CERTIFICATE OF LIABILITY INSURANCE (6) DATE IFMRAIDDYYYY�
CERTIFICATE OF LIABILITY INSURANCE
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 POLICIE S
BELOW. THIS CERTIFICATE OF INSURANCE DOE S,NOT CONSTITUTE A CONTRACT BETWEEhl THE ISSUING INSURER(S).AUTHORIZED
REPRE SENTATFIE OR PRODUCER AND THE CERTIFICATE HOLDER.
IPAPORTANT:It the cerifflicaie holder is an ADDITIONAL IN URED,the pollcy(les)must be endorsed, It SUGROGATtON IS WAIVED.subject
to the terms and conditions of the policy,certain policies may require Z endorSeMeniL A Statement Nan this certificate does not confer
rights to the certificate holder in Neu a(such endorsernent(s).
PRODUCER CPA4T4CT
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Coverage applies only to leamsdeagues comprised of 100%US Lacrosse member parficipants during scheduled supervised lacrosse
activites.Certffiicate Holder is named"Add bonal Insured-with respect to Clearwater Youth Lacrosse.
CERTIFICATE,HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED PIOLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREDF,NOTICE WILL BE DELIVERED 114
CI,ry of C!e ar,,,a T.er ACCORDAHCE WITH THE POLICY PROVISIONS,
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AUTHORIZED REPRESENTATIVE
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