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DATE: 6/10/2014 <br /> CERTIFICATE OF INSURANCE -------- -- -- - <br /> CERTIFICATE NUMBER: 20140610250629 <br /> AGENCY: <br /> ESIX 3 LLC - THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY ANL <br /> d/b/a Entertainment&Sports Insurance eXperts(ESIX) CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES <br /> d/b/a Entertainment and Sports Insurance Agency(California) NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> 2727 Paces Ferry Road,Building Two,Suite 1500 BELOW. <br /> Atlanta,GA 30339 <br /> 678-324-3300(Telephone) <br /> 678-324-3303(Facsimile) <br /> NAMED INSURED: �� - _- � INSURERS AFFORDING COVERAGE: <br /> USA Water Ski Bald Eagle Water Ski Show Inc INSURER A: Philadelphia Indemnity Ins.Co. <br /> 1251 Holy Cow Road 9020 Nashua Ave NE <br /> Polk City FL 33868 Lino Lakes MN 55330 INSURER B: Philadelphia Indemnity Ins.Co. <br /> POLICY/COVERAGE INFORMATION: <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY <br /> REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE <br /> INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES AGGREGATE <br /> LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS <br /> INS TYPE OF INSURANCE: i POLICY NUMBER(S): EFFECTIVE: i EXPIRES: LIMITS: <br /> A GENERAL LIABILITY <br /> 1/1 <br /> iP /2015 <br /> ' X COMMERCIAL HPK1110274 1/1/2014 GENERAL I - { NERAL AGGREGATE(Applies Per Event) $2,000,000 <br /> i LIABILITY --- I 12:01 AM 12:01 AM -GE - -- - 11 <br /> --- i EACH OCCURRENCE $1,000,000 <br /> X Occurrence DAMAGE TO RENTED PREMISES(Each Occ.) $1,000,000 <br /> ' X Participant Legal Liability <br /> ---- -- I MEDICAL EXPENSE(Any one person) -- EXCLUDED <br /> I PERSONAL&ADV INJURY $1,000,000 <br /> PRODUCTS-COMP/OP AGG $2,000,000 <br /> ~B UMBRELLA/EXCESS LIABILITY - <br /> --------— —------ PHU443 - /1/2014- ;1/1/2015 <br /> `"� 6398 .__. ---.-------- ------ ----•-- I <br /> I X Occurrence AGGREGATE(Applies Per Event)-- —$1,000,000 f <br /> — - 12.01 AM 12:01 AM ----- - <br /> X SIR (� EACH OCCURRENCE $1,000,000 <br /> RETENTION/DEDUCTIBLE- - -- - _-$10,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS: r �� <br /> 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 <br /> I Insured-Certificate Holders(Form PI-AM-002). <br /> Coverage only applies with respect to tournaments,practices,exhibitions,clinics and related activities sanctioned and approved by USA Water Ski,Inc. <br /> i <br /> 1 <br /> f <br /> { <br /> s { <br /> i <br /> I <br /> 1 ! <br /> 1= � <br /> CERTIFICATE HOLDER: -- - _— - NOTICE OF CANCELLATION: <br /> City of Centerville �x Should any of the above described policies be cancelled before the expiration date thereof, <br /> c/o Teresa Bender { notice will be delivered in accordance with the policy provisions. <br /> 1880 Main Street AUTHORIZED REPRESENTATIVE: <br /> Centerville MN 55038 <br /> `f <br /> I <br /> I <br />