CERTIFICATE OF LIABILITY INSURANCE (5) CERTIFICATE OF INSURANCE
SPECIAL EVENT LIABILITY GROUP INSURANCE TRUST,A RISK-PURCHASING GROUP
Certificate# 0'4 8 ,8
continued CA License#,0757776
FACILITY OWNER-Additional nsure&(if rnultiPle,cO PRODUCER�
on next Page) HUB International insurance Services Inc-
Pasco County.7227 i-and O'Lakes BOLJievard.Land 01a�es FL.34638- P,O.Box 4047
Concord,CA 94524-4047
2826 .............
PH:926 beg 650D FX:925 609 6550
EVENT INFORMATION
EVEN HOLDER-Named Insured:(if Multiple,continued
next page) instructor
TYPE OF EVENT:
Tampa Bay Bats 1,122- 12131120"l8
EVENT DATE(S)
1,5841 Martha Circle
Lutz,FL 33549 van P
ovis asco CoUniv Fk3ridn SC
per the aitaChed 4St
EVENT LOCATIOMS)'
Norwitisiandinq any ea
ae Isted h�elovi have been i�.,Sued to the 11 orded by the policieg loser bets herj-,,in is�,uhiecl to ail ibe terms.excIL-01-
This k9 ei c9ifilY that the Pakc at askgao, nrfiu�le,rnay be vssued of 118Y Pe tain,ine insurance all
of any contract 0(other docurrienj arth respecI,10 Which tbis cc and condtoo- ns at such P"lic'es hfi Fiend,,] i3nar@nty pcl,to the of any
t Purslanl to the Ronda Surplus I.jacs Law�person, n, Lines�,arrlera do not have Ille plolactiian Of t
,insu d by surp�us ent unlicensed naurer
I his insurance is issuer rig-fit of recoveTY for 111"obtigation 0 an Insord,
INSURER A: COLONY INSURANCE COMPANY pokcy Limits
INSR LTR Type of insurance Policy Number - Effective ExpiratiOn $1,000,000
Each Occurrence
Genera!-neral Aggregate $2,01170,400
personal&Advertising injury $i,000,000
ProductslCompleted operations $2,00 0,000
Aggregate
Commercial 11112018 11112019 Damage to premises Ranted to $1, 000,000
A 103 GL 0021111 You
General Liability Medical Paynwnts $5,000
Liquor Liability Each occurrence NIA
(Aggregate included in General
Liability Aggregatel
COVERAGE7ERM&
o<,currence,Form(CG 0001 il
`rho coverage aflorded by this insurance is primary and not contributing with any insurance held by the"ADDITIONAL INSURED",
Hosk Liquor Liabl�lty_Included. re apply separately to each event insured by this Policy 8s it a
WHEN REQUIRED By WRITTEN CONTRACT, The limits Of ins
issued for that event, who is an insured is amended to include as an additional insured the
separate policy of insurance has been on of organization shown in the schedule below. This insurance does not
as
This insurance aPP11,
,r,ci[ity,owner-Additional insured"a have and any pers
FLM Liquor Liability Included when a apply to: any"Occurrence"which takes place after the event holder ceases to be a tenant in that premises
,crate pr emium ha§been char ed, only loi an ,occurrence"which takes place during the dates indicated under-Event Information"above,
_g�
Al4 participants in athielic activities are
rg-_q red to sign Release and 1Vaiver of
abdiIy forms
COVERAGE EXCLUSIONS�(REFER To pOLICY FOR COMPLETE LISTING OF EXCLUSIONS)
Sexual Abuse&Molestation Specific Events are excluded from coverage. Please see second page for list of excluded events.
On behalf of the Risk Purchasing Group and each Mernber,the Trustee has declined coverage for the Terronsin Risk
insurance Act IT RIA).
