CERTIFICATE OF LIABILITY INSURANCE BXW
ACORD, CERTIFICATE OF LIABILITY INSURANCE DATE5, '° '8
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 lieu of such endorsement(s),
PRODUCER CT
IC & K Insura ce Group, Inc. NAME; SPORTS
_....----FAT. .
P.O. Box 2338 PHO 800-441-3994 260-459-5120
_(AIC_No.Ext —- .....,. WC,
E-MAIL
ADDRESS:
_ . ,
Fort WcIV 1C, In 46801
ADDRESS: KK.SPORTS@KeANDKINSURANCE.COM
INSURER(S)AFFORDING COVERAGE NAIL
INSURER A. NATIONAL CASUALTY COMPANY 11991
INSLINED UNITED STATES NATIONAL SENIOR SPORTS INSURER B:
D/2/A NATIONAL SENIOR GAMES ASSOCIATION INSURER C.-
ORGANIZATION
IN O. '.
P.O. BOX 82.059
BATON ROUGE, INSUR'E'R E:.., LA 7G884 INSURER F:
COVERAGES CERTIFICATE NUMBER: 194.0259 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 CONDITIONOF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TC 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. NC=NOT COVERED
TYPE OF INSUR ANCEPOLICY NUMBER POLICY
YYYY I IYh Y J LIMITS
4001L SUBR, OLICT!7P
LTR ,..-_-_... ........ . ... -- INSP WVD. —_. EmrwVOCt MI�IT1n
X !COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE 1000000
—7
A (CLAIMS-MADE XIOCGUR DCRAJaGETORENTE[7 X04000
--_, 2:01AM 12:01AM PREMISES(Ea occurrence
Owners & Contractors KKO0007191500 12,/31/1")' 12/31118
MED EXP(Any one Person) 5000
- PERSONAL&ADV INJURY q,0000 0 0
GEN=L AGGREGATE LIMIT APPLIES PER' GENERAL AGGREGATE ONE
POLICY I PROJECT ( ;LOG ( PRODUCTS-COMPIOP AGG
CO(i00t
;OTHER: Part LLab NC
BIL
AUTOMOE LIABILITY IIT
(Ea 10 0 0 0 0 0
ANY AUTO12:0 NAM, 12:01AM
A KKO0007191500 72111117 12/31/18 BODILY INIURY(Per perlony
---
OWNED AUTOS DNLY A OSULED BODILYINJIIRY(Per accident)
X (HIRED AUTOS ONLYPROPERTY DAMAGE
AUTOS ONLY Per ascic4eet)
... NsDN-0111NED _
UMBRELLA LIAR OCCUR
EACH OCCURRENCE
EXCESS LIAR
CLAIMS-MADE i AGGREGATE i
DED 7711 RETENTION
WORKERS COMPENSATION PER-STATUE OTHER
AND EMPLOYERS'LIABILITY Y1N
ANY EXECUTIVEPROPRIETOFFICERIME BER ] E L EACH ACCIDENT
EXCLUDED? - NIA;
(Mandatory in NH) E L-DISEASE-EA EMPLOYEE ---
14 yes,describe under
DESCRIPTION OF OPERATIONS below ( E.L.DISEASE-POLICY LIMIT
DESCRIPTION OF OPERAT IS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,may be attached if more space is requiredp
THE CITY OF CLEARWATER IS NAMED AN ADDITIONAL INSURED AS RESPECTS THEIR
INTEREST IN THE LIABILITY ARISING FROM THE OPERATIONS OF THE NAMED INSURED
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE'DESCRIBED POLICIES BE CANCELLED BEFORE
THE CITY OF CLEARWATER THE EXPIRATION (SATE THEREOF, NOTICE WILL BE SLIVERED IN
PO BOX 4:74.8 ACCORDANCE WITH THE POLICY PROVISION
CLEARWATER, FL 33758 AUTHORIZED R N ATI
ACORD 25(2016/03) Q 1988-2015ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD