CERTIFICATE OF LIABILITY INSURANCE (6)
ACORD",
CERTIFICATE OF LIABILITY INSURANCE
CSR AD DATE (MM/DDNYVY)
FOUNVIL 10 04 04
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.
PRODUCER
Greg Roe Insurance, Inc.
9851 State Road 54
New Port Richey FL 34655
Phone: 727-376-0030 Fax:727-376-2262
INSURERS AFFORDING COVERAGE
Foundation Village
Neighborhood Fam1ly Center,Inc
Fam11~ Center~ Inc.
918 WOodlawn :::it.
Clearwater FL 33756
INSURER A:
INSURER B:
INSURER C
INSURER 0:
INSURER E:
Nonprofits Ins. Association
NAIC#
04377
INSURED
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.
IN"'" N'S~t POLICY NUMBER ~l:!.Id%~f.!'~E~E PQ~!fEYt~M'b~Jl..~N LIMITS
LTR TYPE OF INSURANCE DATE MM/DDIYY DATE MM/DDIYY
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
-
A ~ COMMERCIAL GENERAL LIABILITY NIA1812601 10/01/04 10/01/05 ~~1S~S (E~~~';'~nce) $ 100,000
- ~ CLAIMS MADE [!] OCCUR MED EXP (Anyone person) $ 5,000
PERSONAL & ADV INJURY $ 1,000,000
-
GENERAL AGGREGATE $ 3,000,000
~
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $3,000,000
n n PRO. nLOC
POLICY JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
f-- $1,000,000
A ANY AUTO NIA1812601 10/01/04 10/01/05 (Ea accident)
f--
ALL OWNED AUTOS BODILY INJURY
f-- $
~ SCHEDULED AUTOS (Per person)
X HIRED AUTOS BODILY INJURY
f-- $
~ NON-OWNED AUTOS (Per accident)
f-- PROPERTY DAMAGE $
" " . (Per accident)
GARAGE LIABILITY " AUTO ONLY. EA ACCIDENT $
RANYAUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESs/UMBRELLA LIABILITY EACH OCCURRENCE $
tJ OCCUR D CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I TORY LIMITS I IU~~-
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $
~~~Mr.s~Wovj~r~~s below.- - - - - - -- -
- E.L. DISEASE - POLICY LIMIT $
OTHER
A Sexual/Prof Liab NIA1812601 10/01/04 10/01/05 Sxl/Prof 1,000,000
B Buildinc:r Covc:r 190539 02/22/04 02/22/05 Bldc:r Covc:r 303,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
FAXED TO 727 562 4037.
'04 OCT 5 PMl:22
CERTIFICATE HOLDER
CITYCLE
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
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
CITY OF CLEARWATER
ATTN: MARIE ORSELLO
112 SO. OSCEOLA AVENUE
CLEARWATER FL 33756
@ACORDCORPORATION 1988
ACORD 25 (2001/08)
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.
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ACORD 25 (2001/08)