ࡱ> ]`\_ bjbj,E,E ?LN/N/ ..~~~84 .]q }       $!7$2 ~;"]2 ..KG L.8~  f0ju (] 0 $2<$$~x%r\2 2 n $ :  CERTIFICATE OF INSURANCE REQUEST FORM Please return the completed form to Rebecca Charette at  HYPERLINK "mailto:comm@odha.com" comm@odha.com or (613) 224-6079 within 72 hours of the event.FIELDS WITH AN ASTERISK MUST BE FILLED IN AT ALL TIME Please allow 7-10 business days for processing. * This is to certify to: (Name of the organization requesting a proof of insurance)* Address: Name of Insured: HOCKEY CANADA 801 King Edward Avenue, N204, Ottawa ON K1N 6N5 Name of Insured: OTTAWA DISTRICT HOCKEY ASSOCIATION 1247 Kilborn Place, Suite D300, Ottawa ON K1H 6K9 * Name of Team / Association:Name of Contact:Phone Number:E-mail:*Description of Event(s):* Location of the event(s): (name and address)* Date(s): Type of insuranceInsurerPolicy N(Policy period* Limit of Insurance (canadian funds)Commercial Liability InsuranceChartis Insurance company of Canada0511578September 1st, 2010 to September 1st, 2011$2,000,000 General Liability Insurance ____ # of days for cancellation notice (if required) Please include a copy of your lease agreement. FORMCHECKBOX  Please check if a copy if the lease agreement is attached  FORMCHECKBOX  Please check if additional list attached * ADDITIONAL INSURED:1.4.2.5.3.6. THE ABOVE ENTITIES WILL BE ADDED TO THE POLICY AS ADDITIONAL INSURED BUT ONLY WITH RESPECT TO THE OPERATIONS OF THE NAMED INSURED DESCRIBED ABOVE. THE CERTIFICATE APPLIES TO THE MEMBERS AND AUTHORIZED PERSONNEL OF THE INSURED WHILE OPERATING WITHIN THE SCOPE OF THEIR DUTIES AND APPLIES ONLY TO THE DATES OF THE EVENT AS MENTIONED ABOVE. This certificate has been approved by: Branch Executive Director or representative      '()ab, ǹrereXePHhmH sH h*mH sH h445CJaJmH sH h?5CJaJmH sH h$Nh?5CJaJmH sH h*hz}mH sH h*h^mH sH hz}mH sH hth^0JmH sH jh^UmH sH h^mH sH  h*CJ'h*h.56CJ\]mHnHuh.6B*CJ ]ph-jh*6B*CJ U]mHnHphu)- F $Ifgdb<kd$$IfF,,4 Fayt* $$Ifa$gd^$ $Ifa$gd*$ $Ifa$gd. , - / E F S Z _    E I P Q R Ϭެzrf]fRGhb hVmH sH hb hbmH sH hb \mH sH hb hb\mH sH hbmH sH h(bhbmH sH h(bhb5\mH sH hmH sH hz}mH sH hz}5mH sH h?mH sH h+bCJaJmH sH h$Nh+bCJaJmH sH h$Nh?CJaJmH sH h$Nh?5mH sH h?5mH sH hz}56CJmH sH   $IfgdbvkdT$$Ifl0@ , f!04 laytb  $Ifgdbvkd$$Ifl^0@ , f!04 laytb  Q R p q |ss $IfgdbgdVgdbvkd$$Ifl^0@ , f!04 laytb R T p r u        & ' ( 5 6 [ ] ⺯⯥⯚␂uh.|h?CJmH sH h.|h?CJH*mH sH h?CJmH sH h.