CERTIFICATE OF LIABILITY INSURANCE (6) MMIDDA'Y)
CERTIFICATE OF LIABILITY INSURANCE 09DATE(/22f18
PRooucst CERTIFICATE#: 3091201-2018-2 30912
Keystone Risk Managers,LLC
1995 Point Township Drive LL
Northumberland, PA 17867 INSURERS AFFORDING COVERAGE:
ADDITIONAL NAMED INSURED INSURER A: L Insurance Company
CLEARWATER LL INSURER B: National Union Fire Insurance Company of
Peter Mcguff -(Non-Liability) Pittsburgh,PA
1504 seabreeze st AIG Specialty Insurance Company
CLEARWATER,FL 33756 INSURER C:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING
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 AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION
LTR NAMED TYPE Of INSURANCE POLICY NUMBER DATE(MMIDI DATE(MNVDDIYYYY) LIMITS
INSFID
GENERAL LIA]BILFTY EACH OCCURRENCE $1,000,000
A X XOCCURRENCE U11225822 01/01/2018 0110112019 GENERALAGGREGAI I L $2,000,000
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INCL
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PRODUCTSCOMP OPS
X INCL PARTICIPANTS Property Damage Deductible:$250 AGGREGATE $1,000,000
I SeXual Abuse $1,000,000
OCCURRENCE
X SEXUAL ABUSE Sexual Abuse
I AGGREGATE $2,000,/30
1 MEDICAL PAYMENTS Any One Person
EACHLOSS $1,000,000
A X DIRECTORS&OFFICERS 019130066 01/01/2018 0110112019
AGGREGATE $1,000,000
LIMIT OF LIABILITY $100,000 PER
X CYBER LIABILITY COVERAGE 018254546 0110112018 01/0112019 CLAIMS MADE LEAGUE AGGREGATE
C - I
S&P SECURITY AND PRIVACY LABILITY $100,000 PER LEAGUE SUBLIMIT OF LIABILITY RETROACTIVE DATE CONTINUITY DATE
INSURANCE $1,000 PER LEAGUE RETENTION POLICY INCEPTION POLICY INCEPTION
REGULATORY ACTION SUBLIMIT OF $100,000 PER LEAGUE SUBLIMIT OF LIABILITY
LIABILITY $1,000 PER LEAGUE RETENTION
EM VI MANAGF.MPNT INSURANCE $100,000 PER LEAGUE SUBLIMIT OF UA131LITY NOTAPPLICAKE POLICY INCEPTION
$1,000 PER LEAGUE RETENTION
A X CRIME COVERAGE 011408723 11
1 ,101121111 01,0112019 EACH LOSS $35,000
Crime Deductible:$250 Propertyl$1,000 Money AGGREGATE NONE
As in Master Policy: As in Master Policy
B X SPORTS EXCESS ACCIDENT SRG9105434 0110112018 01/01/2019 Med-Max.$100,000
I I I I Deductible $50 Excess
"X"IINDIQATES COVERAGES)SELECIE12 EQ13 ADDITIONAL NAMED IN'5UEED
ADDITIONAL INSURED
Who is an Insured(SECTION 11)of the General Liabi4ty policy Is amended to include as an insured the person or organization shown in the schedule,but only with respect to
liability an'sing out of the above named Little Leagues maintenance or use of ball III or other premises loaned,donated,or rented to that Little League by such person or
organizations and subject to the following additional exclusions:
1.Structural alterations,new construction,maintenance,repair or dernalition operations performed by or on behalf of the person or organization designated in the Schedule andlof
performed by the above named Little League;and
2- That part of the ball field or other premises not being used by the above named Little League,
NAME AND ADDRESS OF PERSON OR ORGANIZEATION:
1,City of Clearwater
INSURED CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE
Little League Baseball Risk Purchasing Group,Inc. WITH THE POLICY PROM SL
539 U.S. RT. 15 Highway
South Williamsport, PA 17702
AUTHORIZED EPRESENTATtIVE�
IMPORTANT
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ORGANIZATIONAL LETTERHEAD
EXEMPTION FOR REQUIRED INSURANCES:
(check if applicable)
Automobile Liability insurance
On behalf of the Clearwater little league 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 little league 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.
Property Insurance
On behalf of the Clearwater little league 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 little league
Title President
Name of Representative: Peter Mcuff
Signature: - --�
Date: 9/19/2018