CERTIFICATE OF LIABILITY INSURANCE (2)
ACORDN
CERTIFICATE OF LIABILITY INSURANC~L~4~ v
DATE (MMlDDNY)
11/12/01
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PRODUCER
Rogers & Associates Insurance
201 Alt 19 South
Palm Harbor FL 34683
Phone: 727-786-4312 Fax:727-786-3684
INSURED
INSURERS AFFORDING COVERAGE
Clearwater High Band Boosters
POBox 4279
Clearwater FL 33758-4279
INSURER k
INSURER B:
INSURER C:
INSURER D:
INSURER E:
American States Business Ins
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
'~f~ TYPE OF INSURANCE POLICY NUMBER ~~~1f7MMlDDNYi . P~k+~~r:I~&'6~~~N LIMITS
GENERAL LIA81L1TY EACH OCCURRENCE $ 500000
-
A X COMMERCIAL GENERAL LIABILITY 01CD45491770 06/20/01 06/20/02 FIRE DAMAGE (Anyone fire) $200000
I CLAIMS MADE ~ OCCUR I MED EXP (Anyone person) $ 10000
PERSONAL & ADV INJURY $ 500000
-
GENERAL AGGREGATE $ 1000000
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1000000
I n PRO- nLOC
POLICY JECT
; AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- $
ANY AUTO (Ea accident)
-
ALL OWNED AUTOS BODILY INJURY
- $
SCHEDULED AUTOS (Per person)
~
HIRED AUTOS BODILY INJURY
- $
NON-OWNED AUTOS (Per accident)
-
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
=1 ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
~ OCCUR D CLAIMS MADE AGGREGATE $
$
=1 DEDUCTIBLE $
RETENTION $ $
.... -WORKERSi;OMPENSATtoN ANOC~ - .- ".-- . ---_._.~ -. ---- -'-,"- - -- ..'...'..' t TORY LIMITS i f'ER" .-..
EMPLOYERS' LIABILITY $
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE $
E.L. DISEASE - POLICY LIMIT $ ..
OTHER
DESCRIPTION OF OPERATIONSlLOCATIONSlVEHICLESlEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Clubs, Civic, Service or Social
City of Clearwater included as additional insured
CERTIFICATE HOLDER I N I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
CITYCLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
City of Clearwater IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
P.O. Box 4748 REPRESENTtTIVES. ~ ~
Clearwater FL 33758-4748 AUTHORIZED "PJltSENT~~~ \. .J_ ...
" ~ -
I -
ACORD 25-S (7/97) () fC ((;.' C ( I" ( C C~ I(
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@ACORDCORPORATION 1988