|h?mH sH  jh?5:h?5:mH sH hz}mH sH h~.h?mH sH ht(h?mH sH h?CJ mH sH h?mH sH h$Nh?5mH sH h?5mH sH *q r s t  $Ifgdbvkd$$Ifl;0 ,l  0-4 laytbt u  $Ifgdbvkd;$$Ifl0 ,l  0-4 laytb d[[[[ $Ifgdbkd$$Ifl\ x&",l x 0-4 laytb d[R $Ifgd^ $Ifgdbkd$$Ifl\ x&",`  0-4 laytb $Ifgdbtkd$$Ifl0 ,`  0-4 laytb t $If^gdb $Ifgdbtkd{$$Ifl0 ,`  0-4 laytb $Ifgdbtkd$$Ifl0 ,`  0-4 laytb   $Ifgdbtkd$$Ifl0 ,`  0-4 laytb     ( 6 \ ||||| $$Ifa$gdbtkd$$Ifl0 ,`  0-4 laytb\ ] | VJJJJJJ $$Ifa$gdbkd? $$IfF      r\ .,     0      4 FaFytb  4 5 6 d e f t u v ׬q_qqMqAqh?CJaJmH sH #j h)h?CJUaJ#j h)h?CJUaJh)h?CJaJmH sH jh)h?CJUaJh)h?CJmH sH h)h?5CJaJmH sH hz}CJmH sH h?CJmH sH hh?CJmH sH h?CJmH sH h?mH sH hh7h?mH sH hh7hmH sH h)h?mH sH   #$If^`#gdb $If^`gdb h$If^h`gdb 4 TK5 ZZ0$If^Z`0gdb $Ifgdbkd $$IfF    r\ .,0    4 FaFytb4 5 6 e |ss $Ifgdb $$Ifa$gdb$a$rkd $$IfF    0,      0    4 FaFytb         " # $ vxyĶ{qi^TJ@ih*CJmH sH hz}CJmH sH h?CJmH sH hrYhz}mH sH hz}mH sH hz}CJmH sH h$Nh?5CJaJmH sH "h$Nh?5:CJaJmH sH h?5:mH sH h)h?5:CJaJh)h?5CJmH sH h)h?56CJmH sH h?56CJmH sH h?mH sH h?CJmH sH h?5:CJmH sH   zq $Ifgdbkd~ $$IfF420,    0,4 FaFf4pytb    $Ifgdb $$Ifa$gdbfkds $$IfF4w,,  0,4 FaFf4ytb      _SJSJ $Ifgdb $$Ifa$gdbkd'$$IfF4\,   0,4 FaFf4ytb    ! " _SJSJ $Ifgdb $$Ifa$gdbkdu$$IfF4\,   0,4 FaFf4ytb" # $ w_VV $Ifgdbkd$$IfF4\,       0,4 FaFf4ytbwxy.`kd$$IfFt"V04 Fad $IfgdrY$a$akd$$IfF,,    0,4 FaFytbgd gdr$a$gdVhz}mH sH h h hjhUhw jhw U = 0P &P/R :pF/ =!"#$% R$$If!vh#v,:V F5,44 Fyt*$$If!vh#v #vf!:V l0,,5 5f!/ 4aytb$$If!vh#v #vf!:V l^0,,5 5f!/ /  / 4aytb$$If!vh#v #vf!:V l^0,,5 5f!/ /  4aytb$$If!vh#vl #v :V l;0-,5l 5 / /  / 4ytb$$If!vh#vl #v :V l0-5l 5 / 4ytb$$If!vh#vl #vx#v#v :V l0-,5l 5x55 / / / / / / /  / 4ytb$$If!vh#v` #v#v#v :V l0-,5` 555 / / /  4ytb$$If!vh#v` #v :V l0-,5` 5 / /  / 4ytb$$If!vh#v` #v :V l0-,5` 5 / 4ytb$$If!vh#v` #v :V l0-,5` 5 / /  / 4ytb$$If!vh#v` #v :V l0-,5` 5 / / / 4ytb$$If!vh#v` #v :V l0-,5` 5 / /  / 4ytb$$IfF!vh#v#v#v#v:V F0      ,5555/  44 FaFytb$$IfF!vh#v#v#v#v:V F0    5555/ 44 FaFytb$$IfF!vh#v#v:V F0    ,55/  / /  / 44 FaFytbhDetDeCheck1$$IfF!vh#v#v:V F420,,55/  /  /  / 44 FaFf4pytb$$IfF!vh#v,:V F4w0,,5,/ /  44 FaFf4ytbL$$IfF!vh#v#v #v#v:V F40,,55 55/  /  / / / / / / / /  44 FaFf4ytb>$$IfF!vh#v#v #v#v:V F40,,55 55/  /  / / / / / / /  44 FaFf4ytbL$$IfF!vh#v#v #v#v:V F40,,55 55/  /  / /  / / / / /  /  44 FaFf4ytb$$IfF!vh#v,:V F0,5,/  44 FaFytb$$Ifd!vh#vV:V F05V44 FadDd99T  C "A ODHA"`b?(I6}-0?Cyˏt=u+n1onEW ĀБj:J@t-PoWQo<;BnP7a8v ζB섵 -yҜZ9։>9 mf|fC=!78%=A LU6GGJ;6ʀN#t@ bY,eSJ9q#ЧxъY cm6u-\(Qqq{~x/r5z/!