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Ir -.II !S�;; u F --Z.. . r.11 C-- Il_ <br />10451 Gulf Boulevard, Treasure Island, Florida 33708-4814 <br />CERTIFICATE OF COVERAGE <br />CERTIFICATE NO: NGC 2917 -01 <br />This document forms a part of Master Commercial General Liability Policy Number GGLO1001 issued to <br />NATIONAL. SKEET SHOOTING ASSOCIATION & NATIONAL. <br />SNORTING CLAYS ASSOCIATION (NSSA-NSCA) <br />ADDITIONAL INSURED/ MEMBERCLUB <br />LOST PAIR RANCH, LLC <br />P.O. BOX 814 <br />SOUTH CLE SLUM VITA 98943-0814 <br />POLICY PERIOD FROM 3/25/2019 TO 3/2512020 <br />12.01 AM Standard Time at the address of the Insured <br />AGENT. <br />Sportsman's Insurance Agency, Inc. <br />1364 North US 1, Suite 503 <br />Ormond Beach, FL 32174 <br />www.siai.net <br />1-800-925-7767 <br />Agent Number: SPORTM <br />LI . <br />_OF INS. . NQE <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 S 10,000 Any One Person <br />Total Commercial General Liability Premium $590.00 <br />Minimum Earned Commercial General Liability Premium $550 <br />ADIDITIONAL OPTIONAL COVERAGES - I <br />Hired Auto and Non -Owned Auto Liability and/or Liquor Liability Coverage Occurrence Form <br />If"ileckd.betnw arld a premium Is indl at@d. _ <br />Hired / Nonowned Autos only - Per Endorsement form GGL99.003 1001 <br />X - Hired Auto and Non -Owned Auto Liability Selected with a Fully Earned Premium of $185.00 <br />Liquor Liability Coverage - Occurrence Form - $1,000,000 Each Common Cause; $1,000,000 Aggregate - Per Form CGO033 1001 <br />X - Liquor Liability Coverage NOT Selected <br />It is hereby understood and agreed that the above additional optional coverages are excluded and do <br />not apply to any excess liability coverages if excess general l'lablity is purchased. <br />POLICY FORMS ANDEN QRSEMENT$ TT N 1_Q THE T <br />GGL99 001 1001; GGL99.001 E 1001; CL175 0286; C00001 1001; I L0168 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 & C00057 0999; GGL99.003 1001 <br />OPTIONAL EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE <br />If sal�ctsd_Iow ani �Rtum_I;ndtilid� <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 20, 2019 <br />Date <br />Total Premium, subject to audit $775.00 <br />',7 h z <br />A thoriz ignature <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 Paqe 1 of 1 <br />