CERTIFICATE OF INSURANCE (2)
ACORD~
CERTIFICATE OF LIABILITY INSURANCt;AMf~~ AD
DATE (MMlDDIYY)
10/21/03
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 POUCIES BELOW.
PROD ER
Roe Insurance, Inc.
9851 State Road 54
New Port Richey FL 34655
Phone: 727-376-0030 Fax: 727-376-2262
INSURED
INSURERS AFFORDING COVERAGE
Family Resources, Inc.
Jane Harper ED
5959 Centrai Ave.
St. Petersburg FL 33701
INSURER A: AIG Insurance Corn
INSURER B: AIG Insurance Corn
INSURER C: Travelers Casual t
INSURER 0:
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 AN'( 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.
I~-r~ TYPE OF INSURANCE POLICY NUMBER DATEIMwG~Y~ "8Al,}i~.:i~w'}'i'N LIMITS
GENERAL LIABILITY EACH OCCURRENCE $1 000,000
-
A X COMMERCIAL GENERAL LIABILITY 02 LX 3295772 0 09/21/03 09/21/04 FIRE DAMAGE (Anyone fire) $ 100,000
- =:J ClAIMS MADE ~ OCCUR
MED EXP (Anyone person) $ 15,000
-
~ PERSONAL & ADV INJURY $1 000,000
GENERAL AGGREGATE $ 3,000,000
-
GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COM~OPAGG $3,000,000
h POLICY il ~rgi nLOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
f---- $1,000,000
A ANY AUTO 02 CA 6266613 0 09/21/03 09/21/04 (Ea accident)
r--
~ ALL OWNED AUTOS BODILY INJURY
(Per person) $
SCHEDULED AUTOS
r--
~ HIRED AUTOS BODILY INJURY
$
X NON-OWNED AUTOS (per accident)
r--
f---- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
R ANY AUTO OTHER THAN EAACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $2,000,000
A ~ OCCUR D ClAIMS MADE 02 UD 4659011 0 09/21/03 09/21/04 AGGREGATE $2,000,000
$
r;:=] DEDUCTIBLE $
X RETENTION $10,000 $
WORKERS COMPENSATION AND X I ~R~I~~WS I IU~~-
B EMPLOYERS' LIABILITY WC6252429 01/01/03 01/03/04 $ 500,000
E.L. EACH ACCIDENT
- ~. ---~- --, -.-.- ------ - ~ ----
- - - - - - .- ~-'--' -",-----,--.- -- ---- E.L. DISEASE - EA EMPLOYEE $ 500,000
E.L. DISEASE - POLICY LIMIT $ 500,000
OTHER
C Employee Dishonest BINDER #2486 09/21/03 09/21/04 employee 250,000
dishonest
DESCRIPTION OF OPERATIONSlLOCATIONSlVEHICLESJEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
EVIDENCE OF COVERAGE DURING POLICY TERM
CERTIFICATE HOLDER I N I ADOITIONAL INSURED; INSURER LETTER: CANCELLATION '.
CITYCLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE T+.I~ EXPIRATION
CITY OF CLEARWATER DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL .-lL ~YS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TOop SO SHALL
NINA BANDONI IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITSi~ENTS OR
P.O.BOX 4748
CLEARWATER FL 33758-4748 REPRESENTATIVES. '.
A 0 REPRESENTAT~, ,"':,
I I / f~ I ,/.." ~ I I .. I :,. :';..:'
",,'
-!,
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) 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 alter the coverage afforded by the policies listed thereon.