CERTIFICATE OF LIABILITY INSURANCE (8)
AUG~24-04 14:28 FROM-
ACQ.BQ.. CERTIFICATE OF LIABILITY INSURANCt:
p~UCY (727)5Zl-4253 FAX (727)527-9455
ARC Northea5t Ass~rance. In~
4790 1st S~reet North
P.O, Box 750fi
St. Petersburg. F~ 33703
Il'4SIlReD COlmtrys e Gol Practlce" Learnlng Center
2987 Mcmullen Roa.d
Clearwater, FL 33761
T-7l9 P.Ol/Ol F-77a
08/24/2004
THIS CERTIFICATE IS ISSUeD AS A MA11'ER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. nU5 cERnFlcATt: Does MOT AMEND. EXTEND OR
ALTER TtiE COVERAGE AF ORCED BY THE POLICIES BELOW.
INSU~ERS AFFORDING cOV~RAGE
II'lSuREf'{A Burl; ngton Insurance COll1'any
INSt.lRJ:Ra Travelers Casua.lty & Surety CO
INSURER C'
INsu~R P
INSURER E
HAIC 'II
23620
AGI=~
THE PO\.ICIj;S OF '''ISURAf>/C!: l.ISTED 6E:l.OW HAVE: BE!:N ISSUED TO TI'lE INSURED NAMED ABovE FOR THE POLICY PERIOD INDICATED NOTWITHSTAN01N
ANY R~auIREMENT, TERM OR CONDITION OF ANY cONTRACT OR OTHER DOCUMENT WITH RESPECT TO WMICH THIS CERTIFICATE NlA Y 6E ISSUED OR
MAY PERTAIN. THE INSuRANCE AFFORDED at 'fHE POLICies DESCRIElE:D l1eR~IN IS suBJECT TO Al.l. TrtE TERMS, EXCL.USIONS AND CONDITIONS OF SUCI1
POLICIES, AGGREGATE LIMITS SHOWN I'VIAY IiAVE ElEEN REOUCED BY PAID CLAIMS.
1!'I.:6 ~gl 1'VPE OF ,~~uRANCE POI.ICT NU~IiJ;A POl.l.ey EFFECTIvE ~JiY iill.P,AATlON UMITS
G\:~liAAL L1AB.....rv 1968001i02 07/1!J/2004 07/19/2005 EAC" OCCURRENCE:: $ 1000OO(]
-::- DAMAGe T9,..RENTE.D 5000ll
X COMMERCIAL GENIiAA... "'lAa'L'TY $
I Cl.AII'JIS MIlDI' m OCCuR MED E;(P (Any Ql1.. I"'! son) $ lOcK
A PERSOAA"'!I. AOV INJUFty $ 100000(
GENe~"'AGGReGATE $ 20000011
GEN'... AGGAIiGA TIS I.IMli APPl.liOS pER PFlODuCTS . COMPtO? AGG $ 200000~
I ,nPRO- n
PO...ICy JeeT I.OC
~O""QBIl.e LJAj;I'''ITY .
COMBINED SINGLE LIMIT $
ANt ALlTO lEailc:oclcnlJ
f--
ALL OWl'4eo AUTOS BODILY IIiJI.JRY
I-- [Per p~l..onl S
SOiEDULEP AuTOS
I--
tllRfD AuTOS BOOII.Y INJuRy S
r-- (P8I acc.Qcm)
NON.oWNEo AuTOS
'--
- PflOPERTY OAMAGE S
(Per ~C:C:ldal1l)
GAIUoGE Wl-ltl...ITY AuTO ONLY - eA ACCIDE::I'lT S
==l ANY AuTO OTnER TH""N EA ACC $
AuTO 0....... Y. AGG $
Qli5SlUMBR~"&.A ...lAIIlu-rr IiACI'l occuARiNCE $
OCCuR 0 ClAIMS MADE AGGREGATE ~
$
R D50uCiI~~E S
RETEI'lTION S $
wORKSftS cOMPeNSATION AND IAC~UB-1432A95-1-03 09/19/2003 09/19/2004 I T"X~~:~!~~ I IOJ~
EIIIPI.01,.R:ii' LIAiIII-llY Ii,... EACt1 ACCIDIONT S 100,000
B ANY PROPRlfTOR/PARTNl:R/EXSCl1TlvE e.... DisEASE. lOA EMPl.OYE::i 100,OOQ
OFFICEM4eI'lll8!f( exCl.uDeD? $
If ,,~e, QBScnbe> ~nCl8r E I. DISIOASE - pO...ICY I.II'~IT $ SOO.OOel
S IiiCIAL PROVISIONS DCIQ..
OTHeR
DeSCflIPTION Of OPERATlONS I I.OCA'nONS I V~ICI.~' ~C:l.USlO":; ADDeD 1$.. EiNllORS"IlI~T I SP\:CtAl. PROVlSION15
StlouLD 11>1'11 of Tl'le ADOvi DESCRIBeD POUCles j;lJ; C:ANCE~l.EiO 8EFOFte T"E
ExPIRATION DA'l'S T"EREOF, T"f 1:i&UING II'l:iiURER Wll.L ENDl:AIIOR TO MAIl.
..1!- DA'Ys tlRlTTl:N "IOTlCE TO Tne c~RTII'ICAn: "OLDER NA""~D TO Tne "'EFT.
8\IT FAILuRE TO MAlL SUe" NOTICi St\lU.l. IMPO~ NO oa",IG,,1'ION OR LIASI",ITY
Of AIo.. !<IND "'PON Tn!! INSuRliR. ITS AGiNTS OR REPRESeNT A r....ss-
A\lT"ORlZ~ REPRJ;$SNTATlvE
On file with Co an
eACORD CORPOAATlOM 191
City of Clea~ater
Par~5 & Recreation
P 0 tlQx 4748
Clearwater, F~ 33758
ACORD ~S l20011Q8) FAX: (727)562-4825