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�ACORD t,:�CERT_IFICAT�E�OF LIABILfTY „,I�IS!L:),I,�N.G��� >:.. `” ��' DATE(MM/DD/YY)
<br />FTC � . s :� a`; 06/26/12
<br />PRODUCER .L _. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
<br />AND CONFERS NO RIGH73 UPON THE CERTIFICATE HOLDER.
<br />FOR SERVICE CALL:
<br />FRANCIS L. DEAN 8a ASSOCIATES OF FLORIDA, LLC
<br />OCALA, FLORIDA
<br />ONLY
<br />TH13 CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
<br />COVERAGE AFFORDED BY THE POLICIES BELOW.
<br />COMPANIES AFFORDING COVERAGE
<br />877!671 -3326
<br />www.fdear111.com
<br />COMPANY RNERPORT INSURANCE COMPANY
<br />A
<br />INSURED SPORTS AND REC. PROVIDERS ASSN. PURCHASING GROUP
<br />COMPANY
<br />TriFytt Sports
<br />1205 N. Red Gum Street, Suite A
<br />B
<br />COMPANY
<br />Anaheim, CA 92805
<br />C
<br />Certll: AP765847-00
<br />COMPANY
<br />y D
<br />- .COVERAGES 1 �I! Y1~>=Y � �Yw v- ..i���. -.. `i�lT li'���.F.atf._s.a��.. rx3+I..avnJ�.w .�� \N �YCSxI� {.1�1.<�,1- Li'_�S r3tW5�.a �S��i's�eL . ILA. L1.. u. f�.. iwu. a. exY:. t.. n� '�.- Sti1S�1.i]x..ivluil�3.`. -a �i.F .�...- 1.`�.�5 —�.� -..rte
<br />��� 4, THIS IS TO CERTIFY THAT THE POUGES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY
<br />- �...sr.r— ssa
<br />PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WRH RESPECT TO
<br />VNiIGH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL
<br />THE TERMS EXCLUSIONS AND CONDITONS OF SUCH POLICIES LIMITS SHOWN MAV HAVE BEEN REDUCED BY PAID CLAIMS.
<br />CD
<br />LTR TYPE OF INSURANCE POLICY NUMBER
<br />GENERAL LIABILITY
<br />A X COMMERGAL GENERAL UP.BILITY
<br />CLAIMS MADE OCCUR FLDA180412
<br />OWNER'S 6 CONTRACTORS PROs
<br />X INCLUDES wTlIETIC
<br />PARTCPANT9
<br />POLICY EFFECTIVE POLICY E %PIRATION LIMITS
<br />DATE Y DATE - GENERAL AGGREGATE $ 2000 000.00
<br />PROOVCT3 {pMP/OP AGG $ 2,000,000 -00
<br />06!13/12 06/'13/'13 PERSONALAAw IN.R)RY $ 1,000,000.00
<br />EACH OCCURRENCE $ 1000000.00
<br />FIRE DAMAGE (Any ona M) $ 300,000.00
<br />MED EXP (Any wr Parson) S S OOO.00
<br />AUTOl110BILE
<br />BLLiTY
<br />COMBINED SINGLE OMIT
<br />$ 1.000.000.00
<br />A
<br />ANY AUTO
<br />ALL OVNVED AUTOS
<br />SCHEDULED AUTOS
<br />HIRED AUTOS
<br />FLDA780412
<br />06/13/12
<br />06/13/13
<br />BODILY INJURY
<br />!Par ��)
<br />$
<br />)(
<br />BOwIY INJURY
<br />(Par axltlaM)
<br />$
<br />)(
<br />NON -OWNED AUTOS
<br />PROPERTY DAMAGE
<br />$
<br />AUTO ONLY -EA ACGDENT
<br />$
<br />GARAGE
<br />LIABILITY
<br />OTHER THAN AVrO ONLY:
<br />FJIG -I ACCIDENT
<br />$
<br />ANY AUTO
<br />AGGREGATE.$
<br />Excess uaauTY
<br />UMBRELLA FORM
<br />EACH OCCURRENCE
<br />'
<br />AGGREGATE
<br />$
<br />OTHER THAN UMBRELLA FORM
<br />WORI(ER TON AND
<br />EMPLOYERS• lNBiITY
<br />W 8TA OT
<br />Tof1Y UM+ra FR
<br />EL EACH ACCIDENT
<br />$
<br />EL DISEASE- POLJGY IJMIT
<br />$
<br />nce PRavRiErOw INCL
<br />PMtNERaE%ECUTrvs EXCL
<br />OFFICERS AAE
<br />EL DISEASE -EA EMPLOYEE
<br />OTHER
<br />pESCRIPTON OF OPERATONS /LOCATONSNEHICLESfSPECtAL REMS
<br />THE CERTIFICATE HOLDER IS ADDED AS AN ADDITIONAL INSURED BUT ONLY VV)TH RESPECT TO LIABILITY ARISING OUT OF OPERATIONS OF
<br />THE NAMED INSURED DURING THE POLICY PERIOD.
<br />Athletic ActivlLes x�
<br />.. -.-. 4 f::. „vr� v.:. t pYn i?L 4'1 'I'?i W � ✓ � xCAl'rCE 10Nji`'a,h` ..j r`•�+ t'+ wt ., f'� < a _H� I nC .� '. `p'F'�Atd �. n_, "X- �',
<br />1'• C: ERTIFICATE- HOLD1r R' �S�L. �.,._._: ��,...--. a'>... ,3 >c...t�..a:�4..i..�i'_- x....v w5 t._...._ i_- �_. rz h.... �,.. er. u��.e. �.. uu _.u__w.....v3:12...'I- tm.�:�... �S. - 4. c1 _w�..�.�>..�_�.ua_i�.:._..k��_ _,:,:.<.�
<br />�- �-•-->✓, ..aso.•�s- • °^x' °�- �°°� °-'�—'�-� SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE
<br />CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE
<br />City of Santa Arta ISSUING COMPANY VNLL ENDEAVOR TO MAIL DAYS
<br />20 Civic Center Plaza WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO
<br />Santa Ana, CA. THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE
<br />NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
<br />- COMPANY, ITS AGENTS OR REPRESENTATIVES.
<br />.. - ..
<br />AUTHORIZED REPRESENTATIVE
<br />Francis L. Dean
<br />.. .. ....._... .. .._
<br />p - a.�e a t,--�s e 14. iz: ' r Wr Z'a tx'x`��.3`v�J�r' 4 f =�} Y u`x {' �s�xr,d�3t�` K`'_ �kt Zt ;s�,s�4�✓c'�'S�'SS.��y�r� -'��;� .1",,, ®;ACOR rCORPORA770N,'�$8$::(
<br />ACRD 25S (1!B$,.,�- k,k..- m....... ?. r '..� .0 a r l u , -:u J ..tea Y�;e, -° Yt a. .,, li...., a . -�<.. - t..�°. r.a C' k ...._. Y � _
<br />,APPROVERS TO FORiVi
<br />A cr 'C,
<br />LISA E. STORGK
<br />Assistant City Attorney ' /�
<br />
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