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CERTIFICATES OF INSURANCE y M C I T Y I. F C LEA R W ATE R Interdepirtment Correspondence Sheet I m: Operations ~ FROM: Risk ~g::;"nt ~(];J;;;J · COPIES: SUBJECT: Certificate of Insurance {!;j/- L.iil' Bo!er;'VE-Z---- 'joVV-^- r;;()~~(ovJ ~~ r. ,;~:",~:\r-. DATE: 5 -f;- 88 Attached certificate of Insurance rreets lease specifications, with following exceptions: '0 / t, , (.. ~ \ ,10 V RECEIVED .. 10 1988 CIry CLEm< : lie> 3:5'(/1) ..---,.'-"'- -,/... " 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, Rodgers & Cummings Insurance Inc. P.O. Box 5148 Clearwater~ Fl. 34618 COMPANIES AFFORDING COVERAGE COMPANY A lETTER Travelers Insurance Co. INSURED CHICHI RODRIQUEZ YOUTH FOUNDATION, 1345 Court Street Clearwater, Fl. 34618 COMPANY B lETTER IN COMPANY lETTER C COMPANY D lETTER THIS IS TO CERTIFY THAT 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 CONDI. TIONS OF SUCH POLICIES, TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE OATE (MMlDD/YV1 POLICY EXPIRATION DATE (MM/DDNY) J ,:A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE ~ OCCURRENCE OWNER'S & CONTRACTORS PROTECTIVE GENERAL AGGREGATE PRODUCTS,COMP/OPS AGGREGATE 02-01-89 PERSONAL & ADVERTISING INJURY EACH OCCURRENCE FIRE DAMAGE (ANY ONE FIRE) MEDICAL EXPENSE (ANY ONE PERSON) 660 607G516-7-COF-88 02-01-88 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS GARAGE LIABILITY CSL $ BODILY INJURY (PER PERSON) $ BOOIL Y INJURY rJ~DENn $ EACH OCCURRENCE OTHER THAN UMBRELLA FORM WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY $ $ $ OTHER DESCRIPTION OF OPERATIONS/LOCATlONSIVEHICLES/RESTRICTIONS/SPECIAllTEMS (DISEASE. POLICY LIMIT) (OISEASE,EACH EMPLOYE.) ":::I" .~ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX, PIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF Y KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES, AUTHORIZ EPRESENTATlVE /2_ ~_ N(~. City of Clearwater P.O. Box 4748 Clearwater, Fl. 33518 ATT: Don Petersen, Risk Manager ~. .. . I.!I -,. . -" . .,. . .. . PRODUCER 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. Shelly, Middlebrooks & O'Leary POBox 2909 Jacksonville, Fl. 32203 COMPANIES AFFORDING COVERAGE INSURED COMPANY A LETTER National Indemnity Co. of Florida COMPANY B LETTER CHI CHI RODRIQUEZ YOUTH I FOUNDATION, INC. 1345 Cour"c St. Clearwater, Fl 34618 COMPANY C LETTER COMPANY D LETTER , r..-:. ::I- .~t _..... !~_..~..,,:,;".:?";!f.~.~; _ _;".,.~,"...__1;,,_.~~~ .,..... ,"U.j.~:~ -"--i""',- ._.........'!t~...'=-t''':'~~.:.: "l ~ " _ f! ..4."-~~:-~..~",--,, ~......' ~r:.r. "'C':'" .. ~,-"'~';" COMPANY E LETTER THIS IS TO CERTIFY THAT 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 CONDI- TIONS OF SUCH POLICIES, co .." LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION ALL LIMITS IN THOUSANDS DATE (MMlDDIYY) DATE (MM/DDI.YYI GENERAL AGGREGATE PRODUCTS,COMP/OPS AGGREGATE PERSONAL & ADVERTISING INJURY EACH OCCURRENCE FIRE DAMAGE (ANY ONE FIRE) MEDICAL EXPENSE (ANY ONE PERSON) CSL $ BODILY INJURY Binder #SDS173 5/9/88 5/9/89 (PER PERSON) $ BOOIL Y INJURY ~"JtoENn $ GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE D OCCURRENCE OWNER.S & CONTRACTORS PROTECTiVE , _f r I i l' AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS X SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS GARAGE LIABILITY EXCESS LIABILITY r ,- OTHER THAN UMBRELLA FORM WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY $ $ $ (DISEASE,POLlCY Uf~IT) (DISEASE.EACH EMPLOYEE) OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I RESTRICTIONS I SPECIAL ITEMS '-., ::s- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX, PlRATlON DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF