CERTIFICATE OF INSURANCE - SPECIAL EVENT (2) CERTIFICATE OF INSURANCE
SPECIAL EVENT LIABILITY GROUP INSURANCE TRUST,A RISK PURCHASING GROUP
Clartificatellif 21448
FACILITY OWNER-Additional insured;(if multiple,continued PRODUCER: CA License#0757776
on next page)
HUB International Insurance Services Inc,
Pasco County,7227 Land O'Lakes Boulevard,Land O'Lakes FL.34638- P.O.Box 4047
2826 Concord,CA 94524-4047
PK 925 609 6500 FX:925 609 6550 speciaLevent@hubintqrrialionat 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): 3111 -12131/2022
Lutz,FL 33549
EVENT LOCATION(S) Various Pasco County Florida Schools per the attached 1st
This is to certify that the policies of insurance listed below have been issued to the insured named above for the event date(s)indicated above. Notwithstanding any requirement,term or
condition of any contract or other document with respect to which this certificate may be issued of may pertain,the insurance afforded by the policies dasuitted herein is subject to all the
terms,exclusions and conditions of such policies.
This insurance is issued pursuant to the Florida Surplus Line-,Law,Persons insured by SLIPfUS Lines carvers do not have the protection of the Fluids insurance GuararuyAcl le the extent of
any right of ofenvery for the obligation of an insolvent unlicensed insurer
INSURER A: COLONY INSURANCE COMPANY
INSR LTR Type of Insurance Policy Number Effective Expiration Policy Limits
Each Occurrence K000,000
General Aggregate $2,000,000
Personal&Advertising Injury $1,000,000
Products/Completed Operations $2,000,000
A Commercial 103 GL 0021111 11112022 1/112023 Aggregate
General Liability Damage to Promises Rented to
$1,000,000
You
Medical Payments $5,000
Liquor Liability Each Occurrence
(Aggregate included in General NIA
Liability Aggragabot
J L
COVERAGE TERMS:
Occurrence Form(CG 000 1)
Host Liquor Liability included. The coverage afforded by this insurance is primary and non-contributing with any
insurance held by the"Additional Insured"as Named Insured,when the"Additional
Full Liquor Liability Included when a Insured" is shown on this Certificate of insurance Endorsement as"Additional Insured"
separate premium has been charged, or WHEN REQUIRED BY WRITTEN CONTRACT.
COVERAGE EXCLUSIONS:(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 Act(TRIA).
Additional Insureds,next page-
Second Page of Certificate Certificate# 21448
OTHER ADDITIONAL INSUREDS:
NAMEIAD
DRESS: Woodland Elementary—38203 Henry Dr.,Zephyrhills, FL 33542
(2)
NAMEIAD Now River Elementary—4710 River Glen Blvd.,Wesley Chapel, FL
DRESS:
(3) 33545
NAMEIAD MPLES,(Mittye P.Locke)Elementary—4339 Evans Ave., New Port
DRESS:
(4� Richey,FL 34652
NAMEIAD
DRESS: Hudson Elementary—7229 Hudson Ave.,Hudson, FL 34667
(5)
NAME/AD James M. Marlowe Elementary School—5642 Cecelia Dr., New Port
DRESS:
(6) Richey, FL 34652
NAME/AD
DRESS: Gulfside Elementary—2329 Anclote Blvd., Holiday, FL 34691
(7)
NAMEIAD Seven Springs Elementary—8025 Mitchell Ranch Rd.,New Port
DRESS: Richey, Fl-34655
(8)
NAME/AD Cypress Elementary—10055 Sweet Bay CL,New Port Richey, FL
DRESS; 34654
(9)
NAMEIAD
DRESS: Longleaf Elementary,3253 Town Avenue, New Port Richey, FL 34655
(10)
NAME/AD Double Branch Elementary,31500 Chancey Blvd.,Wesley Chapel, FL
DRESS:
{11) 33545
NAMEIAD Richey Elementary School,6850 AdamsnStreet, New Port Richey, FL
