CERTIFICATE OF LIABILITY INSURANCE (4)
SAFECO Insurance
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ELLS FARGO INS SERVICES
SOUTHEAST INC
PO BOX 31666
TAMPA, FL 33631
3/13/2008
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
THIS CERTIFICATE DOES NOT AMEN D, EXTEN D OR ALTER THE
COVERAGE AFFORDED BY THE POLICIES BELOW.
A V
A
American States Insurance Company
I
19704
IN SURER
Insured
CLEARWATER HISTORICAL SOCIETY
PO BOX 175
CLEARWATER, FL 34617
INSURER
B
INSURER
C
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THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
NOlWlTHSTANDING ANY REQUIREMENT, TERM OR CONDIllON 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 SUaJECT TO ALL THE
TERMS. EXCLUSIONS AND CONDIllONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
POLICY POLICY
NSR ~DDI EFFECTIVE EXPIRATION
TYPE OF INSURANCE POLICY NUMBER DATE DATE LIMITS
LTR INSD
GENERAL LIABILITY EACH OCCURRENCE T$ ~
A 7 ::J~MERCIAL GENERAL LIAS 01CG11649370 1/20/2008 1/2012009 DAMAGE TO RENTED PREMISES $
CLAIMS MADE[lJOCCUR I\IED EXP (Anv one _I $
PERSONAL 6. ADV INJURY $
GENERAL AGGREGATE $
GEN'l AGG LIMIT Al'PllES PER PROOUCJS - CO\IIP I OP AGG $
71POucv nPRDJECJnLOC $
AUTOMOBILE LIABILITY COMBINED S1NG.E UMIT
A ANY AUTO 01CG11649370 1/20/2008 1/2012009 (Ea acdd<nl) $ 500.000
ALL DIIINED AUTOS BODILY INJURY
"7 SCHEDULED AUTOS (P... ponm) $
HIRED AUTOS BODILY INJURY
7 NON-DIll NED AUTOS IP... acddenl) $
PROPERTY DAMAGE
IP... acddenl) $
~RAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
:J~CCUR DCLAIMS MADE AGGREGATE $
$
~~EDUCJIBLE $
RETENTION $ $
WORKERS' COMPENSATION & IwC SllItulaN Lmll 10th..
EMPLOYERS' LIABILITY VI EL EACH ACCIDENT 1$
~WilmUa~~mDWfCllT'V EL DISEASE - EACH EMPLOYEE -1$ .
~te~llflrSb"OW EL DISEASE - POLICY LIMIT l-$
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
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IN SURER
D
C~y of Clearwater
attn: Margo Walbolt
100 S Myrtle Ave
Clearwater, FL 33756
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLE D BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
~DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHAll IMPOSE NO OBLIGATION
OR LIABILITY OF ANY IIIND UPON THE COMPANY, ITS AGENTS DR REPRE-
SENTATIVES.
AUTHORIZED
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SAFECO Insurance
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IMPORT ANT
If the certificate hdder is an ADDITIONAL INSURED, the poIlcy(iesj must be endorsed. A statement
on this certJficate does not confer rights to the certl fi aile holder in UIII of such endorsanent(sl.
If SUBROGATION IS WAIVED, subject to the tenns and condllms of the policy, certain pdlcles may
r~lre an endorsement. A statement on this certificate does not confer rights to the certlfialle
holder In lieu of such endorsemmt(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this farm does not constitute a contract bdWem
the Issuing insurer(s), authorized representative or prolllcer, and the certifialle holdlS, nor does It
affirmatively or negatively lmend, elllmd or alter the coverage afforded by the pdlcles listed thereon.
ACORD 25 (2001106)