CERTIFICATE OF LIABILITY INSURANCE
I H.......L... rJ.L1 U.l.
ACDRQ CERTIFICATE OF LIABILITY INSURANCE I DArE (MMIDD/YYYY)
09/30/2005
PRODUCER (727)461-3704 FAX (727)441-3l98 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Lancaster Insurance Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
1210 S. Myrtle Ave. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
POBoX 2356
Clearwater, FL 33757 INSURERS AFFORDING COVERAGE NAiC#
INSURED M~ Carmel Communl'ty Development Corp INSURER A: Sco~~sdale Insurance
1751 Kings Highway INSURER B:
Clearwater, FL 33755 INSURER 0:
INSURER D:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAV~ Br;;:EN ISSUED TO THE INSUR~D 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 P"RTAIN. THE INSURANCS AFFORDED BY THE POLICIES DE5CRIBED HEREIN IS SUElJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLlCIES_ AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
IIIISR IADD' riPE OF INSURANCE POLICY NUMBER. POUCV EFFECTIVE Pg~g EXPIRATION UMITS
GeNeML UABI~m CPS0667444 09/Z6/2005 09/26/Z006 EACH OCCURRENCE S 1,000,00
X COMMEROIAL GENERAL LIABILITY DAMAGE TO Fll:III"n:O , SO,OOI
I CLAIMS MADE 00 OCCUR MED EXP (Anyone person) $ 1,001
A PERSONAL & ADV INJURY $ 1,000,001
- GENERAl. AGGREGATE $ 2.000,001
I--
GEIII'L AGGREGATE LIMIT APPLIE8 PER: PRODUCTS-cOM~OPAGG $ Excl ude.
II POLICY n ~~.?-r n LOe
AUTOMOBiLe LIABILITY COMBINED SINGLE LIMIT $
- (Ee accident)
AI-N AUTO
- .
ALL OWNED AUTOS BODILY INJURY
I-- (Per pe"""n) $
SCHe.OULED AUTOS
I--
I-- HIRED AUTOS BODILY INJURY
(per accident) S
NON-OWNEO AUTOS
-
PROPERTY DAMAGE s
(p.". aCCIdent)
GARAGE LIABILITY AUTO ONLY - EA >\CCIDENT $
q ANY AUTO OTHER THAN EA Ace $
AUTO ONLY: AGG $
EXCESSlUMBRELLA LIABILITY . EACH OCCURRENCE $
~ . OCCUR 0 CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE S
RETENTION $ $
WORKERS COMPENSATION AND I WC STATU- I jOJ,tt-
EMPLOYEAS'I.IAB,LrTY e.L. EACH ACCIDENT S
ANY PROPRleTORIPARTNERlEXECUTI\IE
OFFICER/MEMBER EXCLUDED? E.L DISEASE - EA e;MPLOYEe $
If ~9. descnbe under E.L. DISEASE - POliCY L.IMIT
S ECIA!.. PROVISIONS below S
bTIiER
DESCRIPTION 9F OPERATIONS I LOCATlO","S I VEHIClES I EXCWSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS liability subject to the terms,
he Cer~,ficate Holder 1$ an Additional Insured as respects General
~onditions and exclusions of the policy.
CERTIFI
ER
N
SHOULD ANY OF THIil ABOVE DESCRIBED POLICIES BE CANCElLED BEFORE tHE
I!XI'IIVtTION PATE THEREOF, 1lIe! ~:SUING INi5URER WILL ENDEAVOR TO MAIL
....!!L. DAYS ~EN NOTlc.e TO THE CERTIFICATE HOLDE;R NAMED TO THE LEFT.
BUT FAILURE TO MAIL SUCH NOTICE SHAI.L IMPOSE NO OBLIGATION OR llABIUlY
OF ANY KIND UPON THE INSURER, ITS AGeNTS OR REPRESENTATIVES.
AlITlfORU:ED REPRESE TIVE
City of Clearwater
Department of Parks & Recreation
Attn: Kyle
POBox 4748
Clearwater, Fl 33758
ACORD 25 (2001/08) FAX: 562-4825
@ACORD CORPORATION 1988