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DATE: 12/20/2010
<br />CERTIFICATE OF INSURANCE
<br />CERTIFICATE NUMBER: 201011220037621
<br />AGENCY:
<br />Entertainment & Sports Insurance eXperts (ESIX) THIIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
<br />5660 New Nlorthside Drive, Suite 640 NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT
<br />Atlanta, Georgia 30328 AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
<br />Phone: 678-324-3300 Fax: 678-324-3303
<br />NAMED INSURED: INSURERS AFFORDING COVERAGE:
<br />USA Water Ski Lake Owasso Safe Boating Association INISURER A: Philadelphia Indemnity Ins. Co.,
<br />1251 Holy Cow Road 460 W Horseshoe Dr IN�SURER B: Philadelphia Indemnity Ins. Co.,
<br />Polk City, Florida 33868 Shoreview, Minnesota 55126-3001
<br />POLICY/COVERAGE INFORMATION:
<br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEENI ISSUED T O T HE INSURED NAMED ABOVE FORT E POLICY PERIOD INDICATED. NOTWITHSTANDING ANY
<br />REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITHI RESPECT TO WHIICH THIN 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 LIMITS
<br />SHOWNI MAY HAVE BEEN REDUCED BY PAID CLAIMS.
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<br />INS TYPE OF'INISURANICE: 1POLICYNUMBER(S)-1 EFFECTIVE:
<br />A GENERAL LIABILITY
<br />X COM�M�ERCIAL GENERAL PHPK663189 '1 /1 /20 '1 '1 1/1/2012 GENERAL AGGREGATE (Applies Per Event) $2,000,000
<br />LIABILITY 12:01 AM 12:01 AM
<br />1-1 EACH OCCURRENCE $1,000,000
<br />X Occurrence
<br />1-1 DAMAGE, TO RENTED PREMIISE,S (Each Occ.,) $1,000,000
<br />X Participant Legal Liability
<br />ME,D E,XP (Any one person) EXCLUDED
<br />PERSONAL & ADV INJURY $1,000,000
<br />PRODUCTS- COMP /OP AGG $2,000,000
<br />B UIMIBRE,LLA/E,XCE,SS LIABILITY
<br />X Occurrence PHUIB330267 '1 /1 /20 '1 '1 1/1/2012 AGGREGATE (Applies Per Event) $4,000,000
<br />1 12:01 AM 12:01 AM
<br />X SIR EACH OCCURRENCE $4,000,000
<br />RETE,NIT'ION/DEDUCTIIBLE $110,000
<br />SO'
<br />DESCRIPTION OF'O PE RAT'IONS/LOCATI ONIS/VEH IC LES/EXC L,US IONS ADDED BY ENIDORSEMENT/SPECIAL, PROVISIONS:
<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 />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 U'SAWater Ski, Inc.,
<br />..... . . . . . . NONE SIN R SIN SIN SIN SIN SIN SIN SIN SIN SINION
<br />IN) M)NEW My
<br />CERTIFICATE HOLDER: NOTICE OF'CANCEL,LATIONl:
<br />Ramsey County Should any of the above described policies be cancelled before the expiration date hereof,
<br />85 East Vadnais Boulevard notice will be delivered in accordance wiith the policy provisions.
<br />Vadnais Heights, Minnesota 55127 AUTHORIZED REPRESENTATIVE:
<br />ed
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