CERTIFICATE OF LIABILITY INSURANCE (7)
ACORDm CERTIFICATE OF LIABILITY INSURANCE OP 10 ADI DA TE (MM/DDIYYVY)
FOUNVIL 09/29/05
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIDr
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Greg Roe Insurance, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
9851 state Road 54 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
New Port Richey FL 34655
Phone: 727-376-0030 Fax:727-376-2262 INSURERS AFFORDING COVERAGE ; NAIC#
INSURED INSURER A: RiveJ:Port Insurance Company 04377
Foundation Village INSURER B: Underwriters at Lloyd's
Neighborhood F~ly Center,Inc INSURER C:
F~~ centers Inc.
918 oodlawn t. INSURER D:
Clearwater FL 33756
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 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.
LTR NSR[ TYPE OF INSURANCE POLICY NUMBER PD9..~~rJ'~fJ'&~E Pgk ?EY,~~mf,~,gN LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
r-- ~!lliE rul"<<:O" I <:ow
A X COMMERCIAL GENERAL LIABILITY NIA1810965 10/01/04 10/01/05 PREMISES (Ea occurence) $ 100,000
I CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 5,000
PERSONAL & ADV INJURY $ 1,000,000
-
GENERAL AGGREGATE $ 3,000,000
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $3,000,000
I .nPRO- nLOC
POLICY JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- $ 1,000,000
A ANY AUTO NIA1810965 10/01/04 10/01/05 (Ea accident)
-
ALL OWNED AUTOS BODILY INJURY
- $
X SCHEDULED AUTOS (Per person)
-
X HIRED AUTOS BODILY INJURY
- $
X NON-OWNED AUTOS (Per accident)
-
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
~ ANY AUTO OTHER THAN EA ACC $
AUTO ONLY AGG $
EXCESS/UMBRELLA LIABILITY RECEIVED EACH OCCURRENCE $
.::::J OCCUR D CLAIMS MADE AGGREGATE $
SEP 2 9 20m $
~ DEDUCTIBLE $
RETENTION $ nl~1/ .. A . .. $
WORKERS COMPENSATION AND I I TORY LIMITS I IU~~-
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT l $
I-- OFFICER/MEMBER EXCLUDED? - E.L. DISEASE - EA EMPL()YE~r$
If yes, describe under
SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $
OTHER
A Sexual/Prof Liab NIA1810965 10/01/04 10/01/05 Sxl/Prof 1,000,000
B Buildinq Covq 5597 02/22/05 02/22/06 Bldg Covq 303,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
HOLDER IS ADDITIONAL INSURED LIABILITY FOR BLDG LOCATED 918 WOODLAWN DR
CLEARWATER FL 33756, EFF 12/01/99 (OWNER OF BLDG)
CERTIFICATE HOLDER CANCELLATION
CITYCLR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
CITY OF CLEARWATER
ATTN: MR. SCHROEDER
PO BOX 4748
CLEARWATER FL 33758 4748
@ ACORD CORPORATION 1
ACORD 25 (2001/08)