Res. #12-013 - Bald Eagle Waterski Show, Inc.

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DATE: 5/23/2012 CERTIFICATE OF INSURANCE - -- - -- CERTIFICATE NUMBER: 20120507082565 AGENCY: Entertainment & Sports Insurance eXperts (ESIX) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS 5660 New Northside Drive, Suite 640 NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT Atlanta, Georgia 30328 AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone: 678- 324 -3300 Fax: 678- 324 -3303 NAMED INSURED: INSURERS AFFORDING COVERAGE: USA Water Ski Bald Eagle Water Ski Show Inc INSURER A: Philadelphia Indemnity Ins. Co. 1251 Holy Cow Road 6521 White Oak Rd Polk City, Florida 33868 Lino Lakes, Minnesota 55038 INSURER B: Philadelphia Indemnity Ins. Co. POLICY /COVERAGE INFORMATION: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WMTH 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS TYPE OF INSURANCE: 1 POLICY NUMBER(S): EFFECTIVE EXPIRES: 1 LIMITS: A GENERAL LIABILITY X COMMERCIAL GENERAL PHPK808058 1/1/2012 1/1/2013 GENERAL AGGREGATE (Applies Per Event) $2,000,000 LIABILITY 12:01 AM 12:01 AM EACH OCCURRENCE $1,000,000 X Occurrence DAMAGE TO RENTED PREMISES (Each Occ.) $1,000,000 X Participant Legal Liability MEDICAL EXPENSE Any one person) EXCLUDED PERSONAL & ADV INJURY $1,000,000 PRODUCTS - COMP /OP AGG $2,000,000 B UMBRELLA/EXCESS LIABILITY X Occurrence PHUB368206 1/1/2012 1/1/2013 AGGREGATE (Applies Per Event) $4,000,000 12:01 AM 12:01 AM X SIR EACH OCCURRENCE $4,000,000 RETENTION /DEDUCTIBLE $10,000 DESCRIPTION OF OPERATIONS /LOCATIONS/VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS: The certificate holder is an Additional Insured with respect to liability arising out of the negligence of the Named Insured as per the following endorsement: Additional Insured - Certificate Holders (Form PI -AM -002). Coverage only applies with respect to tournaments, practices, exhibitions. clinics and related activities sanctioned and approved by USA Water Ski, Inc. CERTIFICATE HOLDER: NOTICE OF CANCELLATION: City of Centerville Should any of the above described policies be cancelled before the expiration date thereof, 1680 Main Street notice will be delivered In accordance with the policy provisions. Centerville, Minnesota 55038 AUTHORIZED REPRESENTATIVE: / .