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A4C" 6r -- CERTIFICATE OF LIABILITY INSURANCE DATE(MM1DDIYWY) 1 08t18/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCEFt, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Pettineo Insurance 2428 E COMMERCIAL BLVD CONTACT NAME: PAICNyo Ext : (954) 493-9424 F� Nol: FT LAUDERDALE, FL 333084040 E-MAIL ADDRESS: frank@pettineo-Com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: United States Fire Insurance 21113 GENERAL LIABILITY INSURED SPORTS AND RECREATION PROVIDERS ASSOCIATION (PURCHASING GROUP) AND ITS PARTICIPATING MEMBERS: INSURER B : INSURER C: Eagle Eye Officiating, LLC. INSURER D: 9160 NW 25th Street Sunrise, FL 33322 INSURER E $3M,000 INSURER F : COVERAGES CERTIFICATE NUMBER: USP360010 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO !lUFiICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE ADDL INSR SUER WVD POLICY NUMBER POLICY EFF MMJoo POLICY EXP MMI$ LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 FIRE DAMAGE (Any one fire) $3M,000 X COMMERCIAL GENERAL LMILITY MED EXP (Any one person) $0 CLAIMS -MADE M OCCUR A X SRPGAPML-101-0122 12:002022 12:00 AM 0 2:01 M 12:01 AM PERSONAL & ADV INJURY $1,000.000 X INCLUDES ATHLETIC PARTICIPANTS GENERAL AGGREGATE $2,000,000 GEWL AGGREGATE LIMITAPPLIES PER: PRODUCTS -COMPIOP AGG $2,000,000 X POLICY ERCT LOC AUTOMOBILE LIABILITY COMBNED SINGLE LIMIT IFaccident BODILY INJURY (Per person) ANY AUTO ALL OVMED SCHEDULED BODILY INJURY (Per AUTOS AUTOS accidenQ HIREDAUTO NON-OVMED AUTOS PROPERTY DAMAGE Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE AGGREGATE EXCESS LIAB CLAIMS -MADE DED RETENTION S A Accident/Medical Coverage US1671099 08116/2022 12:00 AM 08/1612023 12:01 AM AD&D MAXIMUM MEDICAL DEDUCTIBLE $5,000 $10,0$0 $0 DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (Attach ACORD 104, Additional Remarks Schedule, if more space is required) Covered Activities: Athletic Officials Activities The Certificate Holder is added as an additional insured but only with respect to liability arising out of the named insured during the policy period. Scheduled Activities Exclusion Applies -Please Refer to Named Insured Member Certificate of Coverage CERTIFICATE HOLDER CANCELLATION City of Sunny Isles 18070 Collins ave Sunny Isles Beach, FL 33160 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016103) Q 1988-2016 ACORD CORPORATION. All rights reserved. TU_ A^^rbm •...w.....w.: 1........ wi At%^Mr%