CERTIFICATE OF INSURANCE - SPECIAL EVENT (2) - REVISED CERTIFICATE OF INSURANCE
SPECIAL EVENT LIABILITY GROUP INSURANCE TRUST,A RISK PURCHASING GROUP
REVISED Certificate# 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
PH:925 609 6500 FX:925 609 6550 specialeventphubinternational.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): 3/11-12/31/2022
Lutz,FL 33549
EVENT LOCATION(S) Various Pasco County Florida Schools per the attached list
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 or may pertain,the insurance afforded by the policies described herein is subject to all the
terms,exclusions and conditions of such policies.
This insurance is issued pursuant to the Florida Surplus Lines Law.Persons insured by Surplus Lines carriers do not have the protection of the Florida Insurance Guaranty Act to the extent of
any right of recovery 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 $1,000,000
General Aggregate $2,000,000
Personal&Advertising Injury $1,000,000
Products/Completed Operations $2,000,000
A Commercial 103 GL 0021111 1/1/2022 1/1/2023 Aggregate
General Liability Damage to Premises Rented to $1,000,000
You
Medical Payments $5,000
Liquor Liability Each Occurrence
(Aggregate included in General N/A
Liability Aggregate)
COVERAGE TERMS:
Occurrence Form(CG 0001)
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
Terrorism On behalf of the Risk Purchasing Group and each Member,the Trustee has declined coverage for the Terrorism Risk
Insurance Act(TRIA).
Additional Insureds,next page—
Second Page of Certificate Certificate# 21448
OTHER ADDITIONAL INSUREDS:
NAME/AD
DRESS: Woodland Elementary—38203 Henry Dr.,Zephyrhills, FL 33542
(2)
NAME/AD New River Elementary—4710 River Glen Blvd.,Wesley Chapel, FL
DRESS:
(3) 33545
NAME/AD MPLES(Mittye P. Locke)Elementary—4339 Evans Ave., New Port
DRESS:
(4) Richey, FL 34652
NAME/AD
DRESS: Hudson Elementary—7229 Hudson Ave., Hudson, FL 34667
(5)
NAME/AD James M' Marlowe Elementary School—5642 Cecelia Dr., New Port
DRESS: Richey, FL 34652
(5)
NAME/AD
DRESS: Gulfside Elementary—2329 Anclote Blvd., Holiday, FL 34691
('7)
NAME/AD Seven Springs Elementary—8025 Mitchell Ranch Rd., New Port
DRESS: Richey, FL 34655
NAME/AD Cypress Elementary—10055 Sweet Bay Ct., New Port Richey, FL
DRESS: 34654
(9)
NAME/AD
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
NAME/AD Richey Elementary School,6850 AdamsnStreet, New Port Richey, FL
DRESS:
(12) 34652
NAME/AD Wesley Chapel Elementary,30243 Wells Road,Wesley Chapel, FL
DRESS:
(13) 33545
NAME/AD
DRESS: Sunray Elementary,4815 Sunray Drive, Holiday, FL 34690
(14)
NAME/AD
DRESS: Chasco Elementary,7906 Ridge Road, Port Richey, FL 34668
(15)
Third Page of Certificate Certificate# 21448
NAME/AD
DRESS: Sunlake High School,3023 Sunlake Blvd., Land O'Lakes, FL 34638
(16)
NAME/AD
DRESS: Anclote Elementary,3610 Madison Street, New Port Richey, FL 34652
(1'7)
NAME/AD
DRESS: San Antonio Elementary,32416 Darby Road, Dade City, FL 33525
(18)
NAME/AD
DRESS: Northwest Elementary, 14302 Cobra Way, Hudson, FL 34669
(1J)
NAME/AD Veterans Elementary,26940 Progress Parkway,Wesley Chapel, FL
DRESS:
(20) 33544
NAME/AD
DRESS: Gulf Trace Elementary, 3303 Gulf Trace Blvd., Holiday, FL 34691
(21)
NAME/AD Calusa Elementary,7520 Orchid Lake Road, New Port Richey, FL
DRESS:
(22) 34654
NAME/AD City of Pinellas Park,Attn: Risk Management,5141 78th Avenue N.,
DRESS: Pinellas Park, FL 33781
NAME/AD Regency Park Branch Library,9701 Little Road, New Port Richey, FL
DRESS:
(24) 34654
NAME/AD
DRESS: Hudson Regional Library,8012 Library Road, Hudson, FL 34667
(25)
NAME/AD
DRESS: R.B.Stewart Middle School,38505 10th Avenue,Zephyrhills, FL 33542
(26)
NAME/AD Genesis School,8100 Mitchell Ranch Road, New Port Richey, FL
DRESS: 34655
(2'7)
NAME/AD
DRESS: R'Club Sutherland,3150 N Belcher Road, Palm Harbor, FL 34683
(28)
NAME/AD
DRESS: R'Club MLK,557 10th Street North,St. Petersburg, FL 33705
(29)
Fourth Page of Certificate Certificate# 21448
