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CERTIFiCATE OF INSURANCE
<br />AGENCY:
<br />EntertainmeRt & Sports Insurance eXperts (ESIX)
<br />5660 N'ew Northside Dtive, Suite 640
<br />Atlant&, Georgia 3Q328
<br />Phon.e:678-32A-3300 Fax:678-324-3303
<br />NAMEDINSURED:
<br />13uubdi nt ou 13
<br />o�r�:' �i5�zalo
<br />CERTIFICATE NUMBER: �20� 00105005739
<br />THiS CERTIFICATE IS ISSUED AS A MATTER O� SNFQRMA7IDN ON�Y AN� CON�ERS
<br />NO RIGHTS UPON THE C�RTIRCAT� MOLDER, THlS CERTIFIGATE DOES NOT
<br />Atv1ENp, EXTEN� OR ALiER THE COVERAGE AFFOR�ED BY THE POtICIES BELOW.
<br />INSURERS AFFORDING COVERAGE:
<br />USA Water Ski Lak� Owasso 5afe �oating Associatfon INSURER A: Philadelph.ia lr�demnity Ins. Co.
<br />1251 Holy Cow Road 460 W Horseshoe Dr �
<br />Polk City, �lorida 3386$ Shorevi.ew, Minnesofa 55126-3001 � INSURER B: Philade6phia lndemnity Ins. Co.
<br />� _ �J�
<br />PDLICYICOVERAGE INFORMATION:
<br />THE POUCIES OF INSURANCE LISiED BELOW HAVE $EEN ISSUE� TO THE INSURE� NAM.ED A80VE FQR THE POLICY PERI6fl INDiCATE�. NOT}MTHSTANDING ANY
<br />RE�UIhEMENT, TERM OR CONDI710N OF ANY CONTRACT OR QTHER �OCUMENT WITH RESPECi TO WI tICH THIS CERTlFICATE MAY B� ISSUE� OR MAY PERTAM, THE
<br />INSUf2ANCE AFFOR�E� 6Y THE pOLICIES DESCRI6E� HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUS?DNS AN� C6NOITIONS QF SUCH POLICIES. AGGREGATE LIMITS
<br />SHOWN MAY HAVE BEEN RE�UCED BY PAI� CLAIMS.
<br />IN5 TYPE OF IN.SURA.NC�: POLICY NUM6ER(S}: �I EFFECiIVE: ; EXPI:RES: ', LEMITS: �
<br />� _ _�____.__�___m___� �,��.,,__.._... � �.�
<br />� _ ,,,,..,, _,,,,,,,�__ .. �,_ .__.... _ w _ .,
<br />GA ENERAL LIABILITY
<br />X COMMERCIAL GENERAL � PHPiC509478
<br />LIABILITY m .m �
<br />�
<br />X dccurrenCe '
<br />� j
<br />X Particip�nt Legal Liability �
<br />B { UMBRELLAlEXCESS LIABiLITY
<br />X Occurrence
<br />X SIR
<br />111120�0 i1112�11
<br />........ ........ . . _ , _ . _ .. _
<br />PHUB293258 ,711120i0 111I20Y}
<br />GENERAL AGGREGATE {Applies Per E�eni)
<br />EACH OCCURRENCE
<br />DAMAGE i0 RENTED PREMISES (Each Occ.) �
<br />ME� EXP (Any one person)
<br />PERSONAL 8� ADV ENJUI�Y �
<br />PRODUCTS-COMPIOP A.GG
<br />AGGREGATE (Applies Per E�enij
<br />EACH dCCUf@RENCE ��
<br />RETENTIONI�EaI}CTI BLE
<br />$2, 60D, 000
<br />$1, 400, 000
<br />31,60D,000
<br />EXCLUDEi]
<br />$1,60D, 000
<br />$2,600,000
<br />$a,000,00a
<br />$4,000, 000
<br />$10; 000
<br />DESCRIPTION pF OPERATfONSlLOCATIONSIVEHICLESl�XGLUSlONS ADpEb BY END�RSEMENTlSP�GtAL PROVISIONS:
<br />The certificate holder is an Additivnal Insured wdh tespect to liebility arising out of the negligence af th:e Named Insured as per the folloiwng endorsement: Additional
<br />Insured - CerCificate Holders (Form PI-AM-002}.
<br />Co�erage only applies with respect to tournaments, pracilces, exh�bitfons, clinics and related acifvfties sanctioned' and approved by USA Water 5ki, Inc.
<br />CERTEFICATE HOLDER:
<br />City of Roseviile
<br />2660 CiviC Center Drive
<br />Raseville. Minnesota 551 i3
<br />NOTICE OF CANCELLATION:
<br />SHOUL� ANY OF THE ABOVE DESCRIBED P4LICI�S 8E CANCELLED 6EFORE iHE
<br />EXPIRATIQN �ATE THEREOF, THE INSUR�R WILL ENDEAVOR i0 MAIL 30 DAYS
<br />WRITTEN NOTIC� TO THE CEFi71FICATE HOLQER NAME� TO TFiE LEFT, BUT
<br />FAILURE TO DO SO SHALL IMPOS� NO OBLIGAiION QR LIABILIN OF ANY KIN�
<br />UPON THE INSURER, ITS AGEN7S OR F2EPRESENTATIVES.
<br />AUTH�RIZED REPRESENTATIVE:
<br />f
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