CERTIFICATE OF INSURANCE - SPECIAL EVENTCERTIFICATE OF INSURANCE
SPECIAL EVENT LIABILITY GROUP INSURANCE TRUST, A RISK PURCHASING GROUP
Certificate ll 13785
FACILITY OWNER- Additional Insured: (if multiple, continued
on next page)
PRODUCER: CA License ae757T76
HUB International Insurance Services Inc.
Pasco County. 7227 Land O'Lakes Boulevard Land O'Lakes FL. 34638-
P.O. Box 4047
2826
Concord. CA 945243047
PH: 925 609 6500 FX: 9256096550 swcialevent(dhubinlemational.com
EVENT HOLDER - Named Insured: (if multiple, continued on
EVENT INFORMATION
next page)
Tampa Bay Bats
TYPE OF EVENT:
Instructor
15841 Martha Circle
EVENT DATE(S):
42 - 12(31/2021
Lute. FL 33549
ENT LOCATIONS)
Various Pasty County Florida Sd,00b per the alteche ! list
This N b c.* but the wi cies of inaurame listed below have been soued to IM insured named stove or the event date(s) eldicate l above. NoMNstanding a" requkementterm or
rorMieon of any contract or cider document wM respect to whM the cortress may be issued or may Peden, sew insurance afforded by Ne pdic,es descriied herein'is subject m dl the
deme. exclusions ale corkNms of suds polkies.
TNs Insurance is asusel persons Us has Florida Surybus Lines Law. Foresees bound by Surplus Lilco toners do net have bre pmtedjon of low Florida Insurance Guaranty Ad to Ne estenl
arty righl of recovery for me odgemn of an eesalvent uNgrlsed Meurer.
INSURERA:
COLONY INSURANCE COMPANY
INSR LTR
Type of btsuranca
Policy Number
Effective
Expiration
Policy Limits
Exn occurrence
$1,000,000
General Aggregate
$2,000,000
Personal& Advertising Injury
$1,000,000
ProdudslCompMted Operations
$2,000,000
A
Commercial
103 GL 0021111
1/12021
1/1/2022
Atupol
Gama'. to From. Rented to
$1,000,000
General Liability
You
Medical Payments
$5,000
Liquor Liability Each Occurrence
(Aggregate included in General
N/A
Liability Aggregate)
COVERAGE TERMS:
Occurrence Form ICG DMI)
Host Liquor Liability Included.
The coverage afforded by this insurance is primary and noncontributing with any
insurance held by the "Additional Insured" as Named Insured, when the "Additional
Full Lpuor Lialosty Included when a
Insured" is shown on this Certificate of Insurance Endorsement as "Additional Insured"
separate premium has bean chawed.
or WHEN REQUIRED BY WRITTEN CONTRACT.
COVERAGE "CLUSIONS: (REFER TO POLICY FOR COMPLETE LISTING OF EXCLUSIONS)
— Communicable Diseases
Specific Events are excluded from coverage. Please see Second page for list of excluded events.
— Sexual Abuse & Molestation
On behalf of the Risk Purchasing Group and each Member, the Trustee has declined coverage for the Terrorism Risk
—Terrorism
Insurance Ad (TRIA).
— Additional Insureds. next page —
Second Page of Certificate
Certificate #
13785
OTHER ADDITIONAL INSUREDS:
1
Woodland Elementary-38203 Henry Dr., Zephyrhills, FL 33542
2
New River Elementary-4710 River Glen Blvd., Wesley Chapel, FL 33545
3
IMPLIES (Mitye P. Locke) Elementary-4339 Evans Ave., New Port Richey, FL 34652
4
Hudson Elementary— 7229 Hudson Ave.. Hudson, FL 34667
5
Jamas M. Marlowe Elementary School — 5642 Cecelia Dr., New Port Richey, FL 34652
6
Gu6side Elementary-2329 Anclote Blvd.. Holiday, FL 34891
7
Seven Springs Elementary-8025 Mitchell Ranch Rd., New Port Richey, FL 34655
8
Cypress Elementary— 10055 Sweet Bay CL, New Port Richey, FL 34654
9
Longleaf Elementary, 3253 Town Avenue, New Port Richey, FL 34655
10
Double Branch Elementary, 31500 Chancey Blvd., Wesley Chapel, FL 33545
11
Richey Elementary School, 6850 AdamsnStreet, New Port Richey, FL 34652
12
Wesley Chapel Elementary, 30243 Wells Road Wesley Chapel. FL 33545
13
Sunray Elementary, 4815 Sunray Drive, Holiday, FL 34690
14
Chasco Elementary, 7906 Ridge Road, Port Richey, FL 34668
15
Sunlake High School, 3023 Sunlake Blvd., land O'Lakes, FL 34638
16
Anclote Elementary, 3610 Madison Street, New Port Richey, FL 34652
17
San Antonio Elementary, 32416 Darby Road, Dade City, FL 33525
18
Northwest Elementary, 14302 Cobra Way, Hudson, FL 34669
—Additional Insureds, continue to next page —
Third Page of Certificate
Certificate #
13785
OTHER ADDITIONAL INSUREDS:
19
Veterans Elementary, 26940 Progress Parkway, Wesley Chapel, FL 33544
20
Gulf Trace Elementary, 3303 Gulf Trace Blvd., Holiday, FL 34691
21
