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CERTIFICAT� OF INSURANCE 12-30-03 Tlus is issued as a matter of information only and confers no cer�ificate does aot amend, extend or alter the covcrages affo s upon the certificate holder. This by the policy below. Tlus is to certify that the policy of insuraace listed below has been issued to the insured r�xmed below for the policy period indicated, notwithstanding any requirement, term or condition of any contract or other dc�cument with respect to which this�certificate may be issued or may pertain, the inc,��nce afforded by t�i� policy described herein is subject to a11 the terms, exclusions and conditions of such policy. I�isured: • Producer: iJSA WATER SKI �ND ITS MEMBER CiUBS, COACHES E1ND OFFICIALS 1Z51 HOLY COW ROAD �'OLK CITY, FL 33868 � Sullivan & Strauss Agency,Inc. One Hollow La.ne Lake Success, NY 11042 Tel: 800-225-6560 Fax:516-365-3615 Pc�Iicy #: D064L00819 Effective Date: January 1, 2004 Ins. Co.: U.S. Fidelity & Guaranty Expiration Date: January 1, 20Q5 1 YPE 4F INSURANCE LiMITS (in thousands) (:ommercial General Liability General Aggregate $ 5,000 (Occurrence Form) Each Occurrence $ 1,000 �'roducts/Completed Ops � Aggregate $ 1,000 ��ire Damage Lega1 Liability Any one fire $ 50 Yarticipant Legal Liability � Included REMARKS: 7Ch.e Certificate Holder is only an Additional Insured with respect to liability caused by the zlegligent acts or omissions of the Named Insured. OWNED WATERCRAFT I.IABILITY EXCLUDED {;emificate Holder. CANCELLATION AddihOIIal InS1u'ed 410 -00012 � 5hould� th� above �olicy be cancelled before the datc of expu�attoa, the issuing company will ��LL CI.UBS AFFILIATED WITH USA r,nd�avor to mail 30 days written notice to the ��I'ATERSKI ASSOCIATION & AMERICAN WATER SI{bamed certificate holder, but failure to cnail such A�SOCIATION. notice shall impose ao obli�ation or liability of any 00000 kind upon the compaay, its agcnts or representarivts. Authorized Represeatative: r • _'' � � � � N�1