DRESS:
1,12) 34652
NAMFJAD Wesley Chapel Elementary, 30243 Wells Road,Wesley Chapel, FL
DRESS: 33545
03)
NAME/AD
DRESS: Sunray Elementary,4815 Sunray Drive, Holiday,FL 34690
(14)
NAMEIAD
DRESS: Chasco Elementary,7906 Ridge Road, Port Richey, FL 34668
(15)
Third Page of Certificate Certificate1448
NAMEJAD
DRESS: Sunlake High School,3023 Sunlake Blvd., Land O'Lakes, FL 34638
(16)
NAMEIAD
DRESS: Anclote Elementary,3610 Madison Street, New Port Richey, FL 34652
(17)
NAMEIAD
DRESS: San Antonio Elementary,32416 Darby Road, Dade City, FL 33525
(18)
NAME/AD
DRESS: Northwest Elementary, 14302 Cobra Way, Hudson, FL 34669
(19)
NAMEJAD Veterans Elementary,26940 Progress Parkway,Wesley Chapel, FL
DRESS: 33544
(2 0)
NAMEIAD
DRESS: Gulf Trace Elementary, 3303 Gulf Trace Blvd,, Holiday, FL 34691
(21)
NAMEJAD Calusa Elementary,7520 Orchid Lake Road, New Port Richey, FL
DRESS;
(22) 34654
NAMEJAD City of Pinellas Park,Attn: Risk Management, 5141 78th Avenue N.,
DRESS: Pinellas Park, FL 33781
(23)
NAMEIAD Regency Park Branch Library,9701 Little Road, New Port Richey, FL
DRESS:
(241 34654
NAME/Al)
DRESS. Hudson Regional Library,8012 Library Road,Hudson, FL 34667
(25)
NAMEIAD
DRESS: R.B.Stewart Middle School, 38505 10th Avenue,Zephyrhills,FL 33542
(26)
NAMEJAD Genesis School, 8100 Mitchell Ranch Road, New Port Richey, FL
DRESS: 34655
(27)
NAMEJAD
DRESS: R'Club Sutherland,3150 N Belcher Road, Palm Harbor, FL 34683
(28)
NAMEIAD
DRESS: R'Club ML ,557 10th Street North, St. Petersburg, FL 33705
t2q)
Fourth Page of Certificate I Certificate# 21"8
NAMEIAD Schrader Elementary School, 11041 Little Road, New Port Ritchey, FL
DRESS:
t3o9 34654
NAMEIAD
DRESS: Tarpon Springs Library, 138 E Lemon Street,Tarpon Springs,FL 34689
l3l)
NAMEIAD School Board of Hillsborough County,901 E Kennedy Blvd..Tampa,FL 33602
DRESS: (Locations:Roosevelt Elementary,3205 S.Ferdinand Ave.,Tampa,FL 33629,`Bevis
(32) Elementary,5720 Osprey Ridge Dr.,Lithia,FL 33547:Mort Elementary, 1806 E.Bearrs
Ave.. Tampa.FL 33613:Philip Shore Elementary Magnet, 1908 E.grad Ave.. Tampa.
NAMEIAD Seven Oaks Elementary,27633 Mystic Oak Blvd.,Wesley Chapel, FL
DRESS:
(33) 33543
NAMEtAD
DRESS; The School Board of Polk County, P.O. Box 391,Barlow, FL 33831
(34)
NAMEIAD GMS Delta Academy, Gulf Middle School,6419 Louisiana Ave., New
DRESS:
(35) Port Richey, FL 34653
NAMEIAD RBS Delta Academy, Raymond B. Stewart Middle School, 3385115 10th
DRESS:
(3,G) Ave.,New Port Richey, FL 33542
NAMEtAD HMS Delta Academy, Hudson Middle School, 14540 Cobra Way,
DRESS:
(37) Hudson, FL 34669
NAMEIAD Lake Myrtle Elementary School 22844 Weeks Blvd., Land O'Lakes, FL
DRESS;
(38� 34639
NAMEIAD Cypress Elementary-10055 Sweat Bay Court, New Port Richey, FL
DRESS:
(39) 34654
NAMEIAD Moon Lake Elementary-12019 Tree Breeze Drive,New Port Richey,
DRESS:
(40) FL 34654
NAMEIAD
DRESS: Winthrop Charter School,6204 Scholars Hill Lane, Riverview.FL 33578
(41)
NAME/AD Chester W.Taylor Elementary School, 3638 Morris Bridge Rd.,
DRESS:
(42) Zephyrhills, FL 33543
NAMEIAD
DRESS: City of Clearwater and Clear Water Public Library System
(43)
NAMEIAD Trinity Elementary School,2209 Duck Slough Blvd., New Port Richey,
DRESS:
(44) FL 34655
Fifth Page of Certificate Certificate# 21
NAMEIAD West Zephymills Elementary School,37900 14th Ave.,Zephyrhills, FL
DRESS!
