CERTIFICATE OF LIABILITY INSURANCE
ACORDN
CERTIFICATE OF LIABILITY INSURANC~~~~ P
DATE (MMIDDIYY)
09/03/03
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
Brown & Brown Insurance
111 2nd Avenue N.E. Suite 610
St. Petersburg FL 33701
Phone: 727-456-1800 Fax:727-823-1988
INSURERS AFFORDING COVERAGE
INSURED
Community Service Foundation,
Inc
925 Lakeview Road
Clearwater FL 33756
INSURER A:
INSURER B:
INSURER C:
INSURER D
INSURER E
SAFE CO Insurance Com any
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.
INSR TYPE OF INSURANCE POLICY NUMBER b~~~Mli~5~Yt: P~.L.!.~(~~~IRAWN LIMITS
LTR DATE MM/DDIYY
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
f--
A X COMMERCIAL GENERAL LIABILITY CP 77768000 12/01/02 12/01/03 FIRE DAMAGE (Anyone fire) $ 200,000
I-- :=J' CLAIMS MADE ~ OCCUR
I-- MED EXP (Anyone person) $ 10,000
PERSONAL & ADV INJURY $1,000,000
I--
GENERAL AGGREGATE $3,000,000
I--
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $3,000,000
II n PRO. nLOC
POLICY JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
I-- $
ANY AUTO (Ea accidant)
r----
ALL OWNED AUTOS BODILY INJURY
I-- $
SCHEDULED AUTOS (Per person)
r----
HIRED AUTOS BODILY INJURY
I-- $
NON-OWNED AUTOS (Per accident)
f--
I-- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY- EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
tJ OCCUR D CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I fJWd~YTS I IUJ~-
EMPLOYERS' LIABILITY
- ---- ---.. - - - -.. .-. .- ----.-- --- ,. ". - -'- --- -.--".. .- -.----.-- ---- ELEACH.AC.CIDENT- . - -$--- .-------- '- --' ---
E.L. DISEASE - EA EMPLOYEE $
E.L. DISEASE. POLICY LIMIT $
OTHER
RECEIVED
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESlEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
o (C\ G , C ( Tli C L86K SEP 0 8 2003
.
Cc:. \ ECorJ DtV' (12 { 5 t::- OFFICIAL RECORDS AND
LEGISLATIVE SRVCS DEPT
CERTIFICATE HOLDER I N I ADDITIONAL INSURED; INSURER LETTER: 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
City of Clearwater IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
P. O. Box 4748
Clearwater FL 33758 REPRESENTATIVES.
I AU~~~E~
ACORD 25-5 (7/97)
@ACORDCORPORATION 1988