDICATI'-'D NOT50JITHSTANDING ANY REQUIREMENT, TI'-,Rlvl OR, CONDITION OF ANY CONTRACT OR OTHE-IR 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 POiJCIES LIMITS SI-OVJN MAY HAVE BEEN REDUCED BY PAID CLAIMS
7NA914.
— C
TYPE OF INSULTEi EEE P
RANCE INqR WVD I POLICY NUMBER MM'DDiYYYY) fM21TDB1'1BXYYI LIMITS
A GENERAL LIABILITY X 11/7003967 9/21/2017 09/21/2018
11000,0001
X COMMEI?C,Al.,GI-NE-RALLIAP,`LIIY T—.A m—AC, P7PT r PC,
3001000
LAWS-MADE Li OCCUR ME'D f- Aw one bemr,
X INCLUDES ATHLSTIC11 000,000
_�L R
PARTI-CIPATS N
Gj�LR:,,I_A.GG R_-GA T 3 1 000,000
GLk EGA7'E UM17 AIPIJES PI Ci)(_,T'5COOf-ACG
1 r 0 010 0 0-0
I FOLI,
0C is
AUIOMOSPLE LIABILITY aG,.E`_00"
ANYA10 BODLY N_'GRlY cllei vorEonS
Lire AU10S S
N()N-0'ANED
ALL 0'& U70S
s
UMefRELLA LIAA
-a EACH
E EXCESS C A�MS-MADE 'EGATr�
XCESS�L�IMD
AGGQ
—7IT,rC ON,
RKERS COMPENSATION le"Ic S T A ILI 0
AND EMPLOYERSUASILITY YIN
Ivi
EFFICK,P'��',L�JQE.R �.,XCLU`DED�' I,A EA(,JA
(Mandatory in NHI
I f ye,&de-,Cn be u,�de r
_2,7 S C R�PT I 0,�,,,�J- P-R',,J�ONS M
Q
......... D S ASE
! E
DESCRIPTION OF OPERA,nONS t LOCATIONS I VEHICLES (Attach ACORD 101,Additional R�nnarkS SCbClcjkjje,if njore Spaeo jl,requncd)
Certificate Holder is alga additional inoured.
CERTIFICATE HOLDER CANCELLATION:
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS,
100 Myrtle Ave
Clearwater, FL 33756 AUTHORIZED REPRESENTA FIVE
Terri Tomasik/AMZ
ACCORD 25(2010105) @ 1988-2010 ACORD CORPORATION. AN rIghts reserved.
INS025(,SOICOi 0I The ACORD nanne and logo are registered marks of ACORD