CERTIFICATE OF INSURANCE
ACORDN
CERTIFICATE OF LIABILITY INSURANCE
OP 10 S DATE (MM/DDIYYYY)
CLEA-24 04 15/04
THIS CERTIFICATE IS ISSUED AS A MATTER OFINFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERtiFICATE
HOLDER. THIS CERTIFICATE DOESNOT AMEND, EXTEND OR
ALTER THE COVERAGE AFR:>RDED BY THE POLICIES BELOW.
PRODUCER
Bouchard-Starcrest
101 Starcrest Drive
POBox 6090
Clearwater FL 33758-6090
Phone: 727-447-6481 Fax:727-449-1267
INSURED
INSURERS AFFORDING COVERAGE
Clearwater Lawn Bowls Club
President
1040 Calumet St
Clearwater FL 33755
INSURER A:
INSURER B:
INSURER C:
INSURER D:
INSURER E:
SOUTHERN OWNERS INSURANCE CO
NAIC#
10190
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.
LTR NSR[ TYPE OF INSURANCE POLICY NUMBER DATEiMMJ~ P8k!'1rlij~b'bAJ!..~N LIMITS
GENERAL LIABILITY EACH OCCURRENCE $500,000
I---
A X COMMERCIAL GENERAL LIABILITY 20614827 04/20/04 04/20/05 PREMISES (Ea occurence) $50,000
I CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 5,000
PERSONAL & ADV INJURY $ 500,000
I---
GENERAL AGGREGATE $1,000,000
>--
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS. COMP/OP AGG $ 500,000
Tx ,n PRO- nLOC
X POLICY JECT
~TOMOBILE LIABILITY COMBINED SINGLE LIMIT $
ANY AUTO (Ee accident)
I---
ALL OWNED AUTOS BODILY INJURY
- (Per person) $
- SCHEDULED AUTOS
HIRED AUTOS BODILY INJURY
- (Per accident) $
- NON.OWNED AUTOS
PROPERTY DAMAGE $
,... v~ (Per accident)
'<,. -"-, _....~,~ "" --'''-
GARAGE LIABILITY ,....1. :',' 1J-"'r-, '!AUTO ONLY - EAACCIDENT $
~ ANY AUTO ~ -~. =, ?', .,~. "tu
"
'~'-'- '-.,-".... , OTHER THAN EA ACC $
i i , AUTO ONLY: AGG $
, " . . EACH OCCURRENCE $
EXCESSIUMBRELLA LIABILITY "
:=J OCCUR D CLAIMS MADE , AGGREGATE $
....
F;:;;'! '" ' I $
j ,
I
~ DEDUCTIBLE ---"" .. - . "~,-~.~--.J $
RETENTION $ $
WORKERS COMPENSATION AND I Tg~l ~I~WS I lOJF
ER
EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $
ANY PROPRIETOR!PARTNER!EXECUTIVE
OFFICER!MEMBER EXCLUDED? E.L. DISEASE. EA EMPLOYEE $
~~~Mt"~Wov~~?c5~s below E.L. DISEASE. POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Clubs
CERTIFICATE HOLDER
CANCELLATION
City of Clearwater
Dept of Parks & Recreation
P.O. Box 4748
Clearwater FL 33758-4748
CICL001 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO
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
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHOR EP SENTA
@ACORD CORPORATION 1988
ACORD 25 (2001/08)