CERTIFICATE OF LIABILITY INSURANCE (2)
..~
A CORaM
CERTIFICATE, OF LIABILITY INSURANcI,E
PRODUCER
ACORDIA EAST - TAMPA BAY
P.O. Box 31666
Tampa, FL 33631-3666
727-796-6666
INSURED
INSURERS AFFORDING COVERAGE
Zurich Insurance Company
Zenith Insurance Co
INSURER A:
INSURER B:
INSURER C:
INSURER D:
INSURER E:
Chi Chi Rodriguez Youth
Foundation, Inc.
3030 McMullen Booth Road
Clearwater FL 33761
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.
I~.f: TYPE OF INSURANCE POLICY NUMBER ~~~~;Jt.~~~'J'.l.'if, PgklfEY EXPIRATION LIMITS
A ~ERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
-. ...... 'l'-.<.<-----F:l ",-,...-.,
CLAIMS MADE W OCCUR
CMM58582959
2/01/01
2/01/02
-
-
GEN,L AGGREGATE LIMIT APPLIES PER:
)(l POLICY n j~RT nLOC
A AUTOMOBILE LIABILITY BAP2997221
-
ANY AUTO
-
ALL OWNED AUTOS
-
X SCHEDULED AUTOS
~
X HIRED AUTOS
~
..K.. NON.OWNED AUTOS
-
GARAGE LIABILITY
~ ANY AUTO
A EXCESS LIABILITY UBA58582991
:xi OCCUR D CLAIMS MADE
2/01/01
2/01/02
2/01/01
2/01/02
I DEDUCTIBLE
"Xl RETENTION $
10000
B WORKERS COMPENSATION AND
. _ EMPLOYERS:J.JABI~lTY_
65212
-. -
2/01/01
2/01/02
OTHER
EACH OCCURRENCE $
_,1'IRE DAI'J1AGE (Anyone fire) .$.
MED EXP (Anyone person) $
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
PRODUCTS. COMP/OP AGG $
COMBINED SINGLE LIMIT $
lEa accident)
BODILY INJURY $
(Per person)
BODILY INJURY $
(Per accident)
PROPERTY DAMAGE $
IPer accident)
AUTO ONLY. EA ACCIDENT $
OTHER THAN
AUTO ONLY:
EA ACC $
AGG $
1000000
100000
5000
1000000
2000000
2000000
1000000
1000000
1000000
.. 500000' -
500000
500000
~ [J""".If""<; 'l""'1o' "\l t,r.... r-\.
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS H ~ \ , c.. '\1 ije II .... E eEl V E 0
GLEN OAKS GOLF COURSE AT 1345 COURT ST" CLEARWATER, FL & CHI CHt- - ~
RODRIGUEZ GOLF COURSE AT 3030 MCMULLEN BOOTH ROAD, CLEARWATER, Fo!- " .'
CERTIFICATE HOLDER IS AN ADDITIONAL INSURED IN RESPECTS TO ' FE B 0 2 ?001
GENERAL LIABILITY
EACH OCCURRENCE
AGGREGATE
IWC STATU. I 10TH-
TORY LIMITS I ER
E.L. ~FrAC-CIDEIIIr' - h'"
E.L. DISEASE - EA EMPLOYEE $
E,L. DISEASE - POLICY LIMIT $
CERTIFICATE HOLDER
I X I ADDITIONAL INSURED; INSURER LETTER:
CiTY CLERK DEPARTMWT< MANAGEMENT
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
CITY OF CLEARWATER
ATT-LEO SCHRADER/RISK MGMT DIV
P.O. BOX 4748
CLEARWATER, FL 33758
cc: CI~CL~~~ f~K5Q R~c
ACORD 25-S (7/97)
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES,
( r<. I Sf- AUTHORIZED RE~~T:'
45- 69' ~
" ~~~
...~ @ACORD CORPORATION 1988
IIIIJ -
...
I.
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed, A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s),
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement, A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s),
DISClAIMER---.~-----
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon,
ACORD 25-S (7/97)