Certificate of Insurance
ACORDTI,
CERTIFICATE OF LIABILITY INSURANCE
<w'~.
PRo.DUCER
HAWK RACE CONSULTANTS, L TD,
MOTOR SPORTS INSURANCE
111 GREAT NECK RD, SUITE #317
GREAT NECK, NY 11021
DATE (MM/DD/YYYY)
05/01/2003
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
516-466-9760
APBA OFFSHORE POWER BOAT RACING, LLC
100 2ND AVE SOUTH SUITE #704S
ST. PETERSBURG, FL. 33701
I
_~__ _ ___iJNSURERS AFF~~DI~~~\'I:~~~ _ __
!'NSURERA NATIONWIDE LIFE INSURANCE COMPANY
LINSURER B: COMBINED SPECIAL TV INS, _ ____ __
I'NSURERC: _____________
' INSURER 0:
NAIC#
AMB:Q6~12
A~:18588
INSURED
INSURER E:
._--~---~-~._----_._._-
COVERAGES
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 WHICH THIS CERTIFICATE MAY BE ISSUED OR
MA Y PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
'~,s: ADD'L - - - --------~--r Po.LICYNUMBER ! Po.LICYEFFECTlVE -Po.LlCYEXPIRATim,f-
B
GENERAL LIABILITY
X Co.MMERCIAl GENERAL LIABILITY I KSP-0001047300
---t-- i"-
1_ CLAIMS MADE !-XJ o.CCUR I
X. ERROR& OMISSIONS
'.x! ~fo(o.I&QQ-hiMfT -
12:01 AM
5-19-03
12:01 AM
5-15-03
- I
GEN'l AGGREGATE LIMIT APPLIES PER: 1
PRO.,
PDlICY'
lDC
AUTo.Mo.BllE LIABILITY
ANY AUTO.
All DWNED AUTo.S
SCHEDULED AUTo.S
, HIRED AUTo.S
No.N,o.WNED AUTDS
GARAGE LIABILITY
i ANY AUTO.
I
APP
BY
DATE
- -----.--------------
EXCESS/UMBRELLA LIABILITY
DCCUR '--, CLAIMS MADE
DEDUCTIBLE
RETENTlDN
Wo.RKERS Co.MPENSATlo.N AND
, EMPLo.YERS' LIABILITY
I ANY PRo.PRIETo.R/PARTNER/EXECUTlVE
o.FFICER/MEMBER EXCLUDED?
; If yes. describe under
SPECIAL PRDVISIDNS below
DTHER
A PARTICIPANT
ACCIDENT
KPX-0000136300
12:01 AM
5-15-03
12:01 AM
5-19-03
LIMITS
EACH OCCURRENCE $
DA1iI-mmREi'lTED
PREMISES(Ea oeeurenee) $
MED EXP (Anyone person) $
5,000,000,
300,000,
5,000.
5,000,000,
NONE
5,000,000,
PERSDNAl & ADV INJURY
1- - - _
I GENERAL AGGREGA TE
$
,$
1-"'~O.QlJ<:TS, CDMP/OP AGG $
1
CDMBINED SINGLE LIMIT
(Ea accident)
BODll Y INJURY
(Per person)
BDDll Y INJURY
(Per accident)
i$
PRDPERTY DAMAGE
(Per accident)
1
1$
I AUTDOr-IL"-'I:AA~I[)~Nr..._p
, o.THER THANE~A.c:C ,$
! AUTO. DNl y, AGG : $
I EACH DCCURRENCE
AGGREGA TE
$
$
, $
$
WC STATU, 'DTH,
c. TQRYlJMITS ER
, E.l. EACH ACCIDENT
~~J'~~~ -' E,4 EOMPlDYE E ; $
EL DISEASE, PDlICY LIMIT $
DESCRIPTlo.N o.F o.PERATlDNS / Lo.CATlo.NS / VEHICLES / EXCLUSIDNSADDED BY ENDDRSEMENT / SPECIAL PRo.VISlo.NS
TYPE OF EVENT: US ARMED FORCES DAY APBA MARATHON OFFSHORE GRAND PRIX LOCATION: GULF OF MEXICO, MARATHON, FL.
I
! AD & 0: $10,000.
EXCESS MEDICAL: $20,000. $500. OED.
SHDULD ANY o.F THE ABo.VE DESCRIBED Po.LICIES BE CANCELLED BEFo.RE THE EXPIRATlDN
DATE THEREDF, THE ISSUING INSURER WILL ENDEAVDR TO. MAIL ~ DAYS WRITTEN
MONROE COUNTY BOARD OF COMMISSIONERS NDTlCE TO. THE CERTIFICATE Ho.LDER NAMED TO. THE LEFT, BUT FAILURE TO. DO. So. SHALL
1100 SIMONTON STREET IMPo.SE NO. DBlIGATlo.N DR LIABILITY o.F ANY KIND UPON THE INSURER, ITS AGENTS DR
KEY WET, FL. 33040 REPRESENTATIVES,
AUTHo.RIZED REPRESENTATIVE I d i.JI, ._
RH Felsen ;J:I'I . "0-"
" .(
ADDL. INSUREDS: MONROE COUNTY BOARD OF COMMISSIONERS
CERTIFICATE HOLDER
CANCELLATION
ACORD 25 (2001108)
/
~C:~
, ACORD CORPORATION 1988