CERTIFICATES OF INSURANCE 1992 - 2000
~~.._~~=l
ONLY AND CONFERS NO ~IGHTS UPON THE CERTIFICATE
m, All en & Ass 0 c, In c , HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
811 Do u g la s A v e , ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
p, 0, Box 1138 COMPANIES AFFORDING COVERAGE
Dun e din, F L 34698 COMPANY A c c e p tan c e Ins u ran c e Co,
~: ~ A
Clw Chargers Soccer Club
Inc C Weatherilt
880 Bay Esplanade
Clearwater, FL 33767
COMPANY
B
COMPANY
C
COMPANY
D
INDICATED, NOlWlTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
DATE (MMIODIYY) DATE (MM/DDIYY)
LIMITS
A
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE X OCCUR
OWNER'S & CONTRACTOR'S PROT
P19101843
02/19/1999
; GENERAL AGGREGATE ; $
....................... .............. ",
; PRODUCTS - COMP/OP AGG $
........................-...........
: PERSONAL & ADV INJURY $
02/19/2000 EAciioc'cURREiNCE'...., , $
............................-.................
: FIRE DAMAGE (Anyone fire) . $
........................................
: MED EXP (Anyone person) : $
I, o.o.()" 000
..,......I,..(jOO,OO(j
"'~,!,(),(),(),~,(),(),(),
1,.000.,000.
,.."""""""S(),,!,(),(),(),
excluded
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON,OWNED AUTOS
COMBINED SINGLE LIMIT
$
BODILY INJURY
(Per parson)
$
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE
$
GARAGE LIABILITY
ANY AUTO
: AUTO ONLY.. EA ACCIDENT . $
:' eiTHER' !H~ P;UTO' (iNL i:"" ':~:?::::::::::::::~:?~:::::::::::::::::::::::::::~::~::::::::::::::::::~:::
EACH ACCIDENT $
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
THE PROPRIETOR! INCL
PARTNERS/EXECUTIVE
OFFICERS ARE: EXCL
OTHER
EACH OCCURRENCE
AGGREGATE
AGGREGATE $
$
$
$
. . .. ........ .......
..." .......................
t".-.-:~~.I!~.j.. .. .1~.~. ttijiii:ii:t~i~~f1rrrjfjlij}frf
~ EL EACH ACCIDENT ; $
: EL DISEASE.. POLICY LIMIT $
......-..............................................
: EL DISEASE.. EA EMPLOYEE : $
DESCRIPTION OF OPERATIONSlLOCA TIONSNEHICLES/SPECIAL ITEMS
ity of Clearwater is named an additional insured under the policy,
Jtmnf.I":!W.'lf:::::~:~::::r:~:t:::::~::::~::mm::(::::::f:~::~:::~:~::~::::::::::m::@:r::m:::::::::::tft::m:m:r:ttmr::::::r::::~:r:m(:::m~~:t:~:;;,:;:;;::::::::::;:::;::::,:;:,:;:;:::::::;:_::::::::@@Jt:r:t@:m:r::~::~:m::::(:J:::r::mm:::~:m:J:m::::::::::::::m::t:::::::::::JJ:::m:m:::m@@::::J:::::::::::::::tft::~:::::::::~:::::t:::
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
...11l...- DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
City of Clearwater
p, 0, Box 4748
Cl ea rwa te r, FL 33 7 5 7 -4 748 V'rO~ED rEP^RE~ENTA~VE G
'*gQ.R9~~~Ww."nf::):\t::(:t::~I:)f:,~:t:~,;i:tfttt:~/::t}(:{:~{i(/(~t:tt::~:~:~ttf::r:{t:tttrftt:::~;}~:}~:~:::~ij\~:~~:;d:::\:~:;,,;:;:(,:;"',::'::"..:,,:::::'~:t:,:}:::~:~:~:~@ACORD.:c.ORPQRJrlJOH:::198
.....', ......................................................."... ........... .......... .........;.... .....................;................... ...........;........'..... ............................;.............................:...........:...:.....:.:................................... .... ................;.;..:.:...;...;.;.:...;..:.. ;....:. :::::::::::::::::::':::':::::::::::::.:::::::.::::::::::::::::';:::::;:.:::::::::::::::::;..:;:;:;:;.:::::::<:::::::::::::::':::::::::::::::::::::.::::::::::::;:;:':::.'
OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES.
.....OW...-,.L .l.,L' .l.'-fil:JU ur .LN;:)UKAl\ICt; ========================================== ISSUE DATE
03/05/98
THIS CERTIFICATE IISUED AS MATTER OF INFOR-
MATION ONLY AND CO ~ERS NO RIGHTS UPON THE
CERTIFICATE HOLDER; IT DOES NOT AMEND, EX-
TEND OR ALTER COVERAGE AFFORDED BY THE POL-
ICIES BELOW. COMPANIES AFFORDING COVERAGE:
COMPANY
LETTER A ACCEPTANCE INSURANCE co.
