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1 <br /> <br /> <br />l <br /> <br />( 1 <br /> <br />Proof of Insurance <br /> <br />rl <br /> <br />~ <br /> <br />OP 10' MIA <br /> <br />r I <br /> <br />ACOUO CERTIFICA TE OF LIABILITY INSURANCE I l>AtlIWW.'()():'YYYV) <br />100----- 08/23/11 <br />fHIS CERTIFICATE IS ISSUED AS A MATTER OF ItfFORMATION ONLY AND CONFERS NO RIGHTS UPON TIlE CERTIFICATlO HO~DER, nus <br />CERTIFICATE OOES NOT AFFIRMATIVELY OR NEGATIVE~V AMEND, EXTEND OR A~TER THE COVERAGE AFFORDED !IV TIlE POLICIES <br />BELOW, Tlil$ CERTIFICATE OF INSURANCE OOES NOT CONSTITUTE A CONTRACT !IE TWEEN THE ISSUING IIISURER(S), AUTHORIZEO <br />REPRESENTATIVE OR PROOUCER, AND THE CERTIFICATE HOLDER, <br />IMPORTANT; If th~ ,,,rtmelllo hOld., Is all ADDlTIONAL ItISUREO, tho polleyllos) mUSIl>e "lId.,r<c-d. " SUllROGA TION IS WAIVEO, sub]"c! 10 <br />ltlu t(lrm5 and condi1ion$. of tho policy. eOft..)ln pc.ticlM m;ty roqulro an c-ndorSiOlYll!!nt ^ atil'crne-n[ on this. c.(trtl.l~il1(t dOO'5 no, <:oof&1 rinhts to tho <br />~'tifieato holdo, in 1I0u 0/ .ueh ondo~monU.I, <br />PROOIJe._(Jt 305-9G1-1639i~_~~' <br />CLC Rink S......lc05, IlIe, -.. - '------,.0 - <br />26S~ S L" Jounn Rwd Sulto 90<1 305~176-0556 ~~.""'_ ~-_. - INC,I.j,(of_ <br />Co,., G~bl~. F L 33134 .WAll. <br /> AOD~f:S.1-. <br />MOlluol Rulz ~~~~~~,~., CSA 8..012 - . - - <br /> - - 1~56 ;;c_' <br />- - , -- .. - IN!.UltfJ:lt!lil /.r rc...mOtG COY[RV.J:E -- <br />Ih:5U~rn CSA tioldings. 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PEHIOO <br />INCXO\1El) tlOTWITHSTI,NO<"G ANY R[OtJtP.[I.'ENT, TEFllJ O'l CONC'TION Of ANY CONTIQ\CT CR OT~eR r>O~IJM[NT 'MIll R[SP~CI TO WHICH HUS <br />CERTIH(',.4TE ....Ay BE ISSUED on \,rAY PERTA',L.J TH[ i..JSURM~C( ;.Ff:ORct:O R't' lHE P(lt.ICltS orSCRIO(l) Hf.AEIN 'S sUB..'Eel TO All ni~ Tcnus <br />OCI.U$IONS AW) CONDI noriS OF SIJCH P'OUCJlS U'/IT S SHOWN ";','" I-fA'v'E flFru R"EOIJCCO By PAlO ClA'Q.\S <br />- - .-- - - -. <br />t(,~:' h'P[ {)fIlf'lI'1.lJtf....NCf ;~.;i.~~or I)OL~ MJWnUl l:c.l.olC~'J~;~;.J..~':tl:,,~~J L1t1rT$ <br />J dtNlMJ\1. Lwuun , [h(H <:('C~R~N-tf .-.!. <br />A X con..~v.l (.{_t.f~j... LIAUHllv 6JO.236GC03A 12JJ1110 12/31/11! ~~~J~':~~~J ! S <br />ClI...t.'.SIo\.Il.If X! t.X:Clft4 I I 1 ~I-!OD:I";-,a-..;:'~l __-1-'.- <br />i-x: Contt!1eI1l~1 L1ab: -, __ 1'';-;''0'''''' .;;, "JJIlY $ _ <br />X V:tIU3bloPilp~ _. 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CLI,t.lS-~..,l,(,tt <br />'-- ! OEO..,CftfnE -,' <br />X 'II If.."'.... I 10,000 <br />WC<<'1(r:A$ CO'ofPt~u.no." <br />10"0 I[N.l'tO"'r:AS'lIA~UTl' T r 'I <br />B J ,....j)' ,,".;::~tfT::F-4>APr..H~l!:..i.fCLI 'It. n T <br />t~~i';;~~~~ E~L~lC" L.J ~ .~ .. A <br /> <br />I ~/~~:::~tl ~':''W(R?o.r.o'''i t~M <br />C Pr%n;QIlal L1ob, I <br />,00>0, S5O,000 <br /> <br />QK06803547 <br /> <br />12/31110 <br /> <br />12/31/11 <br /> <br />(....~,~ o.f('\iF;.AUo'l:E <br />A.(iGRr(l.^Tf <br /> <br />, <br />--~- <br />I <br /> <br />10,000.00 <br />lO,OOO,OOC <br /> <br />, I <br /> <br />,UB.23G6C03-A <br /> <br />i <br />I 17131110 <br /> <br />, <br />X j lW l;J~t;;l--1<rlti <br />I l (.4::UACCIXNT _, I <br />I ~ m.s.r AS[ fA [lJPtO'.u. . <br />r . -- ---., <br />11 'U~"'s.f. P'Ct..::-....L".t,T!' <br />07121112 Por Claim <br />IAggrooalo <br /> <br />12131111 <br /> <br />1,OOO,Ol>C <br />1,000,0/)1 <br />1,000,OOi <br />s.ooo,oo <br />s,OOQ,ao <br /> <br />EO 2'17 <br /> <br />07/21111 <br /> <br />CSACENTRArINC~~l~ArON~;~ED'~S'UREDUND[~ ~LtpOLiCiE9S~LiSTEO ABOVE." rHJ"~J <br /> <br />CERTIFICATE HOLDER <br /> <br />CANCELLATION <br /> <br />SPECIME <br /> SHOULD mv OF THE ABOVF. OfSCRiBf.D J>OUCIES DE CANCELlED BEfORE <br />SPECIMEN CERTIFICATE THE EAPIRA nON DATE tHI!.RI:.OF. NOnCE YtllL BE OHWE 11ft) IN <br />ACCOlmMiCE \'iITH THE POLICY P'ROVIS.!ONS <br />FOR ILLUSTRATlml PURPOSES ONLY <br /> 'U'Ho"".o~tr",.n'~ <br /> Manuol Rul2 ~ ...... - <br /> <br />ACORD 25 (2009i09) <br /> <br />~ 1988.2009 ACORD CORPORATION, All ,lgh15 ro>.."'od_ <br />Tho ACORD nom" ~nd I<>go ~ro '"gl:tlomd marks ot ACORD <br /> <br />