CERTIFICATE OF LIABILITY INSURANCE (2) A-C= CERTIFICATE OF LIABILITY INSURANCE 09/20/2018
THIS CERTIFICATE 15 ISSUED AS A MATTER.Or INFORMATION ONLY AND CONFERS NO RIGHTS UPON tHE CERTIRCAIF HOLDCR TRIS CERIFICATE ODES NOT AFFIRMATIVELY OR
NEGATIVELY AMEND E),TFNO ORALTCR THE COVE:RACE AFFQROED BY TWE PCIACIES BELOW.IHISCERTIFKATE OF INSURANCE DOES NOT CONSTITUTV.A CONTRACT BEWEN THE
ISSUINGINSURER(St.AUT'IORIZED REP RES ENTATIVR)R PRO DUCE R.AND THE CE R TI F[CATE HOLDER
IMPORTANT:If We ceffftMte holder 1:5 an ADIDITIONAL INSURfo.tie poicy(ies)mum be endoM--d If SUBROGATION IS WAIVED subjftl lo the to S,and MnMtonli of the PCIlcy.cutain polines may red'u'ro
W endoff-ffnen(A stalem&ton Ibis cOirUdicatL does notairi*righ,ts to ft cWiftate hddff in itiai of su&iaridwsern<rt(sl,
PRODUCER CONTACT NANIE
RPS Bollinger, Inc. PHONE(WC. FAX INC.,
250 JFX Parkway .140 Ext): E�52FIVR No):
ShortHills, NJ 07018-5000 EMAILADDRESS
Phone: 800-446-5311 Faxt 973-921-8236 INSURERS AFFORDING COVERAGE NAIC#
INSURCD INSURER Ai blarkel Insurance Company 38970
USA Softball and Moobers of the JO FL - Florida INSURER B.
Individual RAMgistzation Program
Carlton Benton INSURER C,
1843 Bed.Lvere INSURER O:
L Lakeland, FL 33813 INSURER El
COVERAGES CER71FICATE NUMBER: REVISION NUMBER:
THIS is TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVC FOR THE POLICY PERIOD INDICATED-k07WITHS7ANDINa ANY
REQUIREMENT.TERM OR CONDITION Of ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIJ'ICATE MAY BE ISSUED OR MAY PERTAIM,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.
AMOR TYPE 0FINSURANCE AbFn. sePMICYNLIMSER POLICY Err
UNITS..
DEXTRAL UARLTTY 3602M230069 08/01/18 09/01/19 EACH OCCURRENCE $2,000,000
A _V-0 C016WMCLAL GENERAL UAM ILITY
DAMAGE TO RENTED
CLAUS MADE -VO OCC UR P REM ME$[Ea omurome� $1,000,000
MED EXP(Avoy or*parson) $10,000
W,PartIcIpant Liability SPERSONAL&AUV INJURY $2,000,000
exual Abuse 9 Molevtolion Limb PM's $2.000,DOG
QEM'L AGGREGATE LJ MIT APPLIES M Sexual Atuse B.Wles[alion Aggmgalte 411 rntt suD00.000
POLICY PROIACT %0 LOC GENERAL AGGREGATE WO
oco,OO
PRODUCTS-CON NOP AGG $2,000,000
AUTOMOBILE UAll
ANY AU1`O COMBINED SINGLE LIMIT
(CA Accident)
ALL OWNED AUTOS
SCHEDIA.EDAUTOS BODIVYINJURY
(P*F Person)
HIRED AUTOS
BODILYINJIURY
NON-OWNEDAUTOS
PROPERTY DAMAGE
IPA,Occident)
L%aREUA OCCUR EACH OCCURRENCE
LIAR
AGGREGATE
EXCESS 'CLAIMS All
Lus
ZED RETENTION
WORKERS COOPS NRATION AND WC
STATUTORY
EW UMTS.LOYERm LtA a Li'ry YN OTHER
ANY P R0PRTErORI`AKIrNtRiEXECU THE
OrPICERAMEMBER EXCLUOCL:,Q? - NIA E.L.EACH ACCIDENT S
(Mandatory I a NH}
If Yen,dageKba UWA,DiEsCAPPTiON OF E.L.OISEASC,FA EMPLOYEE $
OPERATIONS 11410* E L DISEAS E-PO LJ CY LIM IT S
OTHER L ------
DESC All TION OF 01-91tATION 111 LOCATION'S I VEHK LES(ATI-h ACORD 101.A ddifl—j Rem wo,Sh.dul�0 WV qac.I.mqA-d)
CCVWA(3E MMER THIS POLICY SHALL "PLY TO LLARILITY CIA THE INSURED ARISING OUT OF THE ADMINISTRATION, PLAY OR
PRACTICE OF AMATEUR SOFTBALL/RhSEBALL, BUT ONLY FOR INCIDENTS INVOLVINQ WDILY INJURY OR PROPERTY DAmArz.