COMPANY
LETTER B
COMPANY
LETTER C
COMPANY
LETTER D
COMPANY
LETTER E
THIS CERTIFIES THAT INSURANCE POLICIES BELOW HAVE BEEN ISSUED TO THE ABOVE
INSURED FOR POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR
CONDITION OF ANY CONTRACT OR DOCUMENT WHICH THIS CERTIFICATE MAY BE ISSUED OR
.MAY..EERTAIN,+-THE.,INSlIRANCK..HERETN lSSUB.IECTTO ALL, TERMS-OE,SUCHP.QLICIEs..~ ~
LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYPE OF INS POLICY NUMBER EFF DATE EXP DATE
A GENERAL LIABILITY CP19100789/98 02/19/98 02/19/99
X COMMERCIAL GENERAL LIABILITY
CL MADE XOCCUR.
OWNER'S & CONTRACTORS PROTECTIVE
PRODUCER
WK. ALLEN & ASSOC. INC.
I
P. O. BOX 1138
DUNEDIN, FL.
34697-1138
INSURED
CLEARWATER CHARGERS SOCCEER CLUB,
INC. % CATHY WEA'l'HERILT
880 BAY ESPLANADE
CLEARWATER, FL 33767
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA
WORKERS' COMPEN-
SATION AND. .c-.
EMPLOYERS' LIABILITY
FORM
LIMITS
GEN AGGREG. $
PR-CMP/OP AG $
PERS&ADV INJ $
EA OCCURR. $
FIRE DAMAGE $
MED. EXPENSE $
COMBINED $
SINGLE LIMIT
BODILY INJ. $
(PER PERSON)
BODILY INJ. $
(PER ACCIDENT)
PROPERTY $
DAMAGE
EA OCCURR. $
AGGREGATE $
1000000
1000000
1000000
1000000
50000
AUTOMOBILE LIAB
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
GARAGE LIABILITY
OTHER
STATUTORY LIMITS
EA ACC-IDEN'I',$,
DIS-POL LIM. $
DIS-EA EMPLY $
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
CONCESSION STAND - 3030 DREW ST, CLEARWATER, FL
ADDITIONAL
CERTIFICATE
CITY OF CLEARWATER
P. O. BOX 4748
CLEARWATER, FL. 33757-4748
INSURED CLAUSE "l'O: CITY OF CLEARWATER
HOLDER ================ CANCELLATION ===============================
SHOULD ABOVE POLICIES BE CANCELLED BEFORE
EXPIRATION DATE, COMPANY WILL ENDEAVOR TO
MAIL 10 DAYS WRITTEN NOTICE TO CERTIFICATE
HOLDER (AT LEFT); FAILURE TO MAIL NOTICE
SHALL IMPOSE NO OBLIGATION OR LIABILITY OF
ANY KIND UPON THE COMPANY, ITS AGENTS OR
REPRESENTATIVES. AUTHORIZED REPRESENTATIVE:
WK ALLEN & ASSOC, INC.
FORM 25-8 (7/90)
([c..~ ~~~
f~" ~
~...........................................~..........'u...
u. .. ~(I ..
~.t.;.K'l'l.1"l.~A'l't; OF INSURANCE ========================================== ISSUE DATE
05/09/97
THIS CERTIFICATE IiPUED AS MATTER OF INFOR-
MATION ONLY AND COtFERS NO RIGHTS UPON THE
CERTIFICATE HOLDER; IT DOES NOT AMEND, EX-
TEND OR ALTER COVERAGE AFFORDED BY THE POL-
ICIES BELOW. COMPANIES AFFORDING COVERAGE:
COMPANY
LETTER A ACCEPTANCE INSURANCE CO.
COMPANY
LETTER B
COMPANY
LETTER C
COMPANY
LETTER D
COMPANY
LETTER E
THIS CERTIFIES THAT INSURANCE POLICIES BELOW HAVE BEEN ISSUED TO THE ABOVE
. INSURED--FORPOI;rcy-pJ:t;.Kl.ulJ'TND1CA'l'BD-:NOTWI'rHSTANbING"ANY ReQUIREMENT ~'TERM-~OR'
CONDITION OF ANY CONTRACT OR DOCUMENT WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE HEREIN IS SUBJECT TO ALL TERMS OF SUCH POLICIES.
LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYPE OF INS POLICY NUMBER EFF DATE EXP DATE
A GENERAL LIABILITY CP19100789 02/19/97 02/19/98
X COMMERCIAL GENERAL LIABILITY
CL MADE XOCCUR.
OWNER'S & CONTRACTORS PROTECTIVE
PRODUCER
WII. ALLEN & ASSOC. INC.
','^
.J
P. O. BOX 1138
DUNEDIN, FL.
