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AQS <br /> 9 CERTIFICATE OF INSURANCE ISSUE DATE(M Y <br /> 1134283 5/11/05 <br /> PRODUCE(/ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY <br /> K & K Insurance Group, Inc. AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> 1712 Magnavox Way CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE <br /> P.O. Box 2338 COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Fort Wayne, In 46801 <br /> COMPANIES AFFORDING COVERAGE <br /> INSURED COMPANY A <br /> LETTER NATIONWIDE LIFE INSURANCE COMP <br /> AMERICAN POWER BOAT ASSOCIATION <br /> 17640 E. NINE MILE RD COMPANY B <br /> P.O. BOX 377 LETTER GREAT AMERICAN ASSURANCE COMPA <br /> EASTPOINTE, MI 48021 COMPANY c <br /> LETTER <br /> COVERAGES <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY <br /> PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO <br /> WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO <br /> ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> CO. TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION <br /> LTR DATE (MdDD/YY) DATE (MvVDDYYY) LIMITS(in thousands) <br /> General Liability 12:01AM 12:01AM General Aggregate $ NONE <br /> B ©Commercial General Liability GL00 5 6 8 9 7 4 9 0 0 12/01/04 12/01/05 Products-Comp/Ops Aggregate $ 5000 <br /> ❑Claims Made®Occur. Personal&Advertising Injury $ 5000 <br /> ❑Owner's&contractors Prot. Each Occurrence $ 5000 <br /> I1110 000 ERRORS Fire Damage(Anyone fire) $ 300 <br /> & OMMISSIONS Medical Expense(Any one person) $ 5 <br /> Participant Legal Liability $ 5000 <br /> Automobile Liability Combined <br /> An auto Single <br /> ElY Limit $ <br /> ❑All owned autos Bodily <br /> ❑Scheduled autos Injury <br /> (per person) <br /> ❑Hired autos Bodily <br /> Non-owned autos (per accident) $ <br /> ❑Garage Liabilityon-owned Da <br /> Excess Liability Each <br /> ❑ Occurrence Aggregate <br /> ❑Other than Umbrella form $ $ <br /> Workers'Compensation Statutory <br /> and $ Each Accident <br /> Employers'Liability $ Disease-Policy Limit <br /> $ Disease-Each Employee <br /> 12:01AM 12:01AM AD&D $ 10 <br /> A Participant KPX0001067600 12/01/04 12/01/05 Primary Medical $ NONE <br /> Accident Excess Medical $ 20 <br /> Weekly Indemnity $ X NON] <br /> DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/RESTRICTIONS/SPECIAL ITEMS <br /> TYPE OF EVENT: SILVER LAKE REGATTA RICK SMITH MEMORIAL DATE 6/11/05 <br /> LOCATION: SILVER LAKE, EVERETT, WA (SEE ATTACHED ADDENDUM) <br /> P.A. COVERAGE: APBA MEMBERS SHOWN ABOVE; NON-MEMBERS 3, 000 AD&D/3,000 EX MED <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE <br /> SEATTLE OUTBOARD ASSOCIATION CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE <br /> HOWARD AND JAN SHAW ISSUING COMPANY WILL ENDEAVOR TO MAIL 3 0 DAYS <br /> 13530 CASCADIAN WAY WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO <br /> EVERETT, WA 98208 THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE <br /> NO OBLIGATION OR LIABILITY OF ANY KIN' UPON THE <br /> COMPANY,ITS AGENTS OR REPR TATIV <br /> 8 AUTHORQED REPRESENTATIVE <br /> r <br /> SL39 f-9 <br />