CERTIFICATE OF LIABILITY INSURANCE (3) DATE IM MWD DIYYYY; '..
CERTIFICATE OF LIABILITY INSURANCE 9/19/2018
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 endorsements.
PRODUCER N CONTACT
M
Gagliardi Insurance Services, Inc. PHONE 1(800) 995-9768 FAXN cove) 414-9199
1315 Walnut Street, Suite 1101 EMAIL sales@gsportsinsurance.com
Philadelphia, PA 19107
INSl1RER S AFFORDING COVERAGB. N,R9c M
#809840 INSURERA Scottsdale insurance 41297
INSURED Suncoast ",Youth Football INSURERB ISE Insurance Corporation 11515
Conference, Inc N R
P.O. Box 6313 INSURER D:
Clearwater, FL 33758 INSURER F
727-642-0497 F, I 777d
COVERAGES CERTIFICATE NUMBER: 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
INDICATEDNOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR.OTHER 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 ND CONDITIONS OF SUCH POLICI€S,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
....._._____. .
ACUL
LTRINSfTYPEOF INSURANCE I..:YN -R POLI 1 EF�. POLIC �. LIMITS
_ 1[. COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
CLAIMS•MADEOCCUR h „siL gzourrn 30(3 000
X Abuse & Molestation ME.DEXP An ome erson s _ 0
A., X ,. -(304[1tlt3736.53— } 5,/1J2Q185/'l./2t3�.. PERSONAL IR.ADV INJURY. $ 1,000,000_
GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $.. NONE*
POLICY1:1 J ECT- E]LOC PRODUCTS COM PfOP AGG 8.. 1,000,000
Raxt c PanC Lc9t $
TI•i 1,000,000
-_
AUTOMOBILE LIABILITY... COMBINED SINGLE LIMIT $..
r m
ANYAUTO BODS LY I NU RY(Re r person) $ 11•W��1®
OWNED SCHEDULED BODILY INJURY(Per amdemt)
AUTOS ONLY AUTOS
HIRED NON OWNED PROPERTY DA AGE S
AUTOS ONLY AUTOS ONLY
$.
UMBRELLA LIABOCCUR EACH OCCURRENCE s
EXCESS LIAB HCLAIMS-MADE AGGREGATE_---__. $
RETENTION
WORKERS COMPENAT ION OTH
AND EMPLOYERS LIABILITY r g"R "ll'
ANYPROPRIETOWPARTNER1EXEC UTIVE NIR E.L.EACH ACCIDENT $
OFPC ERIMEMBER EXCLUDER?
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE s
If es2scribe under
Y
)3 Accident Medical GAH000001 5,/1/2[118 /l/2019 Limit $10GK Ded $250
AD&D $25F
DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES(ACORD 101Additional Remarks Schedule slay be attached if more spam is required)
The Certificate holder is included as an additional insured, but only with
respect to the liability arising out of the negligence of the named insured.
All policy terms and conditions apply.
For use by associations of Clearwater Junior Tornadoes.
S'YFC-CJT 01
City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, ICE
2450 Drew St. ACCOR.DANCEWTHTHEPOLICYPROVISIONS .. WILL BE DELIVERED IN
�
Clearwater, FL 33765
AUTHORIZED REPRESENTATIVE
•
I — I k —
@ 1988-201 L&C06R7CORPORATIOk All rig s reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
EXEMPTION FOR REQUIRED INSURANCES:
(check Ifapplicable)
ZAutom bppe Uabi i r Insurance
On behalf f h _I submit our organization does not gun any vehicles nor do s the
rgani ati n provide or arrange for any transportation/carpooling for any members, participants,
employees,,or volunteers of the organization to any'practices, Karnes,or organization sponsored
activities. 'ilius, aur organization is requesting xe'mption from providing auto liability I nsuirance Per the
Co-Sponsor hip agr em nt.
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