Terrorism
Additional lnsureds,next page
Second Page of Certificate Certificate 00"
OTHER ADDITIONAL INSUREDS:
1 Woodland Elementary- 38203 Henry Dr-Zephyrhrlls-FL 335,42
2
New River Elementary-4710 River Glen Blvd.-..Wesley Chapel, FL 33545
3 MPLES(Mittye P. Locke)Elementary--4339 Evans Ave..New Port Richey, FL 34652
4 Iduclson Elementary--7229 Hudson Ave., Hudson-FL 34667
5 James M. Marlowe Elementary School-5642 Cecelia Dr., New Por-I.Richey,FL 34652
6 Gulfside Elementary-2329 Anclote Blvd ,Holiday,F-L 34691
7 Seven Springs ,'le entary-8025 Wchell Randl Rd.,New Port Richey, I-L 34655
l cy press Elementary - 10055 Sweet Bay Ct. New Pori Richey, FL,34654
—
9 Lorigleaf Elementary,3253 Town Avenue. New Port Richey,Fl-34655
10 Double Brand'i Elementary,31500 Chancey Blvd.,%,'Vesley Chapel,FI-33545
11 Richey Elementary School,6850 Adarnsn Street,New Pori Richey,FL 34652
12 Wesley Chapel Elementary, 30243 NAlells Read-Wesley Chapel.Fl-33545
13 SLInray Elementary,4815 Sunray Drive, Holiday,FL 34690
14 Chasco Elementary, 7906 RAge Road,Pori Richey, FL 34668
15 Sunlake High School.3023 Sunlake Blvd..Land C)Lakes FL 34638
Additional Insured%continue to next page-
Third Page of Certificate Certificate#
OTHER ADDITIONAL INSUREDS:
16 Anclote Elementary,3610 Madison Street,New Port Ri d'iey,F"L 34652
17 San Antonio Elementary, 32416 Darby Road,Dade City, FL'33525
18 INDrthwesL Elementary,-14302 Cobra Way,Hudson, FL 34669
19 Veterans Elementary,26940 Progress Parkway,Wesley Chapel, Fi- 33644
20 Gulf Trace Elementary,3303(3015 race Blvd.. 11oliday,E=L 34691
21 Calusa Elementary,7520 Orchid Lake Road, New Port Richey, Fl-34654
22 City of Pinellas Park,Alin_ Management,5141 78th Avenue N, Pinellas Park,Fl-33781
23 Regency Parle,Branch Library,9701 Little Road, New Port Richey,FL 34654
24 Hudson Regional Library,8012 Library Road,Hudson,FL 34667
25 R,B-Stewart Middle School,38505 101h Avenue,Zephyrhills, FL 33542
26 Genesis School,8100 Mitchell Ranch Road. New Port Richey, FL 34655
27 R'Club Sutherland,3150 N Belcher Road. Palm Harbor, FL 34683
28 R'Club MLK, 557 10th Street North,St. Petersburg, FL 33705
29 Schrader Elementary School. 111041 Little Road,New Port Ritchey,F-L 34654
30 'I'aFpOfl Springs Library, 138 E Street,Tarpon Springs, FL 34689
Additional Insureds,continue to next page- j
Fourth Page of Certificate Certificate#
OTHER ADDITIONAL INSUREDS:
9ciiool Board 4F Hillsborough Couilry,901 T Kenn�,dy Blvd.,Tampa.e L 33602(i.ocarons,Roosovel!Dernentary,320r,S,Fardiriand Ave.Tampa,F1,33629�Bevis Elementary,
31 5720 Osprey RWee Dr_Lithia,FL 331547 Mori Eleruanlary.1806 E.Beans Ave,Tampa,F-1,336,11 Philip Shore rdemonnary Magner 1908 E 2nd Ave,Tarnpa,FL 33605, Clark
Elementary.1,9002 Wood Sage Dr,Tramps,,11l 33647:Bryan Elementary-2006 VV Oak Avonue,Plant City.F 1-335637
32 Seven Oaks Elementary 27633 Mystic Oak Blvd,,Wesley Chapel-FL 33543
33 The School Board of Polk County,P 0.Box 3q1.Barlow,FL 33831
34 GMS Delta Academy,Gulf Middle School,6419 Louisiana Ave,,New Port Richey, Fl...34653
36 RBS Delta Academy, Raymond B,Stew arl Middle School,338505 10th Ave.New Port Richey, FL 33542
36 H(VS Delta Academy, 1-ludson Middle School, 14540 Gothrzi Way, Ftudson, FL 34669
37 lLake Myrtle Elementary School 22844 Weeks Blvd,-Land O'Lakes.F[,34639
38 Cypress Elementary.-10055 Sweat Bay Court,New Port Richey- FL 34654
39 Moon Lake Elementary—12019 Tree Breeze Drive,New Pori Richey,Fl- 34654
40 Winthrop Charier School.6204 Scholars Hifl Lane,Riverview.FL 33578
41 Chester W Taylor Elementary School. 3638 Morris Bridge Rd,,Zephyrlhills,FL 33543
42 City of Clearwater
43 Clear Water Public Library System
44 'Trinity Elementary School,2209 Duck Slough Bivd,, New Po-t Richey, FIL 34655
��"��45
estZephVrhills Elementary School, 37900 14th Ave.,Zephyrhills-FL 33542
46 Sunset Hills Elementary School, 1347 Gulf Rd., Farpon Springs, FL 34689
CANCELLATION Should V e above descnbed noficy(s)be canceled before the expiration date thereof the;ssuing company will andeavorto mad 30 days mntten notrco to the insured event
holder and additionai insureds listed..
I __Ei 3SUED: 1122i201 8
Fifth Page of Certificate Certificate# N"B SS
SPECIFIC EVENT EXCLUSIONS
The following types of events are specifically�excluded and no coverage for them exists on the policies listed on the
front page of this Certificate of Insurance:
Aircraft I Aviation
All Terrain Boarding
Ballooning /Balloon Rides
Base Jumping
Bouldering Events
Boxing
Bungee Jurnping
Carnival Rides
Circuses
Concerts with performances exceeding 6 hours of performance time
Contact Karate/Martial Arts
Contact Sports
Diving
Dodgeball I Gaga Dodgeball
Football / Flag Football (except passing camps with no contact drills)
Gun Shows/ Exhibitions
Hang Gliding
Hockey
Jousting
Kayaking, Rafting or Canoeing in greater than Class 3 rapids
Lacrosse I Rugby
Mechanical Amusement Rides or Services
Motorized Sporting Equipment
Mosh Pits
Mountain Biking
Power Boat Racing
Professional Sporting Activity-, Games, Races, Contests of a professional nature
Pyrotechnics/ Explosives
Rap or Heavy Metal Concerts
Raves
Rock Climbing
Rodeo I Roping Events (includes practice)
Scuba Diving
Sky Diving
Tattoo Expos I Conventions
Tractor/Truck Pulls
Wrestling