CERTIFICATE OF LIABILITY INSURANCE (2)
DATE (MM/DDIYYYY)
COMMU-6 11 30 04
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.
ACORD...
CERTIFICAT(
)F LIABILITY INSURANC
PRODUCER
Brown & Brown Insurance
17757 US Highway 19 N, Ste 660
P.o. Box 2456
Clearwater FL 33757-2456
Phone:727-461-6044 Fax:727-442-7695
INSURED
Community Service Foundation,
Inc
925 Lakeview Road
Clearwater FL 33756
COVERAGES
INSURERS AFFORDING COVERAGE
INSURER A:
INSURER B:
INSURER C:
INSURER D:
INSURER E:
Wirst Hat. Ins. Co. of America
NAlC#
24724
24732
General Insurance Com any
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 TIERMS. EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NSRI POLICY NUMBER DATE iMMIDDIYYl I POUCY EXPI~N LIMITS
LTR TYPE DF INSURANCE DATE MM/D
GENERAL LIABILITY EACH OCCURRENCE $1,000,000
-
A X COMMERCIAL GENERAL LIABILITY 25CC0412531 12/01/04 12/01/05 ~~:S~S lea occurencel $ 2 0 ~.L...q, 00
I 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 AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $3,000,000
I .nPRO- ril LOC
POLICY JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
I-- $
ANY AUTO (Ea accident)
I--
I-- ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS (Per person)
I--
HIRED AUTOS BODILY INJURY
- $
NON-OWNED AUTOS (Per ac:ddent)
-
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY. EA ACCIDENT $
~ ANY AUTO OTHER THAN EAACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
~ OCCUR D CLAIMS MADE AGGREGATIE $
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION ANti 1r0RY L1MITS-r IU~-
EMPLOYERS' LIABILITY
ANY PROPRIETORlPARTNERlEXECUTIVE E.L. EACH ACCIDENT $
OFFICERlMEMBER EXCLUDED? E.L. DISEASE. EA EMPLOYEE $
If~, describe under
S ECIAL PROVISIONS 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
lESCRlPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
;05 .Jm.J 4 PM2:2~:::;
CANCELLATION
CITYC -1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAlL ~ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY IOND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
A~~'E~
::ERTlFICATE HOLDER
City of Clearwater
P. O. Box 4748
Clearwater FL 33758
~CORD 25 (2001/08)
@ACORD CORPORATION 1988