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k AXIS68000(08/ 10) CERTIFICATE OF INSURANCE 06/67/2013 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIOMONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY American Specialty Insurance & Risk Services, Inc . OR NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES 142 North Main Street BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND Roanoke, Indiana 46783 THE CERTIFICATE HOLDER, INSURED INSURERS AFFORDING COVERAGE Special Olympics, Inc. , All Special Olympics Accredited U .S . Programs INS. A: Philadelphia Indemnity Insurance Company 1133 19th Street NW INS . B : Washington , DC 20036 INS , C : SPECIAL OLYMPICS FLORIDA 1915 DON WICKHAM DRIVE CLERMONT, FL 34711 t CERT NUMBER: 1001104344 a 1 COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOT WITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ INS POLICY POLICY POLICY LTR TYPE POLICY NUMBER EFFECTIVE EXPIRATION LIMITS Each Occurrence 11000,000 GL PHPK947621 12/31 /2012 12/31 /2013 Personal and Advertising Injury 11000 ,000 , A General Aggregate 5 ,000 ,000 12: 01 a .m . 12:01 a .m . Products-Completed Operations A re ate 1 ,000 000 Damaae to Premises Rented to You (Any One Premises 1 000 000 Medical Expense Limit (Any One Person Excluded Non-Owned/Hired 'Auto Liability* . 1 V000 =0 AUTO PHPK947621 12/31 /2012 12/31 /2013 A 12:01 a . m . 12: 01 a.m . z x. DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS The Hired Auto Physical Damage limit contains a $1 ,000 collision deductible and a $100 other than collision deductible (for commercially rented vehicles only). Nonowned and Hired Auto (NOHA) liability is excess of any valid and collectible insurance. The Certificateholder is only an Additional Insured with respect to liability caused by the negligence of the Named Insured as per Form PI-AM-002-Additional Insured-Certificateholders, as respects to the SPECIAL OLYMPICS FLORIDA, STATE AQUATICS TOURNAMENT AT NORTH COUNTY AQUATICS CENTER from October 05, 2013 through October 06, 2013. Coverage for property you rent or occupy, property loaned to you and property In the care, custody, or control of the Insured , $100,000 limit subject to a $2 ,500 deductible per loss, excluding watercraft, aircraft, and autos. > i CERTIFICATE HOLDER CANCELLATION 4 INDIAN RIVER COUNTY SHOULD ANY OF THE ABOVE DESCRIBED POLICIE ATTN : DAVE SMITH BE CANCELLED BEFORE THE EXPIRATION DATE ->r NORTH COUNTY AQUATICS CENTER THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. - 9450 95TH STREET VL VERO BEACH , FL 32960 r� AUTHORIZED REPRESENTATIVE r - - - - - - - - - - - - --