34697-1138
INSURED
CLEARWATER CHARGERS SOCCEER CLUB,
INC. % CATHY WEA'l"IIERILT
880 BAY ESPLANADE
CLEARWATER, FL 34630
AUTOMOBILE LIAB
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
GARAGE LIABILITY
LIMITS
GEN AGGREG. $
PR-CMP/OP AG $
PERS&ADV INJ $
EA OCCURR. $
FIRE DAMAGE $
MED. EXPENSE $
COMBINED $
SINGLE LIMIT
BODILY INJ. $
(PER PERSON)
BODILY INJ. $
(PER ACCIDENT)
PROPERTY $
DAMAGE
EA OCCURR. $
AGGREGATE $
1000000
1000000
1000000
1000000
50000
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
'-----WORKERs-'" COM!> .t.;N ;.;;'----.--~~-'~-
SATION AND
EMPLOYERS' LIABILITY
OTHER
---.----,~ -----s-TA Ttf'I'e-RY-I::;rM-I-TS'
EA ACCIDENT $
DIS-POL LIM. $
DIS-EA EMPLY $
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
CONCESSION STAND - 3030 DREW ST, CLEARWATER, FL
ADDITIONAL INSURED CLAUSE TO: CITY OF CLEARWATER
CERTIFICATE HOLDER ================ CANCELLATION ===============================
SHOULD ABOVE POLICIES BE CANCELLED BEFORE
EXPIRATION DATE, COMPANY WILL ENDEAVOR TO
MAIL 10 DAYS WRITTEN NOTICE TO CERTIFICATE
HOLDER (AT LEFT); FAILURE TO MAIL NOTICE
SHALL IMPOSE NO OBLIGATION OR LIABILITY OF
ANY KIND UPON THE COMPANY, ITS AGENTS OR
REPRESENTATIVES. AUTHORIZED REPRESENTATIVE:
~~~~c~~
CITY OF CLEARWATER
P. o. BOX 4748
CLEARWATER, FL. 34617-4748
FORM 25-S (7/90)
-- ~..-".".... .~. fti!i..-. ..eM-. ,.....
- -- - - -,..-- ~--
-, - -
C/Jpt i ~ IfW
ISSUE DATE
12/09/96
J
ML 8527278
Anthem
COMMERCIAL PACKAGE(POLICY
NOTICE OF NON RENEWAL
CASUALTY INSURANCE GROUP
AU
POLICY NUMBER
POLICY PERIOD
TO
12:01 AM
02/20/97
AGENCY P
FROM
12:01 AM
ML 8527278 02/20/96
,NM,!lE.!tiS.UREQANQAODRESS_ '_.._.'__
09 0800
CLEARWATER CHARGERS SOCCER
CLUB, INC. C/O WEATHERILT,
CATHY 880 BAY ESPLANADE
CLEARWATER FL 34630
1..11..1..1.1111...111111..1..1.1111111.111.....1.111....111II
ALLEY REHBAUM & CAPES
2433 GULF TO BAY BLVD
POBOX 4620
CLEARWATER FL 34618-4620
THIS IS NOTICE THAT YOUR POLICY NUMBER ML 8527278 WILL EXPIRE
EFFECTIVE 02/20/97 AT 12:01 A.M. STANDARD TIME AT THE LOCATION OF THE
INSURED PROPERTY. THIS POLICY WILL NOT BE RENEWED.
THE REASON FOR THIS NOTICE IS THAT ANTHEM HAS DISCONTINUED WRITING
COMMERCIAL LINES OF INSURANCE IN FLORIDA.
PREMIUM ADJUSTMENT WILL BE MADE UPON DETERMINATION OF THE FINAL PREMIUM.
YOUR INSURANCE COVERAGE IS IMPORTANT TO YOU. PLEASE CONTACT YOUR AGENT FOR A
REPLACEMENT POLICY.