CERTIFICATE TIFICATE HOLDER IS NAM= AS ADDIVIONAL INSURM, THIS CERTIFICATE IS ISSUED ON BEHALF OFC Crater Bullets
CERTIFICATE HOLDER CANCELLATION
City of Cl mater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF,NO110E WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 4748 AUTH0RIZ5bREPREszNTAnvt
Clearwater, FL 33750 R*WU04PP—
ACORD 25(2 010105) Q 1988.20111)ACORD CORPORATION,All rights reserved,
The ACORD name and 10,90 are registered marks of ACORD
TMS ENDORSEMENT CHANGES THE POLICY-PLEASE READ IT CAREFULLY
ADDITIONAL INSURED-DESIGNATED PERSON OR ORGANIZATION FOR
USA SOFTBALL ACTIVITIES
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
With respect to coverage provided by this endorsement,the provisions of the Coverage Form apply unless
modified by the endorsement.
Named Nn d! USA Softball and Members of the 10 FL - Florida Ind1vidual Rogistration
Program
City of Clearwater
P.ky U—b., P.I,.y P—d Dd.
3602AH230069 A.0—m the M&ct*d C mlif-,.te.1 Njsw ce
N"4 ByON4 Re�
vuove
Markel Insurance Company :ff I
Th—b—--b-i�,eqomd only whM",-dbw is Prepared wiff the put yid 4....1
SCHEDULE
Name of Person or Organization:
As Shown on the Attached Certificate of Insurance
A. The following is added to Section 11-WHO IS AN INSURED:
The person or organization shown in the above SCHEDULE but only with respect to liability arising out
of the organization,promotion,administration and conduct of amateur softball activities,including
games,practices,tournaments,and fund-raising activities,under the rules of the Amateur Softball
Association of America,provided:
a. That if the person or organization is designated as a Team,the person or organization so designated
shall be deemed to include team members,manager,coaches,assistants,batboys,registered
scorekeepers,sponsors,any other individual participating in the official functions of the team,and if
so Indicated,a Field Owner,but only for liability arising out of the designated Tearres amateur
softball activities covered under this policy.
6. That if the person or organization is designated as a League,the interest of the League sha 11 not be
included unless all team members in the League purchase this insurance.
When the interest of the League is so included,the person or organization designated as a League
shall be deerried to include all beams in the league and team menribers,managers,coaches,
assistants,batboys,registered scorekeepers,sponsors,any other individual participating in the
official functions of the League or of any such teams,and if so indicated,a Field Owner,but only for
liability arising out of the designated League's amateur softball activities covered under this policy.
All other terms and conditions of this policy remain unchanged.
19 59 GL 09 98 Includes c oWFIghted material of Insurance Senricas Office.Inc.w ith ft permission Page I of 1
Copyright insurance services Office,Inc.
ORGANIZATIONAL LETTERHEAD
EXEMPTION FOR REQUIRED INSURANCES:
;Zif applicable)
utornobile Liability Insurance
On behalf of the Clearwater Bullets I submit our organization does not own any vehicles nor does the
organization provide or arrange for any transportation/carpooling for any members, participants,
employees,or volunteers of the organization to any practices,games,or organization sponsored
activities. Thus,our organization is requesting exemption from providing auto liability insurance per the
Co-Sponsorship agreement.
workers Compensation/Employers Liability Insurance
On behalf of the Clearwater Bullets I submit our organization does not have paid employees/volunteers
attend any practices,games,or organization sponsored activities. Our workers compensation coverage
also does not provide coverage for volunteers.
Zproperty Insurance
On behalf of the Clearwater Bullets I'submit our organization is exempt from providing property
insurance due to the value of the property. Unless it's damaged as a result of City negligence while in
our care,custody and control,our organization will be responsible for covering any losses.
Name of Organization: Clearwater Bullets
Title: Vice-President
Name of Representative: John Klinefelter
Signature:
Date: September 20 2018