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6Copy - Vpi.3 . <br /> AMERICAN POWER BOAT ASSOCIATION ZOO 41 <br /> CERTIFICATE OF INSURANCE - <br /> w'1 t 1)(Lc ui D ur DerrE cops plion <br /> ERTIFICATEHOLDER FtJt/al J! .702 Z:7—S— — <br /> ity of Everett <br /> 'RODUCERS INSURED <br /> ,merican Specialty Insurance Services,Inc. American Power Boat Association <br /> 42 North Main Street 17640 E.Nine Mile Road,P.O.Box 377 <br /> toanoke.IN 46783 Eastpointe,MI 48021 <br /> COMPANIES AFFORDING COVERAGE <br /> [his Certificate is issued as a matter of information only and COMPANY A United States Fidelity and Guaranty Company <br /> ;onfers no rights upon the certificateholder. This certificate does <br /> iot amend, extend, or alter the coverage afforded by the policy COMPANY B Life Insurance Company of North America <br /> aelow_ <br /> OVERAGES-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 <br /> NITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. <br /> rHE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE-TERMS,EXCLUSIONS ANO CONDmONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN <br /> REDUCED BY PAID CLAIMS. <br /> CO TYPE OF INSURANCE POLICY NUMBER POLICY POLICY <br /> LTR EFF.DATE EXP.DATE LIMITS <br /> A Commercial D064L00778 12/01/03 12/01/04 Products-Completed Operations Aggregate $2,000,000 <br /> General Liability 12:01 A.M. 12:01 A.M. <br /> General Aggregate Limit-Per Event $2,000,000 <br /> Personal&Advertising Injury $1,000,000 <br /> Each Occurrence $1,000,000 <br /> Participant Legal Liability Included <br /> Unintentional Errors&Omissions $50,000 <br /> Property Damage Legal Liability $200,000 <br /> Damage to Premises Rented to You(Any One $300,000 <br /> Premises) <br /> Non-Owned Aircraft Liability Legal Expense $50,000 <br /> Participant Property Physical Damage $50,000 <br /> B Participant PAR 600017 12/01/03 12/01/04 American Power Boat Association Members <br /> Accident 12:01 AM. 12:01 A.M. All Categories of Racing <br /> Accidental Death&Dismemberment $10,000 <br /> Excess Accident Medical $20,000 <br /> Deductible-$250.00 <br /> Non American Power Boat Association <br /> Members <br /> Accidental Death 8 Dismemberment $0 <br /> Excess Accident Medical $1,000 <br /> ADDITIONAL INFORMATION/RESTRICTIONS/SPECIAL ITEMS LIQUOR LIABILITY IS EXCLUDED <br /> The certificateholder is an insured with respect to Endorsement AG 2017 12 98-American Power Boat Association,but only with respect to losses resulting from the Rick <br /> Smith Memorial Regatta event to be held on June 12,2004. <br /> Event Site: Everett,WA-Silver Lake Set Up Date: June 11,2004 Tear Down Date: June 13,2004 <br /> CANCELLATION-SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL <br /> ENDEAVOR TO MAIL 30 DAYS'WRITTEN NOTICE TO THE CERTIFICATEHOLDER,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY <br /> OF ANY KIND UPON THE COMPANY.ITS AGENTS OR REPRESENTATIVES. <br /> • <br /> I, . . <br /> Certificate Number: APBA-04-PB-029A <br /> Date Issued: May 11,2004 David A.Harris <br /> Authorized Representative <br />