ALAN STOWE
AUTHORIZED REPRESENTATIVE
AT TN ':CTTYcLERI<
CITY OF CLEARWATER
POBOX 4748
CLEARWATER FL 34618-4748
FL 00 4 P
LIENHOLDER COPY
:-==========-C E R ~ I=;-~=:-~ 1 E--O j=~-N SUR A N C-~-====--======--====r===-l :~~tDAT~-(MM/DD/YY)-:
I '- I I 1 02/10/94 I
1=============== -- ,- - -- - = - - --I
I P1\'ODUCER I fHlS CERTIfICATE IS ISSUtD AS A MATTER Of INfOF:MATION ONLY AND CIJNFF..RS I
1 I NO RWHTS UPON THE CERTIF ICATE HOl DER. THIS CERTIF lum DOES 1'0101 AMEND, I
1 AlLEY REHBAUM & CAPES IEXTEND OR ALTER THE: COVERAGE AFfORDED BY THE POUCIES BELOW ' 1
1 2433 Gtl F 10 BAY BLVD. 1-- --,-- _.. ----. ---- ---- -..--------------------- -.. -------- -.--.--------..--,---1
I P. O. BOX 4b20 1 COMPANIES AFFORDING COVERAGE I
I CU:.ARWATER FL 34618 1----,..-------- ----,-..---..----,-------------------------.-----,..,-'-----I
1 (81.3) 797-5193 I COMPANY Shelby Insurance Company I
1-" -, -.. -,-----.-----,..-",,-.,-..'-,-, -.. ---, -, -.. -, -. -..,-.-..-..-,----ILETTER A. .,. 1
I INSURE D I C@fiflf'.."-'.,..,-...... ......'.._, .,.--"..-._-,'-.~" , I
I ILETTER B I
I Clea"rwate"r Cha:rge"fs SacceT I DJIIPANY ...~.~... ...., ..-......_,,-.~- ".....,_"""~,_,..__.."L+,.._."..._.........'4".._.."_.." .__","w._."m., .........,,,_.,",
: ~~ ~:;hts~i::~~ilt :~, C,._,.,..., ,.,-,-,-- ,...,.. ......-,. :
1 Clearwate'r. Fl 34b30 ILETTER D I
I ' I COMPANY I
1 IUTlER E I
I = COVERAGES =======- ---- ========--=============--== I
I THIS IS TO CERTIFY THAT THE PCtIClfS OF INSlIRANf..'E LISTED BELOW HAl,{ BE84 ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD I
I INDICATED NOTWITHSTANDING ANY REGUIREl'ENT TERM OR CONDITION Of ANY CONTACT OR OTIR DOCUMENT WITH RESPECT TO WHICH THIS i
1 CERTIFICAtE MAY BE ISSUED OR MAY PERTAIN~ tHE INSURANCE AFFORDED BY THE POlICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. I
I EXCUJSIONS AND CONDITIONS Of SUCH PCUCltS. UMITS SHOWM MAY lWJE: BEEN REDUCED BY PAID CLAIMS. 1
1-- -..--, -------"------..---...-- -- -- -.. -. --.-.. -- -,..-- -.-... -- -- ----,-,----------.-...------ -,--. -._- -------.,..---..-,--------.-,----,--------,---..------1
ICO I 1 I POUCY I POLICY 1 1
I L TR 1 lYPE OF INSURANCE I POLICY NUMBER I EFFECTIVE 1 EXPIRATION 1 LIMITS 1
I 1 I I DATE I DATE I I
1-" - f -.. - -- - ,. -.. -- -.. -.-- ,_.. __h._' -- -, -, t.,. -.-... -., -'" -, ---. -,---..-t---.-..----t-----... -- -f------------------ -.. ----.-,--------,----,----,----1
I 1 GENERAL LIABIU TY I I I I GENERAL AGGREGATE 1 $ 1 000.000 1
1 A 1 I ML 8527278 I 02/20/94 I 02/20/95 I PRODUCTS-COl'IP/OPS AGGREGATE 1$ 1 000 000 I
I 1 [X] COMMfl\'CIAL GENERAL LIABILITY I I I 1 mSOlilA["lAl)TJERT!SIJil(JINJlJRY'll"-'''r''~=''1
I I [] CLAIMS MADE [X] OCCUR. I I 1 I EACH OCCURRENLt: I f-..l.'.'''0 '1
I[ ] OWNER'S & CONTRACTOR'S PROT.I I I I FIRE DAMAGE (AIlyone fHe) .If'''-'''50~''1
1 [ ] _ I I I I MEn ICAL EXPff4Bt: (lfuyol1e jJe-rsonrl f"....--..."5;~10~n
-- -t.,- ------,..,- --..,--..--- -.--- --..- -- ..- t- ,- ..- .- ..- ..- .- .-.- -- --+ ------ --..--- -- .- ..--+---------- --..- --,------------+---------.----1
I AUTOMOBILE LlABILI1Y 1 I I I COMBINED SINGLE 1 I
1 1 1 I 1 UMI r I $ I
I [ ) ANY AUTO I I i 1-----------------------'-----+-..-. u________1
I [ ] ALL OWNED AUTOS 1 1 I I BODILY INJURY 1 I
1 [ ] SCHEDULED AUTOS 1 I I I (Pe'r person) I $ I
1 [ ] HIRED AUTOS I I! 1------------------,-----------+---------,-----1
1 [ ] NCltHJ\rJNED AUTOS I I I I BOD IL Y INJURY 1 I
I [ J GAI\'Al:;E LIABILI TV 1 1 I I (Pe'r accident) I $ I
I [ ] I I I 1---..-----..---.--..---..'-----'--..-."--+..-..---'----.--"--I
I 1 I I I PROPERTY DAMAGE I I
I I I I I I 1$ I
1..- -t..-..- ..,- -- -----,----- ..--- -- ..- ,--t ..--- -- ..---- -- -- -- -- --+---- -- ----+--.- -- --,t ------.------------- ---,----+--- -------- --I
1 I EXCESS LIABILITY I I I I EACH OCCURH4C"E I $ I
1 I [ ]Umbrella fontl 1 I I I' AlJIJRrnATt .., .'...'\$ I
I., I [ ]Other _Than Umbrellafol'll I . -'_ .1 _ L. _ ..u ,___L..._,...,...... n .Inn
