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-- 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.
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