Calusa Elementary, 7520 Orchid Lake Road, New Port Richey, FL 34654
22
City of Pinellas Park, Attn: Risk Management, 5141 78th Avenue N., Pinellas Park, FL 33781
23
Regency Park Branch Library, 9701 Little Road, New Port Richey, FL 34654
24
Hudson Regional Library, 8012 Library Road, Hudson, FL 34667
25
R.B. Stewart Middle School, 38505 10th Avenue, Zephymills, FL 33542
26
Genesis School, 8100 Mitchell Ranch Road, New Port Richey, FL 34655
27
R'Club Sutherland, 3150 N Belcher Road, Palm Harbor, FL 34683
28
R'Club MILK, 557 10th Street North, St. Petersburg, FL 33705
29
Schrader Elementary School, 11041 Little Road, New Port Ritchey, FL 34654
30
Tarpon Springs Library, 138 E Lemon Street, Tarpon Springs, FL 34689
31
School Sparc of H116eoragh County, 901 E Kennedy Blvd, Tempe, FL 33802 (Locations: Roosevelt Elementary, 3295 S. FmAinand Ave., Tampa, FL 33629: Bevis Elsmenury,
5120 Osprey Ridge Dr., LMh , FL 3 7: Man EN .tM , 1808 E. Beam Ave.. Tampa. FL 33613: Ph81p Shwa Elementary "mt 199a E. 2nd Ave.. Tempe. FL 3]695: CleA
Elerreme,, 19002 Wood Sage Dr., Tampa, FL 33617; Bryan Elementary, 2006 W. Oak Avenue Plant Coy, FL 33563)
32
Seven Oaks Elementary, 27633 Mystic Oak Blvd., Wesley Chapel, FL 33543
33
The School Board of Polk County, P.O. Boa 391, Barlow, FL 33831
34
GMS Delta Academy, Gulf Middle School, 6419 Louisiana Ave., New Pon Richey, FL 34653
35
RBS Deas Academy, Raymond B. Stewart Middle School, 33850510th Ave., New Pon Richey, FL 33542
36
HMS Delta Academy, Hudson Middle School, 14540 Cobra Way, Hudson, FL 34669
- Additional Insureds, continue to next page -
Fourth Page of Certificate
Certificate 9 13785
OTHER ADDITIONAL INSUREDS:
37
Lake Myrtle Elementary School 22844 Weeks Blvd., Land O'Lakes, FL 34639
38
Cypress Elementary— 10055 Sweat Bay Court, New Port Richey, FL 34654
39
Moon Lake Elementary-12019 Tree Breeze Drive. New Port Richey. FL 34654
40
Winthrop Charter School, 6204 Scholars Hill Lane, Riverview. FL 33578
41
Chester W. Taylor Elementary School, 3638 Morris Bridge Rd., Zephyrhills, FL 33643
42
City of Clearwater
43
Clear Water Public Library System
44
Trinity Elementary School, 2209 Duck Slough Blvd., New Port Richey. FL 34655
45
West Zephymllls Elementary School, 3790014th Ave.. Zephyrhllls, FL 33542
48
Sunset Hills Elementary School. 1347 Gulf Rd., Tarpon Springs, FL 34689
47
Land O' Lakes High School, 20325 Gator Lane, Land O' Laker, FI 34638
48
Indian Rocks Christian School, 12685 Ulmerton Road, Largo. FL 33774
49
Cape Coral Public Library-921 SW 39 Terrace, Cape Coral, FL
50
South County Regional Library, 231100 Three Oaks Pkwy, Estero, FL
51
Sanibel Public Library- 770 Dunlop Rd., Sanibel, FL 33957
52
Sierra Club 2101 Webster Ste. 1300 Oakland. CA 94612
53
KlnderCare Education LLC, Attn: Risk Management Department, 650 NE Holladay Street, Suite 1400, Portland, OR 97232
54
YMCA Suncoast, 2469 Enterprise Rd., Clearwater, FL 33763
55 1 The Board of Trustees. SL Petersburg Col e
56 Harmony Conservation CaM in Hammy, FL
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AUTHORIZED REPRESENTATIVE:
DATE ISSUED:
4/2/2021
Fifth Page of Certificate Certificate M 13785
SPECIFIC EVENT EXCLUSIONS
The following types of events are specifically excluded and no coverage for them exists on the policies listed on the
front page of this Certificate of Insurance:
Aircraft / Aviation
All Terrain Boarding
Ballooning / Balloon Rides
Base Jumping
Bouldering Events
Boxing
Bungee Jumping
Carnival Rides
Circuses
Concerts with performances exceeding 6 hours of performance time
Contact Karate / Martial Arts
Contact Sports
Diving
Dodgeball I Gaga Dodgeball
Football / Flag Football (except passing camps with no contact drills)
Gun Shows / Exhibitions
Hang Gliding
Hockey
Jousting
Kayaking, Rafting or Canoeing in greater than Class 3 rapids
Lacrosse/Rugby
Mechanical Amusement Rides or Services
Motorized Sporting Equipment
Mosh Pits
Mountain Biking
Power Boat Racing
Professional Sporting Activity; Games, Races, Contests of a professional nature
Pyrotechnics / Explosives
Rap or Heavy Metal Concerts
Raves
Rock Climbing
Rodeo I Roping Events (includes practice)
Scuba Diving
Sky Diving
Tattoo Expos / Conventions
Tractor / Truck Pulls
Wrestling
Zip Lines / Zip Lining