1-- -f---..---- ----------.--,---... ------ +.. -. -.. ---.. -.. -- -... -------+--- -- ----+--..---- ---~ ---- -,---------,---------,---,-----+,---.-------,---,-1
I 1 WORKER'S COMPENSATION 1 I 1 1 I STATUTORY LIMITS 1 I
I I AND I 1 1 I EACH ACCIDENT 1$ I
I 1 EMPLOYERS' LIABILITY 1 I I I DISEASE - POLICY LIMn 1$ 1
I 1 1 I 1 I DISEASE - EACH E.MPLOYEE 1$ I
1-"'-'1-'---" -----------.------.---,.---.. t, -.. -. -.. -, ------------t--. -- ----+--- -----..-t---.------..---..--'-'-------..'----..--'--'----------I
1 I OTHER I 1 1 1 I
I I I I I I 1
1 I 1 I I 1 I
1 Iii I 1 I
1----------...---- -- -------------------------------- -------------------.---------------------..---------------.---1
I DESCRIPTION OF OPERATIONS/LOCATlONS/VEHICLE.5/SPECIAl ITEMS 1
I I
I Additional Insu'red: City of Clearwater I
1 P. O. Box 4748 I
1 Clearwater, F L 34E.18 I
I I
1 = CERTIFICATE HOLDEf< -- - m4CELLATION = ===========--===--==== I
I I Sl-OJIJ) ANY Of HIE: ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE I
I La'rry Dowd 1 EXPIRATION DATE THEREOF THE ISSUING COMPANY WILL WlMVDXXII I
I Clearweate'r Parks & Recreation 1 MIL 10 DAYS WRITTEN ~mCE TO THE CERTIFICATE HOLDER NAMED ro THE I
1 P. O. Box 4748 I ~il(IMXXRmIItIXllOOOUl(XXIlllMXXIftIIIKIXIMJO)(DlJlIUXIftIXDUMIIIIMXIIJt I
L:"'~"Fl =~~= !-;~~~~J
-
___~I~:~: IE~~ Ii::;;:: ~~~][ ~::'. ::II~:::::~r:~II_~~' n::::~_~~I]~:~:~__~~~~""1I ::::~~~~I:~~~lr::~~~~~~~:: "~:~..-____J____________~~~C~~~~__~:~~~~~~~~'~~~~
I PRODUCER I THIS CERTIFICATE IS ISSUED AS A MATTER OF HlFORMATlON Ol-lLY AND CONFERS I
I ! NO RIGHT I~~N THE CERTIFICATE HOLDEF:. THIS CERTIFICATE DOES NOT AMEND, I
I ALLEY, REHBAUM & CAPES I EXTEND OR AUER THE COl)fRAGE AFFO~:[jt:l) BY THE POLICIES BELOW ' I
! PflDt-if: (813) 797-51. 93 1---'-----------------'-..-----------------------------''-------------------1
i P. O. BOX 4620 I CO~PANIES AFFORDING COVERAGE I
I CLEARWATER,.FL 3461.8 1--------------------------------------_______....______---I
I (813) 229-9256 I COMPANY A Insura Insurance Company I
1 I~ffi I
I 1------------------------------_______________________-------------__~___I
1----------------------------------------------1 COMPANY B I
1 INSURED I LETTER i
1 1----------------------------..---------,----------..---..---..--.-..--- i
1 Clearwater Chargers Soccer I COMPANY C
I &~ ~;hts~i~~~~i 1 t : _~~~~~..___________________________,___________________________ ____,_______ i
Clearwater, FL 34630 I COMPANY D I
llirrffi, I
! ------------.----------.------,---------------.-----,-------------_._--,-,------1
i COMPANY E
I 1 liTTER I
1===== COVERAGES ==================================================================================================:================!
1 THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE It4SURED NAMED ABOVE FOR THE POLICY PERIOD i
1 INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TEh~ OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS I
! CERTIFICATE MAY BE ISSUED OR MAY PERTAINi THE INS!J;:ANCE AFFORDED BY THE ~~]LICIES DESCRIBED HEk'EIN IS SUBJECT TO ALL THE TffiMS, 1
i EXCLUSIONS, AND CONDITIONS OF SUCH PCtIC ES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS i
1--------,-:.------------------------------- ------------------------1
I 1 POLICY I PCiL,ICY i
ICO 1 ! IEFFECTIVE ! EXPIRATION 1
I L TR 1 TYPE OF INSURANCE I POLICY NUMBER i DATE I DATE I ALL. LIMITS IN THOUSANDS I
1-.-,-1---------,-------..---------..,-----------1------------,------1----------1----,------1--------------------------......---.-----------1
i 1 GENERAL LIABILITY 1 1 1 I GENERAL AGGREGATE $ 1000 I
I A I (X] COMrfRCIAL GENERAL LIABILITY I MI 0759934 1 02/20/93 1 02/20/94 1 PRODUCTS-COMP/OPS AGGREGATE $ 1000 I
i 1 [X] [ ] CLAIMS MADE [X] OCCURRENCE 1 1 1 1 PERSONAL & ADVERTISING INJURY $ 1000 1
I I [ ] OWtH'S & CONTRACTORS PPOTECTIVE 1 I 1 I EACH OCCURRENCE $ 1000 1
i 1 [ ] I I 1 I FIRE DAMAGE (ANY ONE FIRE> $ 50 i
! I [ ] 1 I 1 I MEDICAL EXPENSE(ANY ONE PERSON)$ 5 !
