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ATTACHMENT A
<br />CERTlFICATE OF iNSURANCE
<br />AGENCY:
<br />ESIX Fntertainment & Spats Insurance eXpeRs
<br />5sso New lVorthside Drive, Sulte B40
<br />Adarita, GA 30328
<br />Phone: (679} 32433Q0 Fax: (67$) 32M38Q3
<br />NAME� INStfREDt
<br />DATE: 1211712013
<br />--- �"�
<br />CER'ffF1CAFE NUi�[BEI2; : ZQ'13't 297216308
<br />7HlS CERTiFtCATE {S IS5UE0 AS A MATFER OF fNFORMAF40N ONLY AND
<br />CONFERS NO RIGIiTS UPAN T#iE CERTlF{CATE HpLpER. THI$ CERTIFICATE [70ES
<br />NOT AMENq EXTEND OR AI.TER 7NE COV�RAGE AFFdRD�D BY THE POLICIE&
<br />BELOW,
<br />iNSUi�eas aF�ar�i»o cavEw►ogc
<br />USA UVater Ski Lake 4vvas.�o 5afe Boadng Assxiation lNSt1RER A: Phiiadelphia lndemniry lns. Co.
<br />� 1251 Holy Cow Road 46U W Horseshae Dr ��g��� g_ philadel hia lndemR ins, Ca
<br />� Polk City FL 33868 Shoreview MN 55 1 28-30 01 p �
<br />POLiCYtCOVERAGE INFOIiMAT[OiY:
<br />TH� POL.ICIES OF INSURAMCE USTEp BELOW HAVE 9EEN I&SUEd TO TFiE lNSUR�D NAMEO ABOVF FpR THE POLICY P
<br />• ER1dD 1NUICATEb. NO71M3F35TANDlM1[G ANY
<br />REQUfREMEKT, TERM pR CQNDITIdN OF ANY COR}TRACT OR OTHER DOCUMENi VNTH RESP�CT TO WHlCH TH1S C�fi3'IFICATE MAY $E ISSUE(3 OR MAY PE3�TAIN, THE
<br />1NSlfRA4VCE AFFORDED 8Y THE POLCfES �E6CR18ED HEiiEIN 1S SUBSECT'E'17 ALL THE 1EFiihA5, EXCLUSIONS ANQ CONDI'T1bN5 OF fiUCH PQLICIE6. AGGf2EGATE
<br />tIM1T5 SHOVNV �,IAY HAVE BEEN REDUCEU 8Y PAfD CLAiMS.
<br />INS 7YPE OF I�ISt7RAN _ _ _ __ . , .. __ .- , -..
<br />CE: POLICY NlJM9Fli(S}: EFFECTIYE: _ EXPIRES: LIMfF8;
<br />� . , _.._� �
<br />A �ENERAL LUIBILFTY __.__ .__
<br />X GONlMERCWL C.,EhlEF2AL PHPK1110274
<br />tiABILITY
<br />_e � .
<br />X OCrurrence
<br />X Partia�nt Legal Laa�fity
<br />�rti2a�a a»t2a�s
<br />12:0'! AM 12:07 Ak1
<br />GENERAL AGGREGATE {Appties Per fverrt� S2,OOQ,QpO
<br />FJ�Ctf OCCURRENCH . $1,OUO,Q06
<br />_., . __ _ .� _.. _ _�_ �_ _ _ _.� _ ._ _
<br />DAMAGE TO REN7E0 PR�M#SES (EaCh OCC.} $1,o0Q,D4U
<br />,_.., _ ... ._ _ _�,_.. __. .. . ...__.... .. _ .. ___ , .
<br />MEDICAL EXPENSE (Any one person} EXCLUt1ED
<br />PEI2SQNAL $ ADV INJURY $1,o0D,04p
<br />PRO�UCFS-COMPI4PAG� ��._�._� � $2,UOQ,d00
<br />_ _.__.__.._.-�.._.,._,__T. ���.�___m_ �T. m.__._.____.
<br />B : UM$RELLA/EXGES$ LIABIttTY
<br />X fl��� PHU8443398 1!1l�014 1l112p15 AGGRECAi'E (ARplies Aer Ev�rn) . T� mm�1,DOO,ROD
<br />12:01 AM 12.01 AM ... . . _,._.__ .. .. . ... .. ......�. _ � �... _. ., . .
<br />X SIR EACH OCCURRENCE S1,4ai7,000
<br />_ _ .J...._._.--- .._.._-. __
<br />RECEISTI�NlDEDi.jCTiBL� �10,400
<br />DESGFi1PT1CAN! OF OPERA7fAN3A.00A71QT13NEHICLES/EXCLUSION3 A�ED 8Y ENDOR8EMENTlSPECWL PROVISiONS:
<br />_ _,_ . ... _.......
<br />TFse oertiticate holder fs an Additioreaf Insuned with respect to liabHtty arlsing out of the negligence oi the Named ir�sured as per the to1lo+Mng endorsement: AddiUonaf
<br />lnsured -Certiflcate Hoiders (Fa�m PI-AM-UO2).
<br />Coverage only appties with respect to toumament& P��. e�ibitlats, dimcs arni rela�ed acdvities sandiorted and �pproved by USA Watsr Ski, inc.
<br />CER'f1FICATE HOLDER:
<br />CRy ot Roseville MN
<br />286P Civic Center 4rivs
<br />Rosevilfe nAN 55113
<br />,, ..._- .
<br />� h10TICE QF CANCEE.I.ATION;
<br />ShouEd any of the abave desaibed paltde� 6e eancelted pefore the s�iradon date theraoi,
<br />aoNcs vAll be delnrered In axar�ance with tha pa�c� provisions,
<br />AUTHORIZED REFRESENTATlVE:
<br />,.,._....,_.�_.,,..._ .,,_,..._...._.�,__ . N__.._.�__,,. _ _..., . �._�.._.._.___
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