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10451 Gulf Boulevard, Treasure Island, Florida 33706-4814 <br />CERTIFICATE OF COVERAGE <br />CERTIFICATE NO: NGC 2917 -00 <br />This document forms a part of Master Commercial General Liability Policy Number GGL01001 issued to <br />NATIONAL SKEET SHOOTING ASSOCIATION & NATIONAL <br />SPORTING CLAYS ASSOCIATION (NSSA-NSCA) <br />ADDITIONAL INSURED/ MEMBERCLUB AGENT: <br />LOST PAIR RANCH, LLC Sportsman's Insurance Agency, Inc. <br />P.O. BOX 814 1364 North US 1, Suite 503 <br />SOUTH CLE ELUM WA 98943-0814 Ormond Beach, FL 32174 <br />www.siai.net <br />POLICY PERIOD FROM 3/25/2018 TO 3/25/2019 1-800-925-7767 <br />12:01 AM Standard Time at the address of the Insured Agent Number: SPORTM <br />LIMITS OF INSURANCE <br />General Aggregate Limit (Other than Products -Completed Operations) NONE <br />Products -Completed Operations Aggregate Limit $1,000,000 <br />Personal and Advertising Injury Limit $1,000,000 <br />Each Occurrence Limit $1,000,000 <br />Damage to Premises Rented to You Limit .$ 100,000 Any One Premises <br />Medical Expense Limit $ 10.000 Any One Person <br />Total Commercial General Liability Premium $550,00 <br />Minimum Earned Commercial General Liability Premium $550 <br />ADDITIONAL OPTIONAL COVERAGES - <br />— Hired Auto and Non -Owned Auto Liability and/or Liquor Liability Coverage Occurrence Form ' <br />If fig, l w and a prie(J,_ <br />Hired / Nonowned Autos only - Per Endorsement form GGL99.003 1001 <br />X - Hired Auto and Non -Owned Auto Liability NOT Selected <br />$185.00 <br />Liquor Liability Coverage - Occurrence Form - $1,000,000 Each Common Cause; $1,000,000 Aggregate - Per Form CGO033 1001 <br />X - Liquor Liability Coverage NOT Selected <br />It is hereby understood and agreed that the above additional optional coverages are excluded and do <br />not apply to any excess liability coverages if excess general liablity is purchased. <br />_ POLICY FORMS AND ENDORSEMENTS ATTACHED ip IME MAS ELR POfJCY <br />GGL99.001 1001; GGL99.001E 1001; CL175 0286; CG0001 1001; IL0168 0101; IL0021 0498; CG2646 0499; CG2639 <br />0499; NSSAGC1 0402; NSSAGC2 0402; CG2011 0196; IL0017 1198; CG2002 1185; CG2026 1185; CGO033 1001; <br />CGO103 1000; CG3107 0200 & CGO057 0999; GGL99.003 1001 <br />OPTIONAL EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE <br />_ _ if selected bsjs�►tvv_�sl�.A�mitlm-i-s.-ir�clf�ated� <br />Excess Liability - Excess General Liability applies separately to the above listed member providing a limit of coverage NOT Selected <br />in excess of the limits of the Master Policy, subject to an annual aggregate limit of coverage NOT Selected <br />X - Excess Coverage NOT Selected <br />March 28, 2018 <br />Date <br />Total Premium, subject to audit $735.00 <br />AdthorizedSignature <br />SHOULD THE ABOVE DESCRIBED POLICY BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE MASTER POLICY PROVISIONS. <br />FMPNSSAGC 072013 <br />Page 1 of 1 <br />