1--..1----------,-----..---.-------,----.--------1------------------- --1----------1---------1---..------.---.--------,-.--------,--'-.-,-,-----,-----1
I 1 AUTOMOBILE LIABILITY I I! 1 Iii
, I I I i CSL I $ I
I I I: ] ANY AUTO I I i --------------- i --------------1
, I I: ] ALL OWI~ED AUTOS I 1 I BOD Ii.. Y II~JURY I !
I 1 ( ] SCHEDULED AUTOS 1 1 (PEF: PERSON) ! $ I
1 i [ ] HIRED AUTOS I 1----,-----------1----------_..__1
1 [ ] NON-OWNED AUTOS I ! BODILY INJURY 1 j
I [ ] GARAGE LIABILITY I 1 (PER ACCIDENT) 1 $ I
I [ ] I 1----------------1--------------1
II! PROPERTY I !
! i I I I iDAMAGE 1$ 1
1---1--------...-.-------- ------------.--....---1------------------1------..--1----..-----1----,- - ------------------------------------- i
I EXCESS LIABILITY I i I EACH OCCURREtU! AGGREGATE I
I [ J UMBRELLA FORM Iii -----------------I-----..-----------!
I I ( ] OTHER THAN Ul'lBI'.'ELLA I ! Iii $ 1 $ i
1---1-----,-----,----------..---------------1-----.-..-----------1---------1---..--..'---1---,-.-------.------------,----------.-------.--- i
1 Iii STATUTORY 1 I
..1 WORKERS'.. COI'IPENSATION . I I----------::--------------:-:-:-==-,--=-=:-~--_=_---.:::l_
1 AND T 1 1 $ (EACH ACCIDENT) -. 1
! EMPL.OYERS' LIABILITY I $ (DISEASE-POLICY LIMIT) I
I I Iii I $ WISEASE-EACH EMPLOyEE) I
1---1-..--..-....-,-----------,---..- -------------! -------------------1-------1--------- i ------------------------------.- ----,---------1
I OTHER i ! I ! j
i ! !
! ! i
! 1 I Ii! I
! --'---------------.-----..------------------------------------------------------,--------------------.---1
I DESCRIPTION OF OPERATIUNS/LOCATIONS/VEHICL.ES/SPECIAL ITEMS
1
1 Certificate Holder is Additional Insured
I
I
1 i
:===== CERTIFICATE HOLDER ========~~~D=~~~L~~I~ov~=~E~~RlBED=~~I~IEs=BE=~A~E~~ED~E;O~~=~~E-EX:==:
1 City of Clearwater MAR 1 7 1993 I PIRATION DATE THEREOF, THE ISSUING COMPANY wILL xxxxxxxxxxx MAIL
1 P. O. Box 4748 I 1B DAYS WRITTEN NOTICf TO THE CERTIFICATE HOLDER NAMF~ TO THE
I Clearwater, FL 34618-4748 1 LEFT. xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx !
1 1 xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx I
1 Attn: Leo W. Sch'rade'l', Esq. CITY CLERK DEPT. 1-------------------------------------------------------------..-----1
I ~:i5k. Manage'r ! AUTHORIZED REPRESENTATIVE !
1_...,__,__,___...__.__,__,_______,_..._ _,_ ,..--.-----....-.______..,___._______L..________ __ --..h~-----.------..,--------.----- ___l
THIS BINDER IS o'A TEMPORAR~'I:~~:C': ::~~:;T:;l~~~:' TO ;:~ ~~:;I:~: :7~:' ON THE FOLLOWINGtAGE DATE: fI2/21/92
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: PRODUCER : COHPANY : BINDER NO
: SHELBY INSURANCE : 92-054 ,
:-------------------------------------------------------------------------:
: EFFECTIVE DATE : EFFECTIVE TIME : EXPIRATION DATE : EXPIRATION TIME :
:-----------------:-----------------:------------------:------------------:
: 02/20/92 : 12:01 [X] AM : 03/20/92 : [X] 12:01 AM :
: : [ ] PM : : [] NOON :
:-------------------------------------------------------------------------i
: [) THIS BINDER IS ISSUED TO EXTEND COVERAGE IN THE ABOVE NAMED :
: COMPANY PER EXPIRING POLICY NO: :
:-------------------------------------------------------------------------:
: CODE SUB-CODE : DESCRIPTION OF OPERATIONS/VEHICLE/PROPERTY (INCLUDING LOCATION) :
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: INSURED : SOCCER CLUB LOCATED AT: --":---...:-":~.::'".<-".,-., 1
\ Clear~ater C~arqers Soccer : 3030 DRDi STREET ",) h~ ['.,; I g IJ ~ij [~1 ,'1'1
, C/O Cdthy WedtheTllt , CLEARWATER, FL , ,-' '_" ''''_''_ "'"-'h..._-. I
: 880 Bay Esplanade : ' ."" ," !,
i Clearwater, FL 3t6S& i IULi[' FE B -24-199'2 llJ?-
: ! ,----, ....~-- Jl : I
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:----- CO"URAGES ----------------------------------------~----------------------------I-ALL LIABILITY LI"ffJ~J'T~~~~~~lr~!
