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r -l-t-f--I t{ e t-, R fi\l\tcE <br />CONlIP, 1.f{Y <br />10451 Gulf Boulevard, Trcasure lsland, Florida 337064814 <br />CERTIFICATE OF COVERAGE <br />CERTIFICATE NO: NGC 2917 -03 <br />This document forms a part of Master Commercial General Liabillty Policy Number GGL01001 issued to <br />NATIONAL SKEET SHOOTING ASSOCIATION & NATIONAL <br />SPoRTTNG CLAYS ASSOCTATTON (NSSA-NSCA) <br />ADDITIONAL INSUREDI MEMBER CLUB <br />LOST PAIR RANCH, LLC <br />P.O. BOX 814 <br />SOUTH CLE ELUM WA 98943.0814 <br />POLTCY pERtOD FROM 3t25t2021 TO 3t25t2022 <br />12:01 AM Standard Time at the address of the lnsured <br />AGENT: <br />Sportsman's lnsurance Agency, lnc. <br />1364 North US 1, Suite 503 <br />Ormond Beach, FL32174 <br />www.siai.net <br />1-800-925-7767 <br />Agent Number: SPORTM <br />GeneralAggregate Limit(Otherthan Products-Completed Operations) NONE <br />Products-Completed OperationsAggregate Limit $1,000,000 <br />Personal and Advertising lnjury 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 ,1p$00 Aly O!9 Person <br />Total Commercial General Liability Premium $550.00 <br />Minimum.Eamed 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 />Hired / Nonowned Autos only - Per Endorsement form GGLS9.003 1001 <br />X - Hired Auto and Non-Owned Auto Liability Selected wlth a Fully Earned Premium of $185.00 <br />Liquor Liability Coverage - Occunence Form - $1,000,000 Each Common Cause; $1,000,000 Aggregate - Per Form CG0033 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 liabillty coverages if excess general liablity ls purchased. <br />GG199.001 1001; GG199.001E 1001; C1175 0286; CG0001 1001; 110168 0101; 110021 0498; CG2646 0499; CG2639 <br />0499; NSSAGC1 04A2; NSSAGC2 0402; CG2011 0196; 110017 1198; CG20021185; CG2026 1185; CG0033 1001; <br />CG0103 1000; CG3107 0200 & CG0057 0999; GG199.003 1001 <br />EXCESS COMME IAL GENERAL <br />Excess Liability - Excess General Liability applies separatelyto the above listed member providing a limit of Coverage NOT Setected <br />in excess of the limits of the Master Policy, subject to an annual aggregate limit of Goverage NOT Selected <br />X - Excess Coverage NOT Selected <br />Total Premium, subiect to audit $735.00 <br />,/rr*/*o***-March 11,2021 <br />Date V Adthorizedsignature <br />SHOULD THE ABOVE DESCRIBED POLICY BE CANCELI FD BEFORE THE EXPIRATION DATE THEREOF, NOT]CE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE MASTER POLICY PROVISIONS. <br />FMPNSSAGC 072013 Pase 1 of1