CERTIFICATE OF INSURANCE (2)
HRH Company of Tampa
5405 Cypress Center Drive
POBox 23968
Tampa, FL 33623
O"'TEIMMiDD/V'l'l
12/23/98
THIS CERTIFICATE IS i ED AS A I\IATTER OF INFORMATION
ONL.Y AND CONFERS '" RIGHTS UPON THE CERTIFICATE
HOL.DER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
AL. TEA THE COVERAGE AFFORDED BY THE POLICIES BELOW.
0:>4,:;;:. ,
SACl ~AX ::,1:)6:~~ :r~l4.V ...t::~_ :~'JV~..1.u..~1A,~
_'\JV:J
PRODUCE~
ACORD", CERTIFICA. E OF LIABILITY INSURA
rYtJ. 0!Jk}L.-
(.js It..-
CE
INSUR ERS AFFORDING COVERAGE
I
jNSLJREO---.---------~--- --- ---~-----------------------.!~;-;~-;centu-ry
Ervins All American Youth Clubinc
: 'NSui'!ER 8:Pafco
Club, Inc. I
1250 Holt Avenue INSuRER C:
: INSuRER D:
Clearwater, FL 34615 ir.SURER:;
COVERAGES
Surety
THE POI.IOESOF INSUAA'IICE USTED BELON HAVE BEEN ISSUED TO TrtE INSURED NAVlED A&NE FOR ThE POUCYPERlOO INDICATED. NOTWITHSTANDING
PNY REQUIREMENT, TERM OR ~omOl'j OF AAv CONTRACT OR OTHER DOCUMENT WITH RESPECT TO W-UOH THIS CERTIFICATE MAY BE ISSUED a:l
MAY PERTMN, THE INSURANCE AFFCR:lED BY THE PO..ICES DESCRlBEC HEREfIl IS SUB.ECT TO ALL THE TEmS. EXCLUSIONS AND COIIDmONS OF SUCH
POUOES. ~GGREGATE LIMITS SHOW:o.I MAY HAVE SEEN R9)L;C8) 5Y PAlO ClAIMS.
;~1~R, TYPEOF INSUR...NCE I POL CYNUlotBER i,,%~iTE ~M'o;.,"'O~ iPOD~~~I~:rtri~ i lllot:rs
A ~NER"'llIUllITY iCCP155512 !12/18/98 12/18/99 iEAC~OCCUR"ENCE . :$500,000
~Mei'!CI...LGENE~I...8!lITY I ' ! FiRED"'M"'Gel...nyon."r1l'1 $50,000
H-J CLAIMS ......DEU OCCUR I I : l.1ED eXP(Anyontpt"on) .. $
~ i i PE~SON"'c&"'DViNJURY 1$
~ I I '3ENER...c...GGR:G",TE 1$500,000
'GE'<'c...3GR;:G"T:cIMIT"PPLIES"ER:: ! i PFlODUCTS .eo/,Jp!op"GG] $
~ . ~ PRO.'----' Ii. I
i I PO;"I CY' I q:CT i L.::lC ! I I
i ...UTOMOBilE liABiliTY I i :lOVBIN:DSir.GLE LIMiT i $
q "~Y "'LiTO i I : ::u,.cidentl :
h "cLOWr.ED"'UTOS : i30DILYIN,IURY '$
i iSC~EOULEDA~"'OS I ~~'1rpIrBOO) ]
r----; I
i I t-';~ED AUTOS I I
n NON <)W" "D"'UTOS I [~,o~C;~~~ITF;Y 1$
· H.. . - I "'"OPERTY:l...~...3e I
~ ~ ~~r accident) I $
~~"'GE liABiliTY
I ANVA:JiO
r-i
, ~ ETE,.~ T!CN
s
~u TO ~~_~~_ACCi 0 EN T l!----~-~
: OTfJE" TH"'N E'" ...ce : $ __
I...UTOCNLY: "'GG S
i EACfJ OCCURRENCE : $
...GIiR EGA TE ! $
, I
I : $
~-_. I
[$
i$
~ESS l''''SI"TY . '
I, " I
~ :>CG:JR : i.CLAt~S YAJE
~_ - i
i I I
. i Je::Jucr:8~E
WORK:,.S COOlPENS...T10N ANO
EIIPLOYER9 li"'BIL'TY
! iT~~i~~J,~s I :O~~'I
! E.. EACH "'CCI:lE"T i $
i E.L.:lISEAS: E" EMFLOYE:] $
f--=.--..----I~-----_.~-
; ,;:.c. [)ISEASE ."OL.:;Y clYT 1$ ..
!
B I OTHE,. COIr.m Fire &
iPACP00042117000
i
;12/09/98!12/09/99 I
I I i
, i i
I
OESCR'PTON OF OPER...rO"lS/,OCA TiONS/VEHiClES/EXC..USiONS "ODED BY E~OORS EMENT/9PEC'''' l PROVISIONS
CERTIFICATE HOLDER
: X I AOOITONAlNSU~EONSJRER "EHE'l:
CANCELLATION
SHOJ lD...NYOFTHEABOVE OESC,. BED "OL'CiES BECA~CELlEO BEFORET~ E EXP'RA 'tON
O"'TETHER EOF, T,j E .SSU,NG ~SUR ER WI II EN DEAVOR TO MA' ~11L._ CAYSWRnEN
NOT:CETOTH E CERT'f'lCATE HO.t: E~ h,lMEO lOT~E lEfT, BUTF""lJRE TO OOSOSH...lL
'MPOSENO OB L.G...TiON OR l...1 " TV OF "'NYK;ND UPO~ TH E :NSU RER"TS AG ENTS OR
City of Clearwate~
P .0. Box 4 74 8
clearwater, FL 33758
ACORD 25-S (7!97) 1 of 2
;#11716
ti) ACORD CORF'ORATION 1988