CERTIFICATES OF INSURANCE (2)
>'....e.......R......T'6IH..i\.TE':AOt........i\.C't..>..-rv...'t'.KIc6I...ib.A.KIH'e.l< ................. DATe (MM'OO"Y)
y............>.>I.r..yf':\'....\,JP.....f':\P.....JI..>. .1~.,;llJ~.~\;.,;............>>.~:cf~{ 11/27/00
., THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND COUFERS NO R~GHTS UPON THE CERT'F1CA1"E
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
""'__=~_::r6~ :.;..r~.".~
ACORD..
p~DOLlCe~
IGreg Roe Insurance. Inc.
19851 State Road 54
/New Port Richey FL 34655
Alvina Davis A062355
Phone No 727-376-0030
-1
1
I
I
COMPANY
A
N~npr~fits Ins. ~~sQ~i~ti~n
FilXNo 727-376-2262
J."!SI)PED
COMPAlfi
B
Foundation Vi1lage
Neighborhood Faud1y Center,Inc
Fa...'!\ily C9!'!.t.~, !n.e.
918 Woodlawn St.
Clearwater FL 33756
COt.llP,.,u,'
c
COM.OAJ',tI
D
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOO
INUI(;AII:.U, NO I WIlffi>JANUING ANJ I<I:.UUI/C~I:.NI, JI:.I<M 01< ~ONUI"ONOt- ANJ ~ONII'CA~I O/C OIHI:./C LJVUJMI:.NI WII/1 /C1:.~"I:.~f 10 IIVHI<';H 1/1IS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORD!D BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TeRMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIUITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
co
LlH
I POUCY EFFECTIVE
DATE (....ooI'() j
I POUC"{ EXPIRATION
O~ 1 E ,MMIOONY)
jyPF OF INSl ,IPANr:F
POI tr:y Nt JMFl~
~e~AL UAelUTY
A I<X.I CO~Me~CV\L GENeRAL ~i
~ CLAJMS MADE ~ OCCUR
H O\.'~'i'~'$.!. ":'vNTRA(,TOR'S PA0T
IUAlll08125
10;01/00
~_GENe~ALAGGReGATe
10;01/01 P~OO\.ICTS.CO""'/OPAGG
IIMlTI'l
I $ 3, 000,000
$ 3,000,000
Pt:RSONAL&ADVU'.JJVR:~$ 1, uuu, auti
Ek":'H OC'.:>.;RREI'lCe :Ii 1 (ooo GOO
... 1nt\ nnn
I ~::~;:::::P:::::) I : ;~~~~vv
A R~:R~::':~OS
n Sc~eOULeO AL'1'OS
[xl HIRED AUTOS
t=j NON.OWNED AUTOS
10/01/01
I COMBINeD SINGLE UMfT
I o-~"""''''~"
I (P~~p'e~~;r'"
r-~~~'~~'I~;~::;-
~er acCident)
I J:1PC'f:'i:=.o:'fv (l,AoM,II.t;E
JlIAla08125
10/01/00
~AGE UABtUTY
IWY AUTO
AL'1'O ONLY, eA ACCIOeNT
I OTHE~ THAN ",.'1'0 ONL \'
~ eACH ACC1DENT
A(:i'-:i~t:(,;iAft::
E)(CESS UABlLiTl
E.'::"CH CCCURRENCE s.
H :~~~'::~~:'~~~~'~,~E'-L~F0PM
.,r-f"r'U::"""''''n:: ~
WO~KERS COMPENSATION AND
I EMPLOYERS'LII'BIUTY
I
I
T-------
I 10/01/01
I 10/01/01
EL EACH ACCIDENT
..--+----------
I
I
EL OOSEASE . POUCY UMrr
I eL DIS~~;MPLOYE~-- $
~-~ . T.-----~-----..-~-._-..---.
I
I
10/01/00
10/01/00
Prof Liab
Sd Liab
Ut::;jl,:1-<1P liON l)t'" Ut-'t=k,..II(,)N::iIU..}'i..;,..11VN~i\it:t1lLLt:~~Pt:LlAL II t:M~
I F~YF.D TO ~2~ 562 4037,
CE'R'fIFICAreHOLOER
CITYCLE
S.~0t~Jz....~ ...! r'( c!" ~ :"E'.0".~ n!::;."2P~.!:a P0UC~S ~.!: ':,^.~!-::'2Lz....=-~ e,ff0~€ ~.~
I' 500,000
I
I $
. r.- - . ..--.-
I'
I~
I
--1
I
1'<
.
~~-=---l
I
1,000,000
1,000,000
CITY OF CLEARWATER
ATTN: MARIE ORSELLO
112 SO. OSCEOLA AVENUE
CLE~.FWATER FL B'156
~)(Ptf:ilAT)()N nATF THF~F=()~. THF l!=;~\ HNr, rnMPAN'i \I",", FNl1FAvnp Tn MAIl
J.~_~._ DAYS,~rrreN NOTICE TO THE CERTIFICATE HOLOER NAMED TO THE LEFT.