Y KINO UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES, AUTHORIZE PRESENTW~ununingS Ins City of Clearwater POBox 4748 Clearwater, Fl. 33518 ttn:Don Petersen, Risk Manager 't' e.lel-II .. ...... ......... "j 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, Rodgers & Cummings Ins Inc POBox 5148 Clearwater, Fl 34618 COMPANIES AFFORDING COVERAGE COMPANY A LETTER Travelers Insurance Co. INSURED COMPANY B LETTER CHI CHI RODRIQUEZ YOUTH FOUNDATION, INC. 1345 Court St Clearwater, Fl. 34618 COMPANY C LETTER COMPANY D LETTER COMPANY E LETTER Ga. ._~,'~ :,.,~.;~:<f"r~~."o ,- ~'-'.."::"_'_'. ~.." .:Q: .' ...,. _ .' T...-~'-.' . ~ '. '\ '. ,:"',,,: ,', ,,,.D- ~::~~ THIS IS TO CERTIFY THAT 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 CONDI- TIONS OF SUCH POLICIES, TYPE OF INSURANCE POLiCY NUMBER POLICY EFFECTIVE POLICY EXPIRATION ALL LIMITS IN THOUSANDS 0,1, TE (MM/ODNY) DATE (MMlDDIYV) GENERAL LIABILITY GENERAL AGGREGATE COMMERCIAL GENERAL LIABILITY PRODUCTS,COMP/OPS AGGREGATE CLAIMS MADE o OCCURRENCE PERSONAL & ADVERTISING INJURY OWNER'S & CONTRACTORS PROTECTIVE EACH OCCURRENCE FIRE DAMAGE (ANY ONE FIRE) MEDICAL EXPENSE (ANY ONE PERSON) AUTOMOBILE LIABILITY ANY AUTO CSL $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (PER PERSON) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS tER $ CCIOENn GARAGE LIABILITY EXCESS LIABILITY EACH OCCURRENCE OTHER THAN UMBRELLA FORM WORKERS' COMPENSATION $ AND UB-272J187-6-88 2/1/88 2/1/89 100 EMPLOYERS' LIABILITY $ 500 (DISEASE,POLlCY LIMIT) $ 100 (DISEASE, EACH EMPLOYEE) OTHER ...,'" "\; " r, ~'~ ~o ' i?' DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES I RESTRICTIONS I SPECIAL ITEMS City of Clearwater POBox 4748 Clearwater, Fl. 33518 Attn: Don Petersen, Risk Manager SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX, PIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 3 0 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 KINO UPON THE CO ANY, ITS AGENTS 0 EPRESENTATIVES, AUTHORIZED REPRESENTATIVE '_~'2,5.S;(11/85)r :,' .,'\ ,:,.:,-..-:. '.~.' ' ~,c.. ,: .:';." .;., ~';~,' ",";-!, '~'>::"",:'-t':;~'~'-;'_'~;:'-';":>.()'<",.;";':"":J">oCJIRlACORU1:ORPORATlOH< .. THIS IS EVIDENCE THAT INSURANCE AS IDENTIFIED BELOW HAS BEEN ISSUED, IS IN FORCE, AND CONVEYS ALL THE RIGHTS AND PRIVILEGES AFFORDED UNDER THE POLICY, PRODUCER COMPANY I Rodgers & Cummings Ins Inc POBox 5148 Clearwater, Fl 34618 CODE SU~ODE Travelers Insurance Co. INSURED LOAN NUMBER CHI CHI RODRIQUEZ YOUTH FOUNDATION, INC. 1345 Court St. Clearwater, Fl. 34618 EFFECTIVE DATE (MMlDDIYY) 2 1 88, THIS REPLACES PRIOR EVIDENCE DATED: PROPERTY INFORMATION LOCA TION/DESCRIPTION 1345 Court Street, Clearwater, Fl. 33516 COVERAGE INFORMATION COVERAGES! PERILS /FORMS AMOUNT OF INSURANCE DEDUCTIBLE All Risk/Replacement Cost-Building #1 110,000 250 All Risk/Replacement Cost-Contents-Building #1 25,000 250 All Risk/Replacement Cost-Building #2 25,000 250 All Risk/Replacement Cost-Con tents-Building #2 2,500 250 All Risk/Replacement Cost-Building #3 8,000 250 All Risk/Replacememt Cost-Building #4 2,000 250 REMARKS (Including Special Conditions) NCELLA TION ' THE POLICY IS SUBJECT TO THE PREMIUMS, FORMS, AND RULES IN EFFECT FOR EACH POLICY PERIOD. SHOULD THE POLICY BE TERMINATED, THE COMPANY WILL GIVE THE ADDITIONAL INTEREST IDENTIFIED BELOW 10- WRITTEN NOTICE, AND WILL SEND NOTIFICATION OF ANY CHANGES TO THE POLICY THAT WOULD AFFECT THAT INTEREST, IN ACCORDANCE WITH THE POLICY PROVISIONS OR AS REQUIRED BY LAW. DITIONAL INTEREST ' NAME AND ADDRESS NATURE OF INTEREST MORTGAGEE ~ ADDmONAL INSURED City of Clearwater POBox 4748 Clearwater, Fl. 33518 Attn:Don Petersen, Risk Manager LOSS PAYEE t::1.. . .... __ ..,. ..... ....