CERTIFICATE OF LIABILITY INSURANCE (4)
rrom: Alvina DaVIs AI: Roe Insurance FaxlD: 727-376-2262 To: Marie O.
Date: 1012103 12:00 PM Page: 2 or 5
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ACORD. CERTIFICATE OF LIABILITY INSURANCE OP ID ~r DATli (MMIDDtYYI
FOUNVIL 10/02/03
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Greg Roe Insurance, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
9851 State Road 54 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
New Port Richey FL34655 INSURERS AFFORDING COVERAGE
Phone: 727-376-0030 Fax: 727-376-2262
---------------- --" --------.--.--"---.-""-----
INSURED ~-" Nonprofits Ins. Association
Foundation Villa~ tSURERB Underwriters at Llovd's
Nei9hborhood F8Ill1ly Center,Ine INSl.I'lERC
Fanu.~ centers Inc.
918 oodlawn t. ~D"__--__--"---.--___._____"____________
Clearwater FL 33756
I INSUREP E
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICA TED" NOTW'THST ANDING
ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO II\IHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERT A/N. 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.
--
INSR TYPE OF INSURANCE POUCY NUMBER =~~ "8,t4iY':=~~N UMlTS
LTR
GENERAL LlABlUTv ~~LPRE'JCE 51,000,000
- "---
A ~ :5MERClAJ- GENERAL UABIUTY NIA1810230 10/01/03 10/01/04 FIRE: QAMA<:E (,Any Me fire) $ 100, 000
-- ._. ClAJMS MADE [i] OCCUR MEO Ei(P (Afr.J one person) 5 5, 000
PERSONAL iI. AI:1"/ INJURY 51,000,000
I
f-- ~E~ERALA~F'l~~_ $ 3,000~~~_
nL ~"GGREGATE LIMIT APPLIES PER PRODUCTS- COMP/OP ~.GG $ 3,000,000
n PR(>_ n
POUCY JECT LOC
~DMOSILE LIABILITY COMBItJED SINGLE lJMfT $1,000,000
A ANY AUTO HIA1810230 lD/Ol/03 10/01/04 (Ea accident)
'--
-- AU. OWNED AIJT(>S BODILY Ir-ul-"Y
5
~ SCHEDULED "-vms (....er pcr:Jon)
~ HiRED AUTOS BODILY INJLP'Y
$
~ NON-OVVNED AUTOS (Per accident)
-- ------- PROPERT'( OAMA.GE 5
(Per aCCident)
~GE LIABILITY AUTO ONLY. EA ~"CCIDENT $
ANY AUTO OTl-lER THAN EAACC $
AUTO ONLY AGG 5
&XCliC$ LlA8fLlTy E/\CH OCCLPPE'NCE ~--_."_._-_._--------
~ OCCUR o ClAIMS MADE -------""."_._-"--
AGGRE~TE __ 5
---
$
R DEDUCTIBLE $
RETENTiON $ $
_ERS COMPENSATION AND I WC STA1U- 1- IO~
TOP.'fLMTS
EMPLOYERS' LIABILITY
!::.l. EACH ACC-lOeNi $ --
E L DISEIoSE ~ E;.. EMPLOYEE $
E.L QlSEASE - POUCY LMT .
OTHER
A Sexual/Prof Liab NIA1810230 10/01103 10/01/04 Sxl/Prof 1,000,000
B Buildinq Covq 190539 02/22/03 02/22/04 Blda Cova 303 000
DESCRIPTION OF OPERATIONS/I.OCATIONSNEHICLESI&XCLUSlONS ADDED BY ENIl<l-.v_CIAL PROVISIONS
FAXED TO 727 562 4037.
CERTIFICATE HOLDER I N I AIlOlTIONIIJ. INSURED; INSURER LI;TTM CANCELLATION
CITYCLE SHOULD ANY OF THE AllOYE DESC_ POLICIIiS 8E CANCELLED SEFORli THE EXPIRATION
DATE T_OF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ OJlYS~N
CITY OF CLEARWATER NOTICE TO THE CstTIFICAT. HO&.DER NAAt50 TO THII LEFT. BUT FAILURE TO DO SO SHALL
ATTN: MARIE ORSELLO
112 SO. OSCEOLA AVENUE IMPOSE NO OBLIGATION OR LIA8lLITY 01' ANY KIND UPON THI; INSUMR.ITS AGENTS OR
CLEARWATER FL 3375RECEIVED R&PRES&NTAT.....S.
mR5Pf1eS&NTATIVE A,
~ ~~.~ ~ . '~~ ~:..
ACORD 25-5 (7/97) 03- @ACORDCORPORATION 1988
OCT
OFFICIAL RECORDS AND
LEGISLATIVE SRVCS OEPT