CERTIFICATE OF INSURANCE (224)
ACO R D",
Client:l:l:: 9838
CERTIFICAT~ OF LIABILITY INSURJjNCE
DANME
PRODUCER
PLATINUM TEAM
HENRY S. LEHR,
POBOX 25001
LEHIGH VALLEY,
INC.
I DATE (MM/DDIYY)
04/27/00
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.
PA
18002-5001
INSURERS AFFORDING COVERAGE
INSURERA:VALIANT - ZE/USI
INSURER B: ZURI CH INSURANCE ( ZE \ US I )
INSURER C:
INSURER D:
INSURED
DANIEL MEMORIAL
4203 SOUTHPOINT BLVD
JACKSONVILLE, FL 32216
I
COVERAGES
THE POUCIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOlWlTHSTANDING
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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
I~f~ TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE P9,~rJ EXPIRATION
A ~NERALLlABILlTY CMM3S106S7S OS/01/00 OS/01/01
X COMMERCIAL GENERAL LIABILITY
I CLAIMS MADE[K] OCCUR
INSURER E:
LIMITS
r--
GEN'L AGGRE~ LIMIT AP~S PER:
il POLICY I I ~~gr I I LaC
~TOMOBILE LIABILITY
r-- ANY AUTO
ALL OWNED AUTOS
EACH OCCURRENCE $1 , 000 . 000
FIREDAMAGE(Anyoneflre $1.000.000
MED EXP (Anyone person) $S 000
PERSONAL & ADV INJURY $1 000 0001
GENERAL AGGREGATE $3 000 000
PRODUCTS-COMP/OP AGG $2 000 000
-
F ECEIVEC COMBINED SINGLE LIMIT $
(Ea accident)
BODIL Y INJURY $
M ~Y 0 4 2000 (Per person)
BODIL Y INJURY $
RISK MANAGEME\JT (Per accident)
PROPERTY DAMAGE S
(Per accident)
-
_ SCHEDULED AUTOS
_ HIRED AUTOS
NON-OWNED AUTOS
-
~ARAGE LIABILITY
I ANY AUTO
B EXCESS LIABILITY CC2926646
=xl OCCUR D CLAIMS MADE
il DEDUCTIBLE
:-xl RETENTION s10 . 000
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
AUTO ONL Y - EA ACCIDENT $
OTHER THAN
AUTO ONL Y:
EA ACC
AGG
S
$
$2 . 000 . 00 C
s2 . 000 . 00 C
$
$
S
OS/01/00 OS/01/01
EACH OCCURRENCE
AGGREGATE
B OTHER PROFESSIONAL SSA911SS334
UX~;rf;,1~;.1 IOJ~
~ACH ACCIDENT $
E.L.DISEASE-EAEMPLOYEE $
E,L, DISEASE-POLICY LIMI $
OS/01/00 OS/01/01 $1,000,000/$3,000,000
-~
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CITY OF CLEARWATER IS LISTED AS ADDITIONAL INSURED AS RESPECTS TO DANIEL
MEMORIALS USE OF THIS SPECIFIC PROPERTY. PARK WILL BE USED AS AN
ALTERNATIVE TO SUSPENSION PROGRAM, RECREATION, COMMUNITY SERVICE PROGRAM
TUTORING AND HOUSEWORK.
CERTIFICATE HOLDER
I 1 ADDmONALlNSURED'INSURER LETTER:
Ice
CITY OF CLEARWATER
SID LICKTONiATTN LARRY DOWD
DANIEL MEMORIAL INC
POBOX 4748
CLEARWATER, FL 337S8
I
ACORD 25-S (7/97)1 of 2 #SS 0 8 3 9!MS 0837
tc.: {<J5K i fA(ZK,5!j <<2 ~
ffP
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATlO~
DATETHEREOF.THEISSUINGINSURERWILLm~GLL[$l~~
NOTlCETOTHE CERTIFICATE HOLDERNAMED~~" ~!o'SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND U~N {Ji7!,N~U. ~MtliilAGENTS O~
REPRESENTATIVES. Iv/A'! \1,.1 ....llUll
AUTHORIZED REPRE~TATIVE
\A}^Jk ~ lAmA
P
, 1"1 I:CLl : I MI::I\I T
ITT Cil ACORD CORPORATION 1988
'....
I
.
I
IMPORTANT
I
I
If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. A statement
on this certificate does not confer rights to the certifICate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or after the coverage afforded by the policies listed thereon.
.>i/;:.,Y {}
. ,.
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ACORD2S-S(7/97)2 of 2 #SS0839/MS0837