CERTIFICATE OF LIABILITY INSURANCE (3)
ACORD.. CERTIFICATE OF LIABILITY INSURANCE OP ID s~ DATE (MM/DDIYYYY)
COHMU - 6 12/03/04
PRODUCER THIS CERTIFICATE IS ISSUED AS A MAITER OF INFORMATION
Brown & Brown Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
17757 US Highway 19 N, Ste 660 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 2456 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Clearwater FL 33757-2456
Phone: 727-46l-6044 Fax:727-442-7695 INSURERS AFFORDING COVERAGE NAlC #
INSURED INSURER A: I'irst Bat. IDS.. Co. of America 24724
INSURER B; General Insurance Company 24732
Community Service Foundation, INSURER C:
Inc
925 Lakeview Road INSURER D:
Clearwater FL 33756
INSURER E;
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 NSRI TYPE OF INSURANCE POLICY NUMBER ~ DATE /MMiDoJv~ LIMITS
GENERAL LIABILITY EACH OCCURRENCE $1,000,000
-
A X COMMERCIAL GENERAL LIABILITY 25CC0412531 12/01/04 12/01/05 ~~~~~s rea occurence) $ 200, 000
l CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $10,000
~ NOHC $1,000,000 PERSONAL & ADV INJURY $1,000,000
GENERAl AGGREGATE $3,000,000
GEN'L AGGn LIMIT APrilS PER: PRODUCTS-COMP~PAGG $3,000,000
~ PRO- '~
POLICY JECT X LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
f-- (Ea accident) $
ANY AUTO
-
- ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS (Per person)
-
HIRED AUTOS BODILY INJURY
I-- (Per accident) $
f-- NON-OWNED AUTOS
PROPERTY DAMAGE $
(Per accident)
GARAGE UABILITY AUTO ONLY- EA ACCIDENT $
1 ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESSlUMBRELLA LIABILITY EACH OCCURRENCE $
tJ OCCUR o CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I TORY LIMITS I 10JH-
ER
EMPLOYERS' UABILITY E.L. EACH ACCIDENT $
ANY PROPRIETORlPARTNERlEXECUTIVE
OFFICERlMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $
g~~~~Jl~~s below E.L. DISEASE - POLICY LIMIT $
OTHER
B Professional Liab. LP77768000B 12/01/04 12/01/05 Prof.Liab $1,000,000/
$3,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAl PROVISIONS
~fill'.F:! fi~ f: j:; ;::rM 1" ljU"}
CERTIFICATE HOLDER
CANCELLATION
CITYC-1
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
IMPOSE NO OBLIGATION OR lIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
City of Clearwater
Attn: Housing Division
P. O. Box 4748
Clearwater FL 33758
~~'!~
A.CORD 25 (2001108)
@ACORD CORPORATION 1988