| 8fwVEͩ3iO1E;콄iKOi>L[k&J6,8 b$c|U[w ^ +BehJ}$*ώܽ@Ps^bMv\8JCIl^|$)g(@-8& ~f$فs̀4(`HWyjxR꫹4[E,N }9w> jX_!!Mqi &M8{~QE-JiSD &s+3wqڬ9)\I5[w++wxXAUyyA1NT?]2ftε:B F<CDY@.9_ܬBAeq"|蝨` *HjsP` /PRtm!.*+T\;#w*(22NkDtC:6bj#=JT)<\1)bdV AC\uݐ%ZۨSR0(A's,Nt9!W>^ҁ/e0ZjӾo)-dS! A_H~;-0$带֝M-1fxu5=Z|U>~ eDY qUBg8z63q6jﶪ,N"-ktn|~]J9@jkH1$d 37߀C@F]u|0bL Ȟ[뷔K|χ.o\^ 0N't?pj7/oW._W!d:,ZzbiMT(?XZpK$ruI7OHf(FEb+G"A a”M;!ΗMnrm$Bh% #/%Jh>0O-\69VFn;wSVgˋ-CiqEVDdF B:H |kV#(D#"j}8P "'Pd[ԍI(`+`/a{?}JD+H p`pIV]1OWl,3Ё1= L*'ΎV`g֟lJc)@iR X8 X*[\m-E T'zG#l/c1wȞ"$\XA; U8}j31@ڢp<P[Y'j,[a,mߛ@4@h*@vJlR8=pW$JpǍ+'!Dr ®@G)pٴH:G@WOsMH'c.8vccowgj%]P`99VlPA8\[MzL;ԋ271m=NOO.,,,L-mlM4js.ZPc%>u BSglvnm͞a.UM2IfL*,#K\.S|\v{_y/6Gn^f8\~:EIk0߁ (H>ܵO]6Y.u{2,˃!$3d&+ɒ8C{elbF~ b =GmO]]0HF#%2<`FvwK 2%f_E C zd,LZ^EؒXFX85Ön&cQA pX¤#ȻwOakYo F1gW1p]*B*ph4 B4 rFooter  H$>oQ> r Footer CharOJQJmH sH PK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭V$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3N)cbJ uV4(Tn 7_?m-ٛ{UBwznʜ"Z xJZp; {/<P;,)''KQk5qpN8KGbe Sd̛\17 pa>SR! 3K4'+rzQ TTIIvt]Kc⫲K#v5+|D~O@%\w_nN[L9KqgVhn R!y+Un;*&/HrT >>\ t=.Tġ S; Z~!P9giCڧ!# B,;X=ۻ,I2UWV9$lk=Aj;{AP79|s*Y;̠[MCۿhf]o{oY=1kyVV5E8Vk+֜\80X4D)!!?*|fv u"xA@T_q64)kڬuV7 t '%;i9s9x,ڎ-45xd8?ǘd/Y|t &LILJ`& -Gt/PK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!0C)theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] L , R  % q t  \ 4    " w  !"#$aeuXG$G$8@(  h  C  #" `? B S  ? ,t@Check1 hrAhrAhrAhrAhrAhrAhrAhrAhrAhrAhrA?F  =EH ; *urn:schemas-microsoft-com:office:smarttagsaddress8*urn:schemas-microsoft-com:office:smarttagsCity9 *urn:schemas-microsoft-com:office:smarttagsplaceB *urn:schemas-microsoft-com:office:smarttagscountry-region9*urn:schemas-microsoft-com:office:smarttagsState:*urn:schemas-microsoft-com:office:smarttagsStreet !@  )IIRpp6]|#)S_IJppXW)i*S!h7E2b 0I<@! &Q7(t(//k8= DF(,FoF:r?rz}_x>u|RK}V44;ra4VS[#0^]/nKl 1bX. =dtOw ?a \Dr,X*5<.|6,u[Z.0Igp@ p@UnknownG*Ax Times New Roman5Symbol3. *Cx ArialA$BCambria Math"=F=FkF  !r42qHP?S[2!xx &C:\MSOFFICE\WINWORD\GENERAL\CERTIE.DOTODHAODHARambeauOh+'0H    (08@ODHAODHA CERTIE.DOTRambeau2Microsoft Office Word@F#@rߐ@u@u՜.+,D՜.+,< hp  B.F.LORENZETTI  ODHA Title 8@ _PID_HLINKSAd'mailto:comm@odha.com  !"#$%&()*+,-./012345678:;<=>?@ABCDEFGHIJKMNOPQRSUVWXYZ[^_bRoot Entry FPuaData '"1Table9$WordDocument ?LSummaryInformation(LDocumentSummaryInformation8TMsoDataStoreu0juINBX4053==2u0juItem  PropertiesUCompObj r   F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q