CERTIFICATE OF LIABILITY INSURANCE (4)
ACORD..
CERTIFICATE OF LIABILITY INSURANC~Eg~~~ S
DATE (MM/DDNY)
PRODUCER
The Connelly Insurance Group
630 Chestnut Street
P.O. Box 2456
Clearwater FL 33757-2456
Phone:727-461-6044 Fax:727-442-7695
OS/20/02
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.
INSURERS AFFORDING COVERAGE
INSURED
Greenwood Community Health
Resource Center, Inc.
1108 N. Greenwood Ave.
Clearwater FL 33756
INSURER A:
INSURER B:
INSURER C
INSURER 0:
I INSURER E:
Zurich Insurance Co.
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.
INSR TYPE OF INSURANCE POLICY NUMBER POfif~ EFffi~E P9L!% E-'\Pll!~WN LIMITS
LTR DATE MM/DDNY DATE MM/DDNY
~NERAL LIABILITY EACH OCCURRENCE $1,000,000
A ~ COMMERCIAL GENERAL LIABILITY PAS38224003 05/02/02 05/02/03 FIRE DAMAGE (Anyone fire) sl,OOO,OOO
~ CLAIMS MADE ~ OCCUR -
f-- MED EXP (Anyone person) S 10,000
-
PERSONAL & ADV INJURY sl,OOO,OOO
~
GENERAL AGGREGATE s2,OOO,OOO
~
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000
h .nPRO- n
POLICY JECT LOG
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
'-- $
ANY AUTO (Ea accident)
-
ALL OWNED AUTOS BODILY INJURY
- $
SCHEDULED AUTOS (Per person)
- --
HIRED AUTOS BODILY INJURY
- S
NON-OWNED AUTOS (Per aCCIdent)
-
- PROPERTY DAMAGE S
(Per acc,dent)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S
R ANY AUTO .-
OTHER THAN EA ACC $
AUTO ONLY' A.GG S
I '
EXCESS LIABILITY I EACH OCCURRENCE $
~ OCCUR D CLAIMS MADE AGGREGATE S
.-,--
S
..~------,-,~."
~ DEDUCTIBLE S
RETENTION $ $
WORKERS COMPENSATION AND I we STATU- .1 [Olr-
TORY LIMITS ER
EMPLOYERS' LIABILITY --
E.L. EACH ACCIDENT S
E.L. DISEASE. EA EMPLOYEE $
E.L DISEASE. POLICY LIMIT $
OTHER
I
DESCRIPTION OF OPERATIONSlLOCATIONSNEHICLESlEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Certificate Holder is named as Additional Insured as respects to
General Liability only.
I N I ADDITIONAL INSUREDj INSURER LETTER: ,
CERTIFICATE HOLDER CANCELLATION
CITYC-2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRA TIO~
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
City NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
of Clearwater IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
P 0 Box 4748
Clearwater FL 33758-4748 REPRESENTATIVES.
AU~ REPRESENTATI~ rlt
, n I II . ' /J....t.-
ACORD 25-S (7/97)
@ACORD CORPORATION 1988