NAME/AD Schrader Elementary School, 11041 Little Road, New Port Ritchey, FL
DRESS:
(30) 34654
NAME/AD
DRESS: Tarpon Springs Library, 138 E Lemon Street,Tarpon Springs, FL 34689
(31)
NAME/AD 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.2nd Ave., Tampa,
NAME/AD Seven Oaks Elementary,27633 Mystic Oak Blvd.,Wesley Chapel, FL
DRESS:
(33) 33543
NAME/AD
DRESS: The School Board of Polk County, P.O. Box 391, Barlow, FL 33831
(34)
NAME/AD GMS Delta Academy,Gulf Middle School,6419 Louisiana Ave., New
DRESS: Port Richey, FL 34653
NAME/AD RBS Delta Academy, Raymond B.Stewart Middle School,338505 10th
DRESS: Ave., New Port Richey, FL 33542
NAME/AD HMS Delta Academy, Hudson Middle School, 14540 Cobra Way,
DRESS:
(37) Hudson, FL 34669
NAME/AD Lake Myrtle Elementary School 22844 Weeks Blvd., Land O'Lakes, FL
DRESS:
(38) 34639
NAME/AD Cypress Elementary—10055 Sweat Bay Court, New Port Richey, FL
DRESS:
(39) 34654
NAME/AD Moon Lake Elementary—12019 Tree Breeze Drive, New Port Richey,
DRESS:
(40) FL 34654
NAME/AD
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
NAME/AD
DRESS: City of Clearwater and Clear Water Public Library System
(43)
NAME/AD Trinity Elementary School,2209 Duck Slough Blvd., New Port Richey,
DRESS:
(44) FL 34655
Fifth Page of Certificate Certificate# 21448
NAME/AD West Zephyrhills Elementary School,37900 14th Ave.,Zephyrhills, FL
DRESS:
(45) 33542
NAME/AD District School Board of Pasco County,20430 Gator Lane, Land
DRESS:
(46) O'Lakes, FL 34638
NAME/AD The School Board of Hillsborough County,901 E Kennedy Boulevard,
DRESS: Tampa, FL 33602
NAME/AD
DRESS: Sunlake High School,3023 Sunlake Blvd., Land O'Lakes, FL 34638
(47)
NAME/AD Sunset Hills Elementary School, 1347 Gulf Rd.,Tarpon Springs, FL
DRESS:
(48) 34689
NAME/AD
DRESS: Land O' Lakes High School,20325 Gator Lane, Land O' Laker, FI 34638
(49)
NAME/AD
DRESS: Indian Rocks Christian School, 12685 Ulmerton Road, Largo, FL 33774
(50)
NAME/AD
DRESS: Cape Coral Public Library-921 SW 39 Terrace,Cape Coral, FL
(51)
NAME/AD
DRESS: South County Regional Library,231100 Three Oaks Pkwy, Estero, FL
(52)
NAME/AD
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
NAME/AD Sierra Club 2101 Webster Ste. 1300 Oakland,CA 94612/Suncoast
DRESS:
(55) Sierra Club, North Pinellas Conservation
NAME/AD
DRESS: MyChabad.org,4010 Park Street N.,St. Petersburg, FL 3709
(56)
NAME/AD
DRESS: Discovery Point,23965 Venezia Dr., Land O'Lakes, FL
(5'7)
NAME/AD KinderCare Education LLC,Attn: Risk Management Department,650
DRESS:
(58) NE Holladay Street,Suite 1400, Portland,OR 97232
NAME/AD
DRESS: YMCA Suncoast,2469 Enterprise Rd.,Clearwater, FL 33763
(59)
Sixth Page of Certificate Certificate# 21448
NAME/AD
DRESS: The Board of Trustees,St. Petersburg College
(68)
NAME/AD
DRESS: Harmony Conservation Cafe in Harmony, FL.
(61)
NAME/AD
DRESS: Turner-Bartels K-8,9190 Emperial Oak Boulevard,Tampa, FL
(62)
NAME/AD Connerton Elementary School
DRESS: 8300 Flourish Dr., Land O'Lakes, FL 34637
NAME/AD Riverhills Elementary Magnet IB World School
DRESS:
(64) 405 S. Riverhills Dr.,Temple Terrace, FL 33617
NAME/AD Paul R.Smith Middle School
DRESS: After School Program
(65) 1410 Sweetbrier Dr., Holiday, F 34691
NAME/AD Seminole R'Club
DRESS:
(66) 10950 74 Ave. N,Seminole, FL
NAME/AD St. Raphael Catholic Church
DRESS: 1376 Snell Isle Blvd. NE,St. Petersburg, FL 33704
NAME/AD St. Petersburg College
DRESS: 2465 Drew St.
(68) Clearwater, FL
NAME/AD
DRESS: City of Clearwater, located at PO Box 4748,Clearwater, FL 33758-4748
(6J)
CANCELLATION: Should the above described policy(s)be canceled before the expiration date thereof,the issuing company will endeavor to mail 30 days written notice to the insured event
holder and additional insureds listed.
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/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/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/Roping Events(includes practice)
Scuba Diving
Sky Diving
Tattoo Expos/Conventions
Tractor/Truck Pulls
Wrestling
Zip Lines/Zip Lining