SIXTH AMENDMENT TO AGREEMENT WITH CERTIFICATE OF INSURANCE
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SIXTH AMENDMENT TO AGREEME~'t\'(
WITH CHI CHI RODRIGUEZ YOUTH FOUNDAT~~~:JNC{!
):
\993
F~C"
THIS SIXTH AMENDMENT TO AGREEMENT is made and entered into this cl /6T
day of ~ , 1993, by and between the CITY OF CLEARWATER,
FLORIDA, a mu~pa 1 corporat ion (the "City"), and the CHI CHI RODRIGUEZ YOUTH
FOUNDATION, INC" a Florida corporation not for profit (the "Foundation").
It is mutua lly agreed that the Agreement between the part ies dated November
12, 1985, as amended, is further amended as follows:
1. Paragraph 34 of the Agreement, relating to the construction of a
nature center and park by the Foundation, is hereby deleted,
2. Except as modified herein, all of the terms and conditions of the
Agreement, as previously amended, shall remain in full force and effect.
IN WITNESS WHEREOF, the undersigned parties have set their hands and seals
the day and year first above written.
CITY OF CLEARWATER, FLORIDA
By:
Approved as to form
and correctn s:
Attest:
~
M. A. Galbralth,
City Attorney
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By:
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Cynt i a E. Goudeau---
City lerk
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Attest:
CHI CHI RODRIGUEZ YOUTH
FOUNDATION, INC.
rilutAlI t ~JYA/;M
Secretary
By:
(SEAL)
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STATE OF FLORIDA
COUNTY OF PINELLAS
Before me the undersigned authority, personally appeared
W\\\\~ .~~./) , as President of Chi Chi
Rodriguez Youth Foundation, Inc., who by me being duly sworn, did acknowledge
before me that he is President of said corporation and did acknowledge that he
executed this instrument as his free act and deed on behalf of said corporation.
IN WITNESS WHEREOF, I hereunto set my hand and affixed my official seal
this Q\~ day of (Y\~ , 199a.
~~~
Notary Public .
My Commission Expires:
,,~;,'!A~:!%;-" AMANDA L WAGNER
f~r~"1~~ MY COMMISSION # CC 246283 EXPIRrs
;~~",~--,;~t: December 15. 1996
";4~h~:t~~~" BONDED THRU TROY fAIN lNSUR.I\N(,E, iNC.
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PRODUCER
Arrerican Busienss Insurance
Southeast, Inc.
P.O. Box 31666
Tampa, FL 33631-3666
3/5/93
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.
I
ISSUE DATE (MM/DDIYY)
CERTIFICATII'.op:;IN$URANCI:
COMPANIES AFFORDING COVERAGE
INSURED
~~T~~~NY B
COMPANY A
LETTER
Travelers Insurance Canpany
COVERAGES
THIS IS TO CERTIFY THAT 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, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
RECEIVED
MAR 0.8 f993
Clry CL
Chi Chi Rodriguez Youth
3030McMullen Booth Road
Clearwater, FL 34621
Foundat ion, Inc. COMPANY C
LETTER
COMPANY D
LETTER
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
DATE (MMIDD/YY) DATE (MM/DD/YY)
LIMITS
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE X OCCUR.
OWNER'S & CONTRACTOR'S PROTo
660607G5167
2/1/93
2/1/94
GENERAL AGGREGATE
PRODUCTS-COMP/OP AGG.
PERSONAL & ADV. INJURY
EACH OCCURRENCE
FIRE DAMAGE (Anyone fire)
MED. EXPENSE (Anyone person) .. $
1,000,000
1,000,000
1,000,000
50~000
5,000
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
COMBINED SINGLE $
LIMIT
BODILY INJURY $
(Per person)
BODILY INJURY $
(Per accident)
PROPERTY DAMAGE $
EACH OCCURRENCE $
AGGREGATE $
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
GARAGE LIABILITY
- -WORKER'S-COMPENSATION
AND
EMPLOYERS' LIABILITY
EACH ACCIDENT $
DISEASE-POLICY LIMIT $
DISEASE-EACH EMPLOYEE $
OTHER
DESCRIPTION OF OPERA TIONS/LOCA TIONS/VEHICLES/SPECIAL ITEMS
1345 Court Street, Clearwater, FL
Certificate holder is an additional insured.
CERTIFICATE HOLDER
CANCELLATION
City of Clearwater
P.O. Box 4748
Clearwater, FL 34618-4748
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
^","OA'" Un.. J~1\kBarrer
@ACORD CORPORATION 1990
ACO.RD 25-S (7/90)
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