CERTIFICATE OF LIABILITY INSURANCE
PRODUCER (727)461-3704
Lancaster Insurance Inc.
1210 s. Myrtle Ave.
POBox 2856
Clearwater, FL 33757
INSURED Bethany Educati ona 1 Program, Inc.
1250 Holt Ave
Clearwater, FL 33755-3342
FAX (727)441-3298
DATE (MM/DDIVYVV)
02/07/2005
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.
ACORQM
CERTIFICATE OF LIABILITY INSURANCE
INSURERS AFFORDING COVERAGE
INSURER A: Scottsdale
INSURER B:
INSURER C:
INSURER 0:
INSURER E:
NAIC#
-,--,,1
--i
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.
INSR DD'l TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
GENERAL LIABILITY CLSI092127 01/03/2005 01/03/2006 EACH OCCURRENCE $ 500.001
I-- DAMAGE TC?_ RENTED
X COMMERCIAL GENERAL LIABILITY $ 100,00C
- ~ CLAIMS MADE 00 OCCUR
MED EXP (Anyone person) $ 5'00J
I--
A PERSONAL & ADV INJURY $ 500,oor
I--
GENERAL AGGREGATE $ 500,OCe
I--
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 500,000
n n PRO- nLOC
POLICY JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT I
I-- (Ea accident) $
ANY AUTO I
- I
ALL OWNED AUTOS BODILY INJURY
- (Per person) $ I
SCHEDULED AUTOS I
-
HIRED AUTOS BODILY INJURY J
- (Per accident) $
NON-OWNED AUTOS
-
- PROPERTY DAMAGE $
(Per accident)
---
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
~ ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
~ OCCUR D CLAIMS MADE "-
AGGREGATE $
$
~ DEDUCTIBLE $
..---
RETENTION $ $
WORKERS COMPENSATION AND I TVX~JT ~II~;' I IOJ~-
EMPLOYERS' LIABILITY '00
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ -I
If yes, describe under E"L. D~EASE - POLICY LIMIT
SPECIAL PROVISIONS below $
OTHER -'-
, ,
t -..l'-__...
.- __oj
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS ~
' ""iiI,,") I
ertificate Holder is also an additional insured. :.~ ' 0/" . I
P;f.<i.i;;~;,. ,'J I
I
-",/~-' "', j
':~OJ\l
CERTIFICATE HOLDER CANCELLATION ~I
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE "1
City of Clearwater EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
Department of Parks & Recreation -.!L DAYS WRITTEN NOTICE TO THE CERTIFI<:ATE HOLDER NAMED TO THE LEe';', j
Attn: Kevin Dunbar BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
POBox 4748 OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES_
Clearwater, FL 33758 AUTHORIZED REPRESENTATIVE
Ronald Lancaster
ACORD 25 (2001/08) FAX: 793-2328
@ACORD CORPORATION -1988