1----- VA ---------------------------------------------------------------------,- ~~4
: TYPE OF INSURANCE : COVERAGES/FORMS : AMOUNT : DEDUCTIBLE : COINSURANCE :
:-----------------------------------------:-------------------------------------------:--------------:--------------:--------------:
: PROPERTY CAUSES OF LOSS : BUILDIIIG - REPLACEMENT COST : 55000: 250: ~0 :
: [] BASIC [] BROAD [X] SPECIAL : CONTENTS - REPLACEMENT COST : 10000: 250: 90 :
: [] : : : :
: [] : : : :
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:------------------~----------------------:-------------------------------------------:--------------------------------------------:
: GENERAL LIABILITY: : GENERAL AGGREGATE $ 1000 :
[X] COMMERCIAL GENERAL LIABILITY : : PRODUCTS-CQMP/OPS AGGREGATE $ 1000 :
, [] [] CLAIMS MADE [X] OCCURRENCE : : PERSONAL & ADVERTISING INJURY $ 1000 :
: ( ] OWNER'S & CONTRACTORS PROTECTIVE : : EACH OCCURRENCE $ 1000 :
: [ ] : : FIRE DAI1AGE (ANY ONE FIRE) $ 50 :
: [] : RETRO DATE FOR CLAIMS MADE: : MEDICAL EXPENSE(ANY ONE PERSOM)$ 5 :
:-----------------------------------------l-------------------------------------------:--------------------------------____________:
: AUTOMOBILE : [] ALL VEHICLES [ ] SCHEDULED VEHICLES: CSL : $ :
[ ] LIABILITY: : BI PERS/ACCID : $ :
: [ ] nOlf\OWUED: : PD : $ :
: [] HIRgD : : MED PAY : $ :
: [] GARAGE : : PIP : $ :
:[] : : Ill' :$ :
:-----------------------------------------:-------------------------------------------i .. .-----------------------------------:
: AUTO PHYSICAL DAMAGE : [] ALL VEHICLES [ ] SCHEDULED VEHICLES: [] lie;,: :
: [] COLLISION: : [] STATED AMOUNT: $ :
: [] orc DED:, : [] OTHER: :
:-----------------------------------------:-------------------------------------------:--------------------------------------------:
: EXCESS LIABILITY: : EACH OCCURRENCE: _ AGGREGATE : SELF- INSURED:
: [] UMBRELLA FORI'I: . -: -- -, - '- - : dRETENTION :
: [] OTHER THAN UI'IBRELLA : RETRO DATE FOR CLAIMS MADE: , : : :
:-----------------------------------------:-------------------------------------------:--------------------------------------------:
: : : STATUTORY : :
: WORKERS' COMPENSATION : :-------------_______________________________:
: AND: : : $ (EACH ACCIDENT) :
: EMPLOYERS' LIABILITY : : : $ (DISEASE-POLICY LIMIT) :
: : : : $ (DISEASE-EACH EMPLOYEE) :
:----------------------------------------------------------------------------------------------------------------------------------:
: SPECIAL CONDITIONS/RESTRICTIONS/OTHER COVERAGES :
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ALLEY, REHBAUM & CAPES
P. O. BOX 4620
CLEARWATER, FL 34618
(813) 797-5193
'===== NAME & ADDRESS =============================================================================================================:
: [] I'[)RTGAGEE (X] ADDITIONAL INSURED :
: [] LOSS PAYEE [ ] I
:-------------------------------------------------------------------------:
: LOAN f :
, ,
, ,
:-------------------------------------------------------------------------:
: \ AUTHORI~EPRES~T~VL. !
: : '1 VlIlttt~ :
~----- --------- - ------- - ---- --- ------ ---- -- -- ------ ---- --~- ------ -- - -- - - --- ----- ------------ --- - - - -- --;;'c-,- ~~-~,-)----- -----~
CITY OF CLEARWATER
P.O. BOX 4748
CLEARWATERt FL 34618-4748
ATTH: CYN HIA GOUDEAU
(i;
!