(45) 33542
NAMEIAD District School Board of Pasco County,20430 Gator Lane, Land
DRESS:
(46) O'Lakes, FL 34638
NAMEIAD The School Board of Hillsborough County, 901 E Kennedy Boulevard,
DRESS: Tampa, FL 33602
(47)
NAMEIAD
DRESS: Sunlake High School,3023 Sunlake Blvd.,Land O'Lakes, FL 34638
(47)
NAMEIAD
Sunset Hills Elementary School, 1347 Gulf Rd.,Tarpon Springs, FL
DRESS-
(48) 34689
NAMEIAD
DRESS: Land 0' Lakes High School,20325 Gator Lane, Land O'Laker, Fl 34638
(49)
NAME/AD
DRESS: Indian Rocks Christian School, 12685 Ulmerton Road,Largo, FL 33774
(50)
NAME/Al)
DRESS: Cape Coral Public Library-921 SW 39 Terrace, Cape Coral, FL
(51)
NAMEJAD
DRESS: South County Regional Library,231100 Three Oaks Pkwy, Estero, FL
(52)
NAMEIAD
DRESS: Sanibel Public Library-770 Dunlop Rd., Sanibel, FL 33957
(53)
NAME/AD Lee County,a political subdivision and Charter County of the State of
DRESS:
(54) Florida,its agents,employees and public officials
NAMEIAD Sierra Club 2101 Webster Ste. 1300 Oakland,CA 94612/Suncoast
DRESS;
(55) Sierra Club,North Pinellas Conservation
NAMEIAD
DRESS: MyChabad.org,4010 Park Street N., St.Petersburg, FL 3709
(56)
NAMEIAD
DRESS: Discovery Point, 23965 Venezia Dr., Land 0' Lakes, FL
(57)
NAMEIAD KinderCare Education LLC,Attn: Risk Management Department,650
DRESS: NE Holladay Street, Suite 1400, Portland,OR 97232
(58)
NAME/AD
DRESS: YMCA Suncoast, 2469 Enterprise Rd,,Clearwater, FL 33763
'59)
Sixth Rage of Certificate Certificate# 21448
NAMEIAD
DRESS: The Board of Trustees,St,Petersburg Coliege
(69)
NAMEIAD
DRESS: Harmony Conservation Cafe in Harmony, FL.
(61)
NAMEIAD
DRESS: Turner-Bartels€i-8, 9190 Emperial Oak Boulevard,Tampa, FL
( )
NAMEIAD Connerton Elementary school
DRESS: 8300 Flourish Dr., Land O'La,kes, FL 34837'
t )
NAME/AD Riverhills Elementary Magnet IB World school
DRESS:
(so) 4175 S. Riv chills Dr.,Temple Terrace,FL 33617
NAMEIAD Paul R.Smith Middle School
DRESS. After School Program
(65) 1410 Sweetbrier Dr., Holiday, F 34691
NAMEIAD Seminole R'Club
DRESS:
10950 74 Ave.N,Seminole, FL
ley
NAMEIAD St.Raphael Catholic Church
DRESS:
(67) 1376 Snell Isle Blvd.NE, St.Petersburg, FL 33794
OANGELLATIW Should the above described pollcy(s)be canceted before the expirabon data thereof.the issuing company wilt endeavor to ma#3P days wrNen ooflca to the insurod event
holder and additib.nal insureds tested.
AUTHORIZED REPRESENTATIVE: �,�'*�� _ DATE ISSUED, 3/10/2022
Seventh Page of Certificate Certificate# 21448
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 I Aviation
All Terrain Boarding
Ballooning I Balloon Rides
Base Jumping
Bouldering Events
Boxing
Bungee Jumping
Carnival Rides
Circuses
Concerts with performances exceeding 6 hours of performance time
Contact Karate 1 Martial Arts
Contact Sports
Diving
Dodgeball I Gaga Dodgeball
Football 1 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 I 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 I Explosives
Rap or Heavy Metal Concerts
Raves
Rock Climbing
Rodeo I Roping Events(includes practice)
Scuba Diving
Sky Diving
Tattoo Expos I Conventions
Tractor!Truck pulls
Wrestling
Zip tines/Zip Lining