BiJT FAILURE TO w.JL SUCH NOTICE SHALL IMPOSe NO OBLIGATION OR UA6lUW
OF ~N KINO UPON THE COMPANY. ITS AGENTS O~ ~ePRESeNTAThES.
~O~O~EP~ESENTAnYE
A1vina Davis A0623S5
PRODUCER
MARSH USA INC
1225 17TH STREET, SUITE 2100
DENVER, CO 80202-5534
ATTN: SHARON TIMMONS
303-308-4680
3320 -12345-5/10-00-01 ARC
CERTIFICATE NUMBER
SEA-000084712-00
THIS CERTIFICATE IS ISSUED AS OF INFORMATION ONLY AND CONFERS
NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE
POLICY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
AFFORDED BY THE POLICIES DESCRIBED HEREIN.
COMPANIES AFFORDING COVERAGE
COMPANY
A LUMBERMENS MUTUAL CASUALTY CO
ARCADIS GERAGHTY & MILLER INC
ATTN: KRISTA SCHELHAAS
630 PLAZA DRIVE, SUITE 200
HIGHLANDS RANCH, CO 80129
COMPANY
B HARTFORD INSURANCE CO OF MW
INSURED
COMPANY
C NATIONAL UNION FIRE INSURANCE CO
COMPANY
D
sup~rsedesahd,replaces any previously issued certificate.
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY
PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS AND EXCLUSIONS OF SUCH POLICIES. LIMITS SHOWN
MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO
LTR
TYPE OF INSURANCE
POUCY NUMBER
'--'-l-'--
POUCY EFFECTIVE POUCY EXPIRATION
DATE (MM/DDIYY) DATE (MM/DDIYY)
B
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
46UENGY8026 (AOS)
46UENGY8664 (TX)
01/01/01
'01/01/01
01/01/02
01/01/02
LIMITS
GENERAL AGGREGATE $ 2,000,000
PRODUCTS - COMP/OP AGG $ 2,000,000
PERSONAL & ADV INJURY $ 2,000,000
EACH OCCURRENCE $ 2,000,000
FIRE DAMAGE (Anyone fire) $ 1,000,000
------.
MED EXP An one erson) $ 10,000
COMBINED SINGLE LIMIT $ 1,000,000
----- -----.-
BODILY INJURY $
(Per person)
-----'--
BODILY INJURY $
(Per accident)
PROPERTY DAMAGE $
GENERAL UABIUTY
A X COMMERCIAL GENERAL LIABILITY 4LS000012-02
CLAIMS MADE [8] OCCUR
OWNER'S & CONTRACTOR'S PROT
01/01/01
01/01/02
AUTOMOBILE LIABILITY
EXCESS UABlUTY
C -l UMBRELLA FORM
I OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
_ _ ..EMPLOYERS~ IJABlL!T'C .
BE7406689
01/01/01
01/01/02
AUTO ONLY - EA ACCIDENT
! OTHER THAN AUTO ONLY:
i__~ ACCIDE.I'JT
AGGREGATE
EACH OCCURRENCE
AGGREGATE
$
GARAGE UABILITY
B
46WEf15X2536 --
]'ilO1;OI u
--"_..--.-"'_...---.-_._-
01/01/02
X
EL EACH ACCIDENT
EL DISEASE-POLICY LIMIT
5,000,000
ANY AUTO
A
THE PROPRIETOR/
PARTNERS/EXECUTIVE
OFFICERS ARE:
THER CLAIMS-MADE
PROFESSIONAL & OCC
FORM EXCESS L1AB
W/POLLUTION
INCL
EXCL
EL DISEASE-EACH EMPLOYEE
1,000,000
1,000,000
1,000,000
i4LS000136-01
02/14/00
02/14/01
10,000,000
I
I
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS (UMITS MAY BE SUBJECT TO DEDUCTIBLES OR RETENTIONS)
HE CITY OF CLEARWATER IS NAMED ADDITIONAL INSURED ON GENERAL LIABILITY AND AUTOMOBILE LIABILITY AS REQUIRED BY WRITTEN
CONTRACT WAIVER OF SUBROGATION APPLIES TO GENERAL LIABILITY AND AUTOMOBILE LIABILITY AS REQUIRED BY WRITTEN CONTRACT
GENERAL LIABILITY AND AUTOMOBILE LIABILITY ARE PRIMARY COVERAGE AND CROSS LIABILITY APPLIES TO GENERAL LIABILITY AND
UTOMOBILE LIABILITY RE: PHASE I, SITE AT 1498 S. GREENWOOD AVENUE, CLEARWATER, FLORIDA.
CERTIFICATE H~lJDER CANCELLATION
SHOULD ANY Of THE POLICIES DESCRlBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,
THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL ----30 DAYS IJ\JRITTEN NOTICE TO THE
CITY OF CLEARWATER
ATTN CITY CLERK
PO BOX 4748
CLEARWATER, FL 33758-4748
CERTIFICATE HOLDER NAMED HEREIN, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE, ITS AGENTS OR REPRESENTATIVES.
MARSH USA INC.
BY: Ray Leonard
MM1 (9/99)
~J~
VAUD AS'OF:J2/21100