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c n N D I TIn N S
Th,is Cnmpany b,ind!=', tIJE' }:..ind (<:::,)
pre~eding p~ge. Thi~ insurance is
and limitatjnns nf the poljcy(jps)
of insurance stipulated on thp
subject t8 the terms, conditions
in current use by the Cnrnpany.
This binder m~y be c~ncelled by the Insured by surrender of this
binder or by ~l'jtten notjce to the Cornp~ny stating when cancellation
will be effective. This binder may be cancelled by the Company by
notice to the Jnsu:re(~ in accord8ncp o;.;Jith the policy conditions.
This binder is cancelled when replaced by a policy. If this binder
is not replaced by a policy, the Cornp8ny is entitled to charge a
premium for the binder according to the Rules and Rates in use by
the company.
A P P I. I CAB I. E
I N
N E V A D A
Any F'8];"'SOn tJhlJ 'i:'efTIses t8
of ]ess than $1,000,000.00
not more than $500.00, and
the hi ndel' as f'J"ncd" nf
t heI'efx'cHfl.
accept a binder ~hich provides coverage
when pronf rpquired: (A) Shall he fined
(8) is li~ble tlJ the party presenting
j nSlTri".nce for actual damaqe!;? sustained
A.~..III'e INSURANCE E;;l!W" 1 ISSU:;~:;~M~DDIY;J
THIS BINDER IS A TEMPORARY INSURANCE CONTRACT, SUBJECT TO THE CONDITIONS SHOWN ON THE REVERSE
SIDE OF THIS FORM.
ALLEY dHlWJM & CAPES
P.O. Boa 4620
CLE.ARWATER, FL. 34618-4620
COMPANY BINDER NO.
SHELBY INS. CO. 91-0014
EFFECTIVE EXPIRATION
DATE TIME DATE TIME
X AM X 12:01 AM
1/10/91 12:01 PM 2/2.0/91 NOON
PRODUCER
CODE
SUB-CODE
THIS BINDER IS ISSUED TO EXTEND COVERAGE IN THE ABOVE NAMED
COMPANY PER EXPIRING POLICY NO:
CLEAR.WATER CHARGERS soccn CLUB, INC.
2920 EAGLE ESTATES CIRCLE S
CLEARWATER, FL. 34621
DESCRIPTION OF OPERATIONSNEHICLES/PROPERTY (Including Location)
l.\ E t E 1'1 Ell
~tt. , 6 \99\
c"y CLERK
SOCCER CLUB SITUATED
3030 DUW ST..
CBEAllWATER, FL.
INSURED
COV~E$ "
TYPE OF INSURANCE
PROPERTY CAUSES OF LOSS
COVERAGElFORMS
AMOUNT
'efNliTS
DEDUCTIBLE COINSUR.
BASIC
BROAD X SPEC,
BUILDING UPLACBKEMT COST
ItJIIItISS PDSOltAL PROPDTY - R/C
$55,000.
10,000.
$250.
25eJ
90%
90%
RETRO DATE FOR CLAIMS MADE:
GENERAL AGGREGATE $ 1 , 000,000.
PRODUCTS - COMP/OP AGG, $ 1.000,000.
PERSONAL & ADV, INJURY $ 1,000.000.
EACH OCCURRENCE 1 , 000 , 000.
FIRE DAMAGE (Anyone fire) $ 50 , 000.
MED, EXPENSE (Anyone person) $ 5 000.
COMBINED SINGLE LIMIT $
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) $
PROPERTY DAMAGE $
MEDICAL PAYMENTS $
PERSONAL INJURY PROT, $
UNINSURED MOTORIST $
$
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE X OCCUR
OWNER'S & CONTRACTOR'S PROT,
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON,OWNED AUTOS
GARAGE LIABILITY
AUTO PHYSICAL DAMAGE DEDUCTIBLE
COLLISION:
OTHER THAN COL:
,EXCESS LIABILITY
ALL VEHICLES
SCHEDULED VEHICLES
ACTUAL CASH VALUE
STATED AMOUNT $
OTHER
'EACH OCCURRENCE $-'
AGGREGATE $
SELF,INSURED RETENTION $
STATUTORY LIMITS
EACH ACCIDENT $
DISEASE,POLlCY LIMIT $
DISEASE,EACH EMPLOYEE $
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
RETRO DATE FOR CLAIMS MADE:
WORKER'S COMPENSATION
AND
EMPLOYER'S LIABILITY
SPECIAL CONDITIONS/OTHER COVERAGES
. NAME & ADDRESS
CITY OF CLEARWATER
P.O. BOX 4748
CLEARWATER, FL. 34618-4748
MORTGAGEE
LOSS PAYEE
LOAN #
I
ADDITIONAL INSURED
AUTHORIZED REPRESENTATIVE
,.
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ATTEN; CYNTHIA GOUDEAU
ACORD